Right to Know Charges
Right to Know Charges

Nursing Home Residents Have the Right to Know Charges

Nursing home residents and their legal representatives have a right to know charges and the specific services for which the resident is being charged.   It is important to ensure that a resident is receiving all the cares and medical treatments which are needed pursuant to the resident’s Care Plan and Doctor’s Orders.   A resident has the right to know the amount of all charges and the amount he/she is being billed or billed in their name.

The charges are determined through a 7 day look back period in part of what is called the Resident Assessment Instrument RAI, the needs and medical risks for each resident is determined during this period.  Based on the needs of the resident the billing level called a RUG level is determined.  There are dozens of RUG levels and generally the higher the RUG score the more the government is charged for the care.

Make sure you get a copy of the MDS form, it is the Minimum Data Set form used as part of the RAI process and it should determine the levels of care and treatment needed.  It should also be used to determine the appropriate level of care for each resident.  There are state and federal requirements on this issue COMPREHENSIVE RESIDENT ASSESSMENTS and CARE PLANS.   The assessments must be done by a qualified professional in the area being evaluated such as a RN nurse, dietician, occupational therapist, etc.

I have seen many nursing homes bill for 2 persons to provide assistance with ADLs (Activities of Daily Living), such as bathing, eating, dressing, toileting, etc.  then only one person being provided.  There is a section of the RAI manual 3.0 Section G, which the nursing homes rely on to support the practice of having less care than billed provided in this area.  This exception to the rule of providing a resident all the care they are billed for is very limited and only applies to persons who are making improvement from muscle deconditioning, medication overdose, stroke, etc.  The thought is the nursing home can allow a person to push themselves towards recovery (if properly supervised).  This exception seldom applies as most persons I have represented in the nursing home are either static or declining and the need the cares as billed.

Another issue on this areas is that the determination of when one or two persons is to be provided to a resident is being determined by a nursing assistance, who generally have very little medical or nursing training and are in the facilities to provide the daily ADL cares, not make health care decisions.   These NAR (nursing assistances registered) cannot make the decision on the number of care providers needed for a resident.  This determination must be done through the Care Plan and their interdisciplinary team of professionals.  This is a common occurrence which is not fair to the party paying the bills and puts vulnerable residents at risk of serious injury or death.

§483.10   Resident rights.

The resident has a right to a dignified existence, self-determination, and communication with and access to persons and services inside and outside the facility. A facility must protect and promote the rights of each resident, including each of the following rights: (b)(5) The facility must— (i) Inform each resident who is entitled to Medicaid benefits, in writing, at the time of admission to the nursing facility or, when the resident becomes eligible for Medicaid of— (A) The items and services that are included in nursing facility services under the State plan and for which the resident may not be charged; (B) Those other items and services that the facility offers and for which the resident may be charged, and the amount of charges for those services; and (ii) Inform each resident when changes are made to the items and services specified in paragraphs (5)(i) (A) and (B) of this section.

Attorney Kenneth LaBore has handled serious medical malpractice and nursing home cases for years and has developed knowledge about the rights of vulnerable adults and resident of nursing home and other long term care facilities.

If you are concerned about incidents of abuse or neglect or have questions about resident rights call Ken LaBore at 612-743-9048 or toll-free at 1-888-452-6589.  Ken can be reached by email at: KLaBore@MNnursinghomeneglect.com

Right to Know Charges for Services Provided to Resident in Nursing Home