In the last column we discussed the selection of a care facility.  What other decisions might you face, and what steps should you take going forward to monitor the level of care of your loved one?

Important contract issues.

Many facilities require the admitted person to sign a contract which contains an arbitration clause, which means that many if not all potential disputes, including claims for negligence, will go before a panel of arbitrators rather than a jury. Although serious negligent care incidents are generally very rare in good facilities, experts from the care side and advocates feel these provisions are a significant advantage to the care facility. They keep legitimate claims of negligent care out of the public light, which likely does not help anyone’s long-term benefit.  Try to decline signing these if you can.

Who is the responsible party to pay?  If you are signing for your loved one by using a power of attorney, make sure you sign your loved one’s name and note you are signing merely as your loved one’s agent.  Make it clear you are signing as one’s power of attorney (poa) or agent-in-fact (aif).  You do not have to be a financial guarantor for your loved one by being personally liable contractually for their care.

Some short-term care and discharge issues you may encounter.

  • Know your options before a crisis. Go to to become familiar with the different levels of care, such as assisted living/skill/memory care. The Piedmont Triad Regional Council, the area agency on aging, has descriptions of the different levels of care.
  • Know what Medicare does and does not cover, particularly rehab services. The first 100 days may be allowed by Medicare, but it is not a guarantee of coverage. Discuss the payment plan with the business office in advance or upfront.
  • Transfer/discharge issues. Facilities are obligated by laws and regulations to issue written notifications that specify the date of and reasons for discharge. The discharge plan must meet the timing and “safe and orderly” criteria, which mean the facility cannot simply call up a family member and tell them to come and pick up their loved one that day, with no care plan/services in place. And you have a right to appeal, but in a short time frame so act fast.

If your loved one is in a long-term care facility, here are some suggestions to help you monitor their care.

  • Make unannounced visits at unpredictable times with regard to the residents’ schedules.
  • Keep notes when you visit—date, time of day, and the overall conditions you find.
  • Know the person to whom you are speaking as well as their position with the facility, and keep track of your requests. It is not unreasonable to ask for a proper response within a set time frame from the administrator or designated grievance contact.
  • You, the supervisors and the advocate-ombudsmen ( 336.904.0300) cannot solve all the issues. Ombudsmen are not punitive or regulatory (like the DHSR complaint intake unit. 800.624.3004.) As noted in the last column, they are advocates for residents in long-term care.
  • Keep a cool head. Belligerence and being excessively demanding do not help. Find out what the facilities grievance procedure is and select a point person to communicate any concerns. Give the facility a chance to make things right. The object is to correct any issues going forward. As experienced care-side professionals and advocates will tell you, a lawyer being asked to intervene or to send a letter too early in the process before a facility is given a fair chance to rectify a problem will not help the process.

Remember: An informed choice is a smart choice.

Mike Wells is a partner with Wells Law, PLLC in Winston-Salem.  His email address is and his telephone number is 336.283.8700.