Article Updated: April 29, 2022
Power of Attorney for Nursing Home Admission
Many of my clients signed a power of attorney document prior to their nursing home admission.
Below, you will learn the ins and outs of these POA documents, including what responsibilities you accept by becoming the POA for a nursing home resident.
If you are the POA for someone who you suspect is suffering abuse in a nursing home, you have the legal right to sue the bad facility for a monetary recovery. To accomplish that, contact me – using the contact form or my number below – for a consultation about the nursing home litigation process.
Clickable Table of Contents
Nursing Home Admission POAs
10 – About the Author
Power of Attorney
There is often confusion about power of attorney nursing home admissions and whether or not decisions you take as an agent can lead to personal liability.
A power of attorney can be drafted to address multiple needs that an elderly individual may have. This can mean they need help taking care of their finances or taking care of their own personal health.
A POA can even be crafted in a narrow manner to only give certain powers to an agent and not comprehensive sweeping authority in every area of the principal’s life.
Wording on a POA is important and the issue of nursing home admissions is a sensitive area where you must very carefully read and understand the POA to understand whether or not there is authority to admit the principal to a nursing home.
Usually, the kind of POA that is involved in a decision like this is a medical POA or healthcare POA document. In this kind of POA, usually the agent does have the authority to make decisions on things like assisted living, hospice and nursing home admissions.
No matter what kind of POA a person has in place, one thing that is expected in all decisions is that the agent act in a way that is in the best interest of the principal.
The decision of a POA agent to admit a principal to a nursing home therefore needs to be backed with a clear set if arguments as to why the decision is in the best interest of the elderly individual.
Involving family members and the principal’s doctors in the decision can help to avoid liability.
Uniform Power of Attorney Act
Every state has its own specific rules that govern how a POA is written and executed. Additionally, each state also governs how a POA is even interpreted.
For the U.S. this creates a challenge in understanding a POA and what level of authority there is, which is why in 2006 there was the creation of the Uniform Law Commission.
With this commission came the creation of the Uniform Power of Attorney Act (UPOAA) to help create universal rules for the execution of POAs.
This act ensures that POA documents are explicit in what powers and authorities a POA has.
As of 2021 the Uniform Law Commission and some form of the UPOAA are used in 29 states in the U.S. including states like Maryland, Virginia, Pennsylvania, Texas, North Carolina, Ohio and many more.
Medical Power of Attorney Rights
Generally speaking, a medical POA is given to help with healthcare decisions that need to be made for an individual. So long as the principal has their faculties and is mentally competent, they will continue to make their own medical decisions.
The medical POA kicks in when the principal is not longer mentally competent. Because of this it is important to note that a POA agent generally may not admit an individual to a nursing home if the principal in sound mind does not want to go.
A medical POA does have a great deal of power over the healthcare decisions of an individual who is not mentally competent which can include:
◊ Making decisions on what the principal eats
◊ Deciding where the principal lives, including being placed in assisted living or nursing homes
◊ Selecting the doctors that the principal sees
◊ Choosing the medical care that is given to the principal such as surgery, hospital admissions, home healthcare, rehabilitation
A medical POA has even enough authority to override a spouse who wants to make decisions for their principal which highlights how much power is given over in a medical POA to make decisions for care.
Mental Competency & Power Of Attorney Nursing Home Admissions
A POAs authority rests mainly within a scenario where their principal is no longer mentally competent and therefore cannot make decisions for themselves.
POAs can be drafted and signed, which brings them into an active state, but their use will really kick in when the principal is not able to make their own decisions.
This can happen because of an accident, sudden onset of a medical condition or the worsening of an existing healthcare problem, like cognitive decline diseases.
Because of this, an agent usually cannot make a nursing home admission unless the principal agrees to it. If the principal does not agree and is found to be mentally competent then there is no reason that they cannot make their own living decisions, including refusal on a nursing home admission.
A principal needs to be declared incompetent for them to be under the authority of their medical POA and only then can a POA admit someone to a nursing home without their expressed permission.
As long as you can still communicate for yourself and express your needs to family, friends and doctors, the chances that you will be ignored are not very high.
Most nursing homes need medical paperwork, records and orders for nursing home admissions and a doctor is not likely to ignore your wishes as this would be a form of malpractice.
Requirements For Nursing Home Admission
A nursing home is usually used for seniors who have health issues or serious conditions that require them to be under frequent medical supervision and need the kind of around the clock care that family often cannot provide.
Each state has its own specific rules on who can be admitted to a nursing home and in order to be admitted, an individual needs to meet the state’s criteria and requirements. It is for this reason that medical records and a doctor’s orders are almost always required in nursing home admissions processes.
These requirements for entry are generally monitored by the Centers for Medicare & Medicaid Services (CMS) and states are required to work within their parameters. States do however have the ability to have different requirements, so long as they operate within the CMS overall rules.
Because of these possible variations, there is no one size fits all nursing home admission requirements.
What works in the state of Maryland for a nursing home admission may not work in Oregon for example.
A POA therefore does not have a blank slate to admit someone to a nursing home as they have to make their decision under a number of limitations such as the desires of the principal when they are competent, their states own nursing home admission requirements, and the recommendations of the principal’s doctors.
Power of Attorney Nursing Home Admissions & Healthcare Needs
An important part of the POA’s nursing home admissions decision-making process will come from the healthcare needs of the principal.
In order to be placed in a nursing home, as was noted, a person has to meet state requirements for admission.
A physician needs to be heavily involved in the process of a nursing home admission because it will be a physician that verifies that additional healthcare needs are required.
If a POA begins to suspect that their principal needs to be admitted to a nursing home, the first step will be to get an assessment at either a hospital or with a primary care physician to see if there is a belief that the principal would benefit from nursing care or that they are no longer mentally competent.
This assessment is free in some states like in the state of Maryland where there is an adult evaluation and review service (AERS) offered for free to a senior who may need to be admitted to a nursing home.
Because there are so many differences in nursing home admissions from state to state, it is advisable to be familiar with relevant state laws and regulations.
Power Of Attorney Nursing Home Admissions Process
The POA will face a tedious process when they need to admit someone to a nursing home and in order to go through the process effectively there needs to be understanding of what documents you need and what steps you need to take.
What Documents Do You Need
The first step is to understand the documents that you will need because this will impact your understanding of what steps you need to take in the admissions process.
The first step that needs to be take is to speak to either a nurse, or a social worker or a primary care physician to assess if the individual is in need of nursing care.
Once this has been done, there will need to be an order written for nursing care and given to the POA with the medical authority over the principals healthcare decisions.
In addition to this order for nursing care, a physician will also need to give an order for medications and treatment that are needed for the principal.
An up to date physical examination report and medical history is also needed as the nursing home will require this to be provided upon admission so they know what vaccinations and medical processes the patient is in need of upon entry.
Another highly important part of the nursing home admissions process is to get the proper state required form filled out to give to the nursing home staff upon admission.
Lastly, there is a need to complete all the needed paperwork for the nursing home on the day that the principal is being admitted. If the principal is not able to do this on their own, the POA will be responsible for these admissions papers for the nursing home to be filled out.
The POA will be responsible for every step of the process and will be speaking on behalf of, signing on behalf of and acknowledging on behalf of the principal all the admission stages of the nursing home process.
Additional Documents You May Need
In addition to the paperwork listed above, there is also the need for other documents that a POA needs to bring in order to admit a principal to a nursing home. This includes:
◊ The POAs paperwork where the principal has given them the right to make healthcare decisions
◊ Any DNR paperwork or other healthcare directives that the principal or the POA on behalf of the principal has drafted
◊ Food/ dietary requirements
◊ Any living wills
◊ MOLST orders
◊ End of Life wishes
POA Financial Responsibilities In Nursing Home Admissions
A POA has certain responsibilities that come along with them making an admission of someone to a nursing home. Financial obligations are not absolutely the POAs responsibility just because they made the admission.
Financial liability is one of the major areas of concern for an agent, and usually, a POA allows the agent to admit the principal to a nursing home without them taking on personal liability for their finances out of their own assets.
This may seem confusing because upon admission to a nursing home, the financial aspects are discussed and if the principal is not competent they cannot acknowledge the financial parts, and the medical POA is the one acknowledging these requirements.
Because of this confusion, a POA agent needs to make it clear, preferably in writing, that they are only signing for the admission of the principal to the nursing home so that the nursing home knows clearly that the agent is not personally guaranteeing the payment of debts.
If the medical POA is also the person who has general POA authority or financial POA authority, in the admissions process they need to give the nursing home admissions staff information regarding Medicare enrollment, supplemental insurance, information on pensions, SSI funds or any other retirement funds or benefits as well as since much of this will be used to address the nursing home’s fees and overall payment of debt.
Liabilities in Nursing Home Admissions & POAs
Liabilities related to nursing home admission are about more than just the financial problems that come with the admission but the care that the individual ends up receiving in care as well.
A principal’s family for example may try to hold a POA accountable if the nursing home they selected is understaffed and negligent in a way that causes the death of their loved one.
Often time family members only find out after death that their family member in a nursing home was treated poorly and that the facility was subpar.
If the POA is not careful they can end up signing documents that force the principal and their family to become bound to settle disputes in arbitration only.
This is a poor position, because to be in arbitration the nursing home has the upper hand.
It is for this reason that as the POA you need to be very careful with any admissions documents that you sign because what you sign now can limit what actions you or family can take later on to recover damages in a civil lawsuit.
One case from Arkansas highlights the importance of making sure a POA ensures that they are signing admissions documents that are in the best interest of the client.
In this case an elderly woman was treated so abhorrently in care that a jury awarded the family $78 million dollars in a verdict but this would have been capped with only $250,000 in economic damages and no punitive damages.
To avoid potential liability for being the person who signed the admissions paperwork, look for any clauses requiring pre-dispute binding arbitration and also seek legal counsel if you are being forced into arbitration later on.
Get Power Of Attorney Nursing Home Admission Guidance
I do not personally do power of attorney work for nursing home admissions. When I get involved is when, after an admission, a nursing home resident is injured while in the facility.
In that regard, I have helped hundreds of nursing home abuse victims and their family seek justice.
If someone you know is being or has been hurt in a nursing home, call me for a free consultation and ask how I can help you seek justice.
Reza Davani, Esq.
State Bar No.: #1212110211
Federal Bar No.: #30168
Supporting Literature, Citations & Resources:
Gandhi, A. (2020). Picking your patients: Selective admissions in the nursing home industry. Available at SSRN 3613950.
Bagby, K., & Souza, S. (2012). Ending Unfair Arbitration: Fighting Against the Enforcement of Arbitration Agreements in Long-Term Care Contracts. J. Contemp. Health L. & Pol’y, 29, 183.
Tripp, L. (2008). A Senior Moment: The Executive Branch Solution to the Problem of Binding Arbitration Agreements in Nursing Home Admission Contracts. Campbell L. Rev., 31, 157.
McAuley, W. J., Buchanan, R. J., Travis, S. S., Wang, S., & Kim, M. (2006). Recent trends in advance directives at nursing home admission and one year after admission. The gerontologist, 46(3), 377-381.
Brown ex rel. Brown v. Genesis Healthcare, 724 S.E.2d 250, 228 W. Va. 646 (2011).
About the Author
This nursing home and medical malpractice article was written by Baltimore, Maryland nursing home attorney Reza Davani, Esquire. Mr. Davani received his Juris Doctor degree from a Tier 1 law school, the University of Maryland Francs King Carey School of Law. He received his first license to practice law from the State of Maryland’s Court of Appeals (MD State License No. 1212110211), and just four months later received a federal law license from the United States District Court for the District of Maryland (Federal License No. 30168).
Mr. Davani has been practicing law for over 10 years. He began practicing law by helping clients as a sanctioned student lawyer before receiving his law license, and second chaired his first jury trial in federal court before even graduating law school. He is a registered member of the Maryland Association for Justice (MAJ), the American Bar Association (ABA), the American Association for Justice (AAJ), and was formerly on the MAJ’s Legislative Leader’s Circle.
Mr. Davani has taken over 20 cases to trial in state and federal court, and favorably settled well over 100 cases for injured victims. He has personally helped his clients recover over $15,000,000 in personal injury, medical malpractice, and nursing home abuse settlements and verdicts in Maryland and other states. He is dedicated to fighting for justice, and welcomes the opportunity to help you.
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