What Should You Check Before Signing a Nursing Home or Assisted Living Admission Agreement?

The short answer: read the agreement before admission day, sign it only in the capacity you actually hold, and never sign as a guarantor. A nursing home that takes Medicare or Medicaid is barred by federal law from requiring a family member to guarantee payment, from requiring a resident to waive Medicaid, and from making arbitration a condition of admission. An assisted living agreement is governed by state law and by contract, and in most respects it is the thinner document: fewer rules protect the resident, so the words on the page matter more. In both settings, the person most at risk is the adult child who signs quickly at the admissions desk, under a title like “responsible party,” without knowing what it means.

This article covers who should sign and how, what federal law forbids in a nursing home agreement, what New Jersey, New York, and Connecticut require in an assisted living agreement, what “responsible party” does and does not obligate you to, and the clauses to look for in either document. For the decision that comes before the paperwork, see our companion article on how to choose an assisted living facility.

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Why Does the Paperwork Arrive at the Worst Moment?

Because admission usually follows a hospital discharge, and the hospital wants the bed. The family is handed a packet of thirty to sixty pages, told the room is available today, and asked to sign at a desk. Nothing in the law requires that. Ask for the complete admission packet in advance, take it away from the building, and read it. If the facility says the packet cannot leave the premises, that is information about the facility. Federal regulations governing nursing homes state at 42 C.F.R. 483.10(g)(18)(v) that “the terms of an admission contract by or on behalf of an individual seeking admission to the facility must not conflict with the requirements of these regulations,” and the requirements described below are the ones most often contradicted.

Who Should Sign, and in What Capacity?

If the resident has capacity, the resident signs. A daughter who signs for a mother who could have signed herself has taken on a role the law did not require.

If the resident lacks capacity and has a durable power of attorney, the agent signs, and the signature line should read, in words, “as agent under power of attorney dated” and the date, or “as attorney-in-fact for” and the resident’s name. Attach a copy of the power of attorney. An agent who signs only their own name, or who signs on a line labeled “responsible party” without qualification, invites the argument later that they signed personally. Our articles on the types of power of attorney and co-agents explain what the document must say for the agent to have this authority.

If the resident lacks capacity and there is no power of attorney, no one in the family has legal authority to bind the resident, and the facility knows it. It will still ask someone to sign. That person should sign nothing that creates personal liability, should strike any guarantee, and should limit any “responsible party” undertaking to what the law allows, described next. In the longer run, a guardianship may be needed, and our article on who decides when there is no proxy explains the routes in each state.

What Does “Responsible Party” Mean?

It is a contract term, not a legal one, and it means whatever the agreement says. In a well-drafted nursing home agreement it means a person with access to the resident’s income and assets who agrees to use them to pay the facility, to apply for Medicaid when the money runs low, and to cooperate with the application. That is the role federal law permits. In a badly drafted or deliberately vague agreement it shades into a guarantee.

The New Jersey Supreme Court addressed the term directly in Manahawkin Convalescent v. O’Neill, decided March 11, 2014. A daughter signed her mother’s nursing home admission agreement as “Responsible Party,” paid the bills from her mother’s account, and was sued by the facility for a balance after her mother died. The Court held that the agreement itself did not violate the Nursing Home Act because “nowhere in the definition of ‘Responsible Party,’ or the Admission Agreement’s provision addressing the Responsible Party’s role in the payment of resident’s obligations, is there any suggestion that the Responsible Party commits his or her personal assets to pay for the resident’s care.” But the unanimous Court added a warning: “We caution nursing homes and their counsel, however, that the NHA’s constraints on the liability of a ‘Responsible Party’ should be clearly reflected in contracts and communications between facilities and individuals who arrange payment on a resident’s behalf.” The facility, the Court said, “should have explained” in the agreement “the specific obligations that may be imposed upon a Responsible Party” and the remedies for default.

The lesson runs in both directions. A responsible party who signs a compliant agreement is not a guarantor and cannot be made to pay from their own pocket. A responsible party who then mishandles the role, by spending the resident’s money on something else, by failing to apply for Medicaid, or by refusing to supply the documents the application needs, can be sued for breach of contract and can end up paying anyway. Our earlier articles on when an adult child can be liable for a parent’s nursing home bill and whether a nursing home can hold family members responsible describe the cases. Before accepting the role, read the definition, confirm that it is limited to paying from the resident’s funds and cooperating with Medicaid, and understand that it is a job with duties.

What Does Federal Law Forbid in a Nursing Home Agreement?

Every nursing home that participates in Medicare or Medicaid, which is nearly all of them, must comply with 42 C.F.R. Part 483. The provisions that bear on the admission agreement are these.

No third-party guarantee. Under 42 C.F.R. 483.15(a)(3), “the facility must not request or require a third party guarantee of payment to the facility as a condition of admission or expedited admission, or continued stay in the facility. However, the facility may request and require a resident representative who has legal access to a resident’s income or resources available to pay for facility care to sign a contract, without incurring personal financial liability, to provide facility payment from the resident’s income or resources.” The statute behind it, 42 U.S.C. 1396r(c)(5)(A)(ii), uses the same words. Each state repeats the rule. New Jersey’s N.J.S.A. 30:13-3.1(a)(2) provides that a nursing home “shall not require a third party guarantee of payment to the facility as a condition of admission or expedited admission to, or continued residence in, that facility,” and N.J.S.A. 30:13-8(b) allows treble damages to “a resident or alleged third party guarantor of payment who prevails” in enforcing it. New York’s 10 NYCRR 415.3(b)(1) provides that a facility “shall not require a third-party guarantee of payment to the facility as a condition of admission, or expedited admission, or continued stay.” Connecticut’s General Statutes 19a-550(b)(28) provides that a patient “shall not be required to give a third-party guarantee of payment to the facility as a condition of admission to, or continued stay in, such facility,” and section 19a-550(e) adds that these rights “may not be reduced, rescinded or abrogated by contract.”

No waiver of Medicare or Medicaid. Under 42 C.F.R. 483.15(a)(2), the facility must “not request or require residents or potential residents to waive their rights” to Medicare or Medicaid, and must “not request or require oral or written assurance that residents or potential residents are not eligible for, or will not apply for, Medicare or Medicaid benefits.” A clause promising a fixed period of private payment before the resident may apply for Medicaid is exactly such an assurance. New York’s 415.3(b)(3) and (4) and Connecticut’s 19a-550(b)(25) repeat the rule.

No waiver of liability for lost property. The same section, at 483.15(a)(2)(iii), bars a facility from requiring residents to waive “potential facility liability for losses of personal property.” The clause appears in many agreements anyway.

Charges disclosed, changes noticed, refunds paid. Under 42 C.F.R. 483.10(g)(18), the facility must inform the resident “before, or at the time of admission” of the services available and their charges, must give written notice “at least 60 days prior” to a change in charges for extra items and services, must refund prepaid amounts if the resident dies or is transferred and does not return “regardless of any minimum stay or discharge notice requirements,” and must pay refunds “within 30 days from the resident’s date of discharge.” New York’s 415.3(b)(2) permits prepayment of “basic services not exceeding three months” and nothing more.

Arbitration only by real consent. Under 42 C.F.R. 483.70(m), in force since September 16, 2019, “the facility must not require any resident or his or her representative to sign an agreement for binding arbitration as a condition of admission to, or as a requirement to continue to receive care at, the facility.” The agreement must be explained “in a form and manner that he or she understands,” must name a neutral arbitrator and a convenient venue, must “explicitly grant the resident or his or her representative the right to rescind the agreement within 30 calendar days of signing it,” must state that signing is not a condition of admission, and “may not contain any language that prohibits or discourages the resident or anyone else from communicating with federal, state, or local officials, including” the Long-Term Care Ombudsman. Our article on the 2019 arbitration rule describes how it came about. The practical advice is simple: you may decline to sign the arbitration agreement, the facility may not refuse admission because you declined, and if you signed under pressure you have 30 days to undo it in writing.

Discharge only for listed reasons, with notice. Under 42 C.F.R. 483.15(c), a facility “must permit each resident to remain in the facility” unless one of six conditions is met: the resident’s needs cannot be met, the resident no longer needs the services, the safety or the health of others is endangered, the resident has failed to pay “after reasonable and appropriate notice,” or the facility closes. Notice must ordinarily be given “at least 30 days before the resident is transferred or discharged,” in writing, with a copy to the Ombudsman, and the facility may not discharge while an appeal is pending unless health or safety requires it. Under 483.15(d) and (e), before any hospital transfer the facility must give written notice of its bed-hold policy, and it must have a written policy on return that lets a Medicaid- or Medicare-eligible resident come back to the previous room “if available or immediately upon the first availability of a bed in a semi-private room.” Our article on nursing home eviction after a hospital stay covers what to do when a facility ignores these rules. Read the agreement’s transfer and discharge section against them.

What Do the States Require in an Assisted Living Agreement?

None of the federal rules above applies to assisted living. Each state has its own requirements, and they differ enough that the same clause can be lawful in one state and void in the next.

New Jersey

Under N.J.A.C. 8:36-6.2(a), an assisted living residence or comprehensive personal care home “shall disclose in the admission agreement the service it will provide, the public programs or benefits that it accepts or delivers, the policies that affect a resident’s ability to remain in the residence,” and any waivers of physical plant standards. Under 8:36-6.2(b), it must inform residents in writing of “any and all fees for services provided and charges for supplies,” may not charge for a higher level of care “without documentation of reassessment by the registered nurse,” and may not charge more than the agreed rate “unless written notification is provided.” Under 8:36-6.2(c), a security deposit earns interest, is held “in trust for the resident,” and is returned “upon discharge or death minus any outstanding payment owed.” Under 8:36-5.1(e), the agreement “shall clearly specify if the facility or program will or will not retain residents” who develop each of the higher-care conditions the rule lists, “to what extent, and, if applicable, at what additional cost.” Under 8:36-5.14, an involuntary discharge requires written notice “at least 30 days in advance” stating “the reason for discharge and the resident’s right to appeal,” with exceptions for the listed medical conditions and emergencies. New Jersey’s regulations do not contain a ban on third-party guarantees in assisted living; the statutory ban in N.J.S.A. 30:13-3.1 applies, by its own terms, to certified nursing homes. A New Jersey assisted living agreement that asks a family member to guarantee payment is asking for something the law neither requires nor forbids, and the answer is no. New Jersey courts will, however, refuse to enforce assisted living arbitration terms that go too far: in Estate of Ruszala v. Brookdale Living Communities, 415 N.J. Super. 272 (App. Div. 2010), the Appellate Division struck arbitration clauses that barred depositions of staff, capped damages, and eliminated punitive damages, calling them “an unconscionable wall of protection for nursing home operators.”

New York

New York’s Public Health Law 4658 sets the minimum contents of an assisted living residency agreement, which must be signed by the operator, the resident, and “any other party to be charged,” and must include the services and base rate, the supplemental services and their fees, “a description of the process through which the agreement may be modified, amended, or terminated,” the criteria for admission and continued residence, the “procedures and standards for termination of contract, discharge and transfer,” the billing procedures, the procedures if the resident can no longer pay, and the refund terms. A separate disclosure sheet must state whether the residence holds an enhanced or special needs certificate, disclose the operator’s ownership interests in service providers, confirm that “residents shall have the right to choose their health care providers, notwithstanding any other agreement,” disclose “the availability of public funds,” and give the Department of Health complaint number and the Ombudsman’s contact information. The regulations at 10 NYCRR 1001.8(f) require 12-point type and plain language and require the operator to use the Department’s model agreement or an approved substitute. Two provisions have no counterpart in the other states. Under 1001.8(f)(4)(xvii), the operator “cannot mandate that a resident or other person agree to a guarantor of payment as a condition of admission unless the operator has reasonably determined, on a case by case basis,” that the resident lacks the capacity or means to pay. And under 1001.8(b)(2)(xvi), the resident must receive “written notice of any fee increase not less than 45 days prior to the proposed effective date.” Termination follows the adult care facility rules at 18 NYCRR 487.5(f): “at least 30 days’ written notice, on a form prescribed by the department,” which must tell the resident that if they object they “may remain in the facility while the operator commences a court proceeding, and unless the court finds in favor of the operator.” A New York assisted living resident cannot be put out without a judge, and the agreement may not say otherwise.

Connecticut

Connecticut splits the agreement in two. The residency agreement with the managed residential community is governed by General Statutes 19a-700, which requires plain language in 14-point type, “a full and fair disclosure of all charges, fees, expenses and costs,” for agreements signed on or after October 1, 2024 a history of fee adjustments over the prior three years, “the conditions under which the agreement can be terminated by either party,” and a cap on the estate’s liability at 15 days after death once the unit is vacated. Under section 19a-694, the community must give 90 days’ notice of fee increases and refund within the first 45 days, and the resident has the rights of a tenant under Title 47a. The care is separately contracted with a licensed assisted living services agency, whose client bill of rights under Regulation 19-13-D105(m) must include “a description of available services, charges and billing mechanisms” with notice of changes “no less than fifteen (15) working days prior,” the “circumstances under which the client may be discharged,” and “the client’s right to terminate or reduce services at any time.” The individualized service plan required by section 19a-699 must state “the scope, type and frequency of such services, an itemized cost of such services,” and be “in writing, signed by the resident, or the resident’s legal representative.” If the resident is placed in a dementia unit, section 19a-562(b) requires a written disclosure “signed by the patient or responsible party” covering staffing, training, and “the cost of care and any additional fees.” We have found no Connecticut statute or regulation barring a guarantee in a managed residential community agreement, so, as in New Jersey, the protection is declining to sign one.

Which Clauses Deserve the Most Attention?

In either setting, read these sections first, and ask for changes in writing before anyone signs:

1. The signature block and definitions. Who is signing, in what capacity, and what “responsible party,” “sponsor,” “designated representative,” or “guarantor” is defined to mean. Strike any personal guarantee. Add the agent’s capacity beside the signature.
2. The arbitration agreement. Usually a separate document. In a nursing home, decline it or rescind within 30 days. In assisted living, read the terms for limits on discovery, caps on damages, exclusion of punitive damages, and shortened deadlines, and ask for it to be removed or made optional.
3. Payment source and Medicaid. What the agreement says happens when private funds run out. In a nursing home, any required period of private pay or promise not to apply for Medicaid is unlawful. In assisted living, ask whether the facility accepts Medicaid at all, in which units, after how long, and what it does when a resident’s Medicaid application is pending. Our article on what a Medicaid application requires shows why a responsible party who takes on the application should understand the job.
4. Care levels and reassessment. How care tiers are assigned, who assesses, how often, what notice the resident gets of a tier change, and whether the family may see the assessment and dispute it.
5. Rate increases. How much notice, how often, and whether the agreement caps them. Ask for the last three years of increases in writing; Connecticut requires it in the agreement and the others do not.
6. Deposits, community fees, and refunds. Whether the deposit earns interest and is held in trust, what a “community fee” buys, and exactly when each is refundable, including on death, hospitalization, or a move to a higher level of care.
7. Discharge criteria and hospital readmission. What conditions allow the facility to end the residency, how much notice it must give, what appeal or court process exists, and whether the apartment or bed is held during a hospital stay, at what cost, and what the resident must show to return.
8. Charges after death or departure. How many days of notice the resident must give to leave, and how long charges continue after death. Connecticut caps estate liability at 15 days after the unit is vacated; other agreements often run a full month or more.
9. Personal property, photographs, and records. Waivers of liability for lost property are void in a nursing home and unwelcome in assisted living. Consents to photograph or to share medical information should be limited to what care requires.
10. Collection terms. Interest on late balances, attorney’s fees, and consent to judgment. These are the clauses a facility uses against a responsible party, and they should be read with the Manahawkin caution in mind.

How Should the Signing Itself Be Handled?

Ask that the resident’s own physician or the family’s attorney have seen the packet. Initial each page you agree to and strike, initial, and date each change; a facility that will not accept handwritten changes should be asked to produce a corrected agreement. Attach the power of attorney or guardianship judgment. Sign the arbitration agreement, if at all, only after the 30-day rescission language is confirmed. Take a complete signed copy home the same day, with every addendum, and keep it with the resident’s other documents; the facility’s file copy is not the family’s. Note the date on the calendar for any rescission period. And keep the resident rights statement the facility must give you, because it is the document that tells you what the agreement may not take away.

Our article on what to do first when a parent enters a nursing home covers the broader first-week checklist of which the agreement is one part.

Plan Well. Live Better.

An admission agreement is the one contract most families sign without reading, at the moment they can least afford a mistake. At Milvidskiy Law Group, we review nursing home and assisted living agreements before they are signed, tell families what to strike and what to add, and make sure the person who signs has the authority to do it and no more liability than the law allows. Learn more about our elder law services.

Milvidskiy Law Group did not represent any party in Manahawkin Convalescent v. O’Neill or Estate of Ruszala v. Brookdale Living Communities, which are described from the published opinions. This article is for general informational purposes only and does not constitute legal advice. Reading it does not create an attorney-client relationship. Whether a particular clause is enforceable depends on its wording, the facility’s licensure and certification, and the state; the federal regulations and the New Jersey, New York, and Connecticut statutes and regulations described were verified in September 2026 and should be confirmed before relying on them.