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Getting ducks in a row-Preparing for the paperwork involved to move into a senior living community




In a digitized world, we are still faced with an absurd amount of paperwork. Sure, our doctors offices have mostly digitized and there are “portals” and “e-scripts”, but I seem to always have to fill something out and sign it whenever I go in anyway.


Senior living is not like checking into a hotel and people seem to be surprised when they are met with an Oxford Dictionary worth of paperwork to complete in order to move themselves or their loved one in. Sometimes you can download it off a portal, or receive it digitally, or even e-sign it, depending on the company.


Every senior living company is different and every state has different regulations if you are looking into personal care, assisted living or memory care; but, even for independent living, please be prepared to do some homework for your sake and the sake of your loved one, because nobody wants to be surprised at the closing table.

List of items you may be presented with:


Rental agreement or contract:


A rental agreement or contract can be 45–70 pages long and will generally have several addendums regarding the terms and cost, the services provided, the company rules, the home rules, the state rules, an arbitration agreement, a resident rights agreement, a motorized wheel chair agreement, a key or fob agreement, maybe a fitness center or pool agreement, a privacy agreement, a call bell agreement, a transportation agreement, a grievance policy agreement, a parking agreement, a photo consent, the list goes on! Some companies require several signatures on the addendums so please be prepared to read through carefully before sitting down to a signing. This will save you, your loved one, and the person walking you through the signing, time and energy. My suggestion is to read it and place sticky notes or tags on places where you have questions or concerns to ask before the scheduled signing.


Just as an aside, there will most likely be a termination segment to your rental agreement or contract. I suggest that you read that carefully and ask questions. Most rental communities in senior living are month to month and you can move out anytime with the idea that you are financially on the hook for 30 days after giving written notice of vacating. Some places will also have a clause that if the building can no longer provide adequate care or the resident passes away, the lease will be terminated when the family vacates the apartment, negating the 30 day rule, and refunds will be administered for any pro rated payments made. Make sure you read this fine print and understand what this particular company requires.


Some contracts require a resident signature as well as a responsible payer signature or even a financial guarantor if the resident doesn’t meet the financial requirements of the community. Most companies like to know that someone else will also be held responsible for making payments, such as a financial power of attorney who has access to the resident’s money. Make sure you understand this before signing. Many families don’t like to be held responsible for such a large sum of money and want to know if they are personally responsible or if they are just responsible to pay with their ward’s money. This might be one of the good questions to ask before scheduled signing. How does this particular company handle late payments, and who can they come after if the bill is not paid?


The Arbitration Agreement:


Most people are shocked and concerned about an arbitration agreement. What is it and do you have to sign it? It all depends on the company. These are usually written by the managing company’s legal team and helps to protect the building and the company from going in front of a judge and jury in the case of a law suit against the building or the managing company. It is an agreement that you will consider settling in arbitration instead of going to full blown judge and jury court. While court cases do happen in senior living, arbitration can generally settle cases without the pain of having you, your family and/or your elderly loved one being deposed by the company’s legal team and then dragging the drama out in court for a jury to decide.


If you have questions about your arbitration agreement, which may be binding, I would definitely suggest speaking to an eldercare attorney. One eldercare attorney I know doesn’t want any of his clients to sign an arbitration agreement until he reads it and he might make suggestions to how it can be better understood by the signee. So if you are concerned or confused, please make this connection before the day of signing.


Resident Application and Emergency Contact Information:


In addition to the rental agreement, there may be an application that asks personal information as well as emergency contact information which needs to be completed thoroughly. I can’t tell you how many times families were scrambling at signing to fill this out at the eleventh hour, having to look up aunt Mary’s phone number, address and email address as the third emergency contact. Please be sure to get all this information together before you show up to signing.


Some companies ask for a “getting to know you” section of paperwork which is usually pretty fun to fill out and may ask questions about early life such as parents’ names, siblings, children, grandchildren, previous occupation and previous hobbies as well as current ones. The purpose of this is so that the wellness director and activities director can inform the rest of the team about the new resident’s interests. It helps with incorporating a new person into the community and is like gold for someone with memory loss as it informs the team how to best interact and engage. It’s definitely worth filling out, though it’s generally optional.


Copies of Legal Paperwork:


Copies of power of attorney, living will, DNR (if applicable) and health care proxy paperwork is generally required at signing also, even for independent living. The purpose of this is in the case of an emergency where the resident can’t speak for himself/herself, the home knows who is the trusted advocate. If you are shopping for senior living options, please be sure that you have copies of this at or before signing. I would also suggest updating any paperwork that is over five years old to be sure that it’s still up to date with you or your loved one’s most recent wishes. Just a reminder, 2019 was five years ago!


Just to be clear, if you are the power of attorney for your loved one who can no longer sign a rental agreement or contract, you will be the one to sign for them.


POLST Form:


Physician orders for life sustaining treatment or POLST forms are fairly new to the move-in packets and not all buildings or companies require them, but in my opinion, they are an easy way to determine what level of life sustaining treatment you or your loved one would want in the case of an emergency. In Pennsylvania, where I’m most familiar, the downloadable form is filled out by the person moving in or their family, and then signed by the primary care physician. The multiple choice questions are simple and clear, explaining different scenarios and you can check off what your wishes are. The purpose of this form is that it can indicate your wishes if you are unconscious or even deceased. Will they administer CPR and try to bring you back, or will they let nature take it’s course? The DNR paperwork can often be hidden in the business office and while it has your wishes drawn up by a lawyer, it’s not easily accessible and can often be lengthy to read. The POLST forms are generally kept in a more accessible place like the nurses’ station. These forms are required to be copied on bright colored paper so they are easy to find quickly. They will also often be sent to the hospital if you need to go to the emergency room so that your wishes will be continued in the hospital.


Some independent living communities will ask that you keep a POLST form in your apartment in a location that is easy to access, like on the refrigerator.


Choice of Physician Forms:


Most assisted living or personal care homes will ask for the information about all of your health care providers so be sure to also have that information available including names, addresses and phone numbers for all of your doctors offices. Most buildings will also offer the option to switch to the in-house primary care physician and some other physicians that either have an office at the building or that do house call visits within. My suggestion is to consider this. It doesn’t mean you have to give up your specialists but can be a game changer for a resident who has an immediate medical problem that needs attention. Most primary care physician offices will just tell you to go the emergency room if their office is closed and you need immediate medical attention. With the in-house doctor, the building wellness director can generally get things moving quickly without having the resident moved to the ER.


Documentation of Medical Evaluation (or whatever form your state requires for Personal Care or Assisted Living):


Medical paperwork is the most trying, in my non-medical opinion. For independent living, many companies require some form of doctor’s release for a resident to use the fitness center or pool, but because they aren’t licensed to care for the residents, the attention to detail isn’t as imperative.


In personal care or assisted living, the physician signed form is generally much more involved and most buildings request this form ahead of move-in so the director of wellness has time to build the chart and face sheet, order the medications, come up with a plan of care, etc. Please don’t brush this off. Make it a priority to get yourself or your loved one to the doctor to have the medical paperwork filled out and signed. And while you’re there, have the doctor sign the POLST too. Either way, you, as your own advocate, or advocate for your loved one will need to ensure that it’s up to date and accurate with all your diagnoses and medications, including dosage. Even if you are going to self-medicate in assisted living or personal care, the community is still required to oversee and they need an up-to-date medication list, including over-the-counter medications, signed by a doctor. Most states have a window of time in which the form can be submitted, so it generally requires an office visit within 30–60 days of move-in, even if you just went three months ago. Be sure to ask the nurse at the community what the window of time is for receiving this document as it can set back a move-in date and mess up everyone’s plans.


In my early days of senior living sales, I had a lady move in with all her paperwork. She was 99 years old and her daughters quickly became concerned with her sudden fatigue. The wellness nurse told me that it was no wonder she was tired, she was on oxycodone twice a day for pain in accordance to her physician signed medical form. When I told the daughters, they said that she hasn’t been on that for four years and somehow the doctor kept the oxy on her med list from an old injury. The misunderstanding came because the daughters didn’t read the paperwork before submitting it. The wellness nurse has to do what the doctor orders, so please, double check your loved one’s med list before submitting! This error was fixed quickly, but please keep in mind that the building doesn’t know you or your loved one’s medical history and it’s your job to ensure that the doctors orders align with your plan of care and that your medication list is accurate. Doctors make mistakes as they often rush this process and/or print out something from your existing chart that may be out of date.


Copies of your health insurance and/or Medicare Card:


If you are moving into personal care, memory care or assisted living, most communities will want a copy of your insurance cards for the pharmacy, out patient rehab, and physicians who come into the community. Please be sure to have up to date cards that can be copied or send pictures of the cards.


Pharmacy Agreement:


Some personal care or assisted living buildings will ask that you sign on to the in-house pharmacy. This can be a surprise to a resident or family who are used to getting their prescriptions from a mail-away pharmacy or even the Veterans Administration. My recommendation is to sign on and get as much information as you can. If your loved one receives his/her meds through the VA, most pharmacies will re-package them for the home, and they may absorb the cost of that if you ask.


Most in-house pharmacies will deliver medications to the building at all hours, and they will package the medications to fit appropriately in the med carts, which is why they are preferred. If you chose to not sign on to the in-house pharmacy, some companies will ask you to pay a penalty to have the meds re-packaged. The reason they want you to sign on is because it helps the director of wellness regulate you or your loved one’s medications more appropriately and can cut down on medication errors. If you are still getting your meds through CVS or Express Scripts, they aren’t packaged the way the building might need it and you would have to pay to have them re-packaged through a third party anyway, so take that all into consideration.


If you are planning to take your own meds, you can keep your own pharmacy; but, you might be asked to keep all medications in a locked drawer or safe and you will most likely be audited by the director of wellness from time to time to ensure you or your loved one is still compliant with your medication regimen.


Choice of Funeral Home:


I have not run into this personally, but I think it’s a good one to include because I have been in buildings where they ask their residents to have this chosen in the case of an unexpected death. I’ve also been in buildings where there wasn’t a funeral home chosen, the kids couldn’t be reached and the deceased was left for a while with no funeral home to claim them.


Some seniors pre-pay for their funerals also to have less for their children to worry about when the time comes and it’s good to ask that folks at this stage of life at least have an idea of who will aid them in their final move.


The purpose of this article is to help you and your loved one prepare for a move to senior living. If you are coming off a crisis situation where you or your loved one is in skilled rehab and has three days to get everything together to decide where you’re going to go for care, the paperwork might be the last thing that you want to think about. Be sure to ask plenty of questions and be as prepared as possible.


If you have read this far, you are either really interested in this topic or have someone who might be ready to move soon. I commend you for your dedication!


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