F0847

D

Failure to Ensure Residents and Representatives Understood Binding Arbitration Agreements

Washington, District Of Columbia Survey Completed on 03-12-2026

Penalty

No penalty information released

Summary

Facility staff failed to ensure that residents and/or their representatives understood the binding arbitration agreements included in the admission packet. The facility’s standard arbitration form stated that any disputes regarding services or health care provided by the facility would be resolved through binding arbitration, that signing the agreement waived statutory and constitutional rights to have claims decided in court before a judge and jury, and that signing was not a precondition for admission. The agreement also stated that the resident should seek legal counsel and that the agreement could be rescinded in writing within 30 days by certified mail. However, interviews with residents and representatives who had signed these agreements showed no evidence that staff clearly explained these provisions or confirmed that signers understood what they were agreeing to.

One resident with multiple sclerosis, muscle spasms, contractures, anemia, and weakness was cognitively intact with a BIMS score of 14 and had electronically signed the arbitration agreement as his own representative. He reported understanding the concept of arbitration generally but did not remember signing the facility’s arbitration agreement and stated he was not clear on what he was signing at the time. He did not recall the admissions staff clearly explaining that he should seek legal counsel before signing or that he would be giving up certain legal rights, and he stated that he would not have signed had he understood this. Another resident with dysphagia, hemiplegia following cerebral infarction, a gastrostomy, type 2 diabetes, cognitive communication issues, generalized muscle weakness, and gout had an initial BIMS score of 0, indicating severely impaired cognition, and a later BIMS score of 15, indicating intact cognition. The arbitration agreement for this resident was signed by the resident and an emergency contact as representative. During a telephone interview, the emergency contact stated they did not remember signing anything that would prevent the resident or family from taking the facility to court, and that the arbitration process and agreement were not made clear before signing.

A third resident with rib fracture, protein-calorie malnutrition, atrial fibrillation, systolic congestive heart failure, generalized muscle weakness, and cognitive communication deficit was documented as her own responsible party and had a BIMS score of 15, indicating intact cognition. The arbitration agreement in her record was electronically signed by an emergency contact as her representative. The resident stated she did not remember signing any legal papers like that, noted there were many papers to sign at admission, and reported that a family member present at admission would not have allowed her to sign such a document. A fourth resident with hemiplegia, clavicle fracture, hematuria, generalized muscle weakness, adjustment disorder, and cognitive communication deficit had a BIMS score of 14 and a power of attorney as representative. The arbitration agreement was electronically signed by the representative, who later stated she did not understand what she was signing, was unsure how arbitration works, and was more focused on the resident’s health at the time. She did not recall being advised to seek legal counsel or being clearly informed that signing meant giving up the right to pursue legal action in court.

The Director of Admissions reported that arbitration agreements are included in the admission packet and that she waits for a BIMS score before reviewing them with residents or representatives. She stated that for residents with BIMS scores of 12 or higher, she meets with the resident and/or representative to review the admission packet and arbitration agreement, and for residents with lower BIMS scores she meets with the representative if they wish to sign. She described asking whether they had heard of binding arbitration and explaining that by signing they agree to use the facility’s arbitrator rather than their own legal counsel for unresolved grievances, disputes, or legal matters, and that signing is voluntary and not required for admission. She also stated she tells them they have 30 days to change their minds, but acknowledged that the process she described for rescinding—contacting her by phone or in person so she can notify the regional office—is not outlined in the document itself, which specifies rescission by written notice via certified mail. When asked how she determines understanding, she stated that she simply asks if they understand, and surveyor interviews found no evidence that staff explanations ensured residents or representatives truly understood the binding arbitration agreements they signed.