Failure to ensure informed consent for ADR agreements: two residents signed ADR forms without understanding that they were waiving the right to litigate in court. One resident was cognitively intact with chronic pain and anemia, and the other had HTN and anxiety disorder. Both later stated they had not received the ADR education they needed and would not have signed the forms if the process and loss of court rights had been explained.
Failure to Ensure Understanding of Arbitration Agreement: Two residents with documented clear comprehension signed the facility’s arbitration agreement shortly after admission, but later reported they did not understand what they were signing and felt the paperwork was rushed or not explained. One resident said she was in pain after surgery and trusted staff, while the other said she had just had a heart attack and did not recall the arbitration terms. The BOM stated all residents signed, and the NHA referenced the need to explain the agreement and the right to refuse.
A resident with Alzheimer's disease and severe cognitive loss signed a binding arbitration agreement even though the medical record showed the resident was not capable of understanding the Bill of Rights or making medical treatment decisions. The Admissions Director said the agreement was reviewed with the resident or representative after admission and that confusion might prompt a nurse or SW review, but the facility policy did not address assessing competence before signing. In a group interview, 10 residents said they did not know what the arbitration agreement was or whether they had signed one.
A resident admitted for orthopedic aftercare signed a voluntary binding arbitration agreement, but later said he had no idea what it was and did not recall signing it. The NHA and AA reported the agreement was not explained well, the AA did not know residents had 30 days to revoke in writing, and the admission binder did not include a description of arbitration; the resident also signed both acceptance and declination forms.
Arbitration Agreement Missing Required Resident Rights Language: A resident with multiple diagnoses, including dementia, COPD, and dysphagia, had an arbitration agreement that did not state that signing was not a condition of admission or continued care, and did not state that the resident could communicate with federal, state, or local officials, including surveyors and the State Long Term Care Ombudsman. The AD confirmed the omissions after the agreement was reviewed during the survey process.
Incomplete Arbitration Agreement Process: A resident who was cognitively intact had an ALTERNATIVE DISPUTE RESOLUTION AGREEMENT that was electronically signed, but most required initials were missing and the acknowledgement that he understood and voluntarily entered the agreement was not initialed. The resident later stated he probably did not understand the paperwork and so did not sign it, while staff and the NHA agreed the contract was not completed in full.
A facility failed to explain arbitration agreements in a way residents could understand during admission paperwork. Four residents who signed the agreements later reported confusion, lack of recall, or regret about signing, while the SW said he asks if they understand arbitration and explains it as a mediator-based way to resolve issues and that signing is not required for admission.
A facility failed to ensure 3 residents clearly understood the binding arbitration agreement and their right to refuse it. Two residents with BIMS 15/15 said they did not recall signing and would not have agreed if they knew it prevented disputes from going to a judge, jury, or trial; a third resident said the agreement was never explained that way and only recalled being told disputes under $20,000 would be handled in-house. The AD said residents were given a packet of documents and that the explanation of binding was not fully understood.
Binding Arbitration Agreement Not Clearly Explained: The facility failed to ensure three residents understood the Binding Arbitration agreement they signed. Two residents with BIMS scores of 10/15 and 15/15, and another resident with a BIMS score of 15/15, did not recall agreeing to arbitration or understanding that it waived the right to judge, jury, or trial. The AD said the packet was left in residents’ rooms for review and described arbitration with a simple sibling analogy, but acknowledged they did not explain that it limited the right to resolve disputes through judge, jury, or trial.
A resident who was cognitively intact and their own decision maker signed a binding arbitration agreement, but later said they did not recall discussing or signing it and would not have agreed if they had understood it waived the right to court litigation. The DOMA said staff described arbitration only as a voluntary third-party process and did not explain the waiver of the right to litigation, while the NHA said the agreement was optional and believed the waiver language was simply written in the document.
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