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Medical Forum / Diseases and Disorders / Alzheimer's / October 2007

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Contract negotiation with LTCF in Ontario

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CarlosWA - 08 Sep 2007 00:28 GMT
Yesterday, I moved my mother to a LTCF in Ontario. I have Power of
Attorney for both Personal care and Property. I had asked for the
contract three months ago and they refuse to give a copy saying it
would be a quick process. Today I obtained a copy and I think that
there are inappropriate responsibilities assigned to me.

My mother has Alzheimers disease, is 86 years old and has no mental
capacity to make her own decisions. She was placed through the CCAC
(Community Care Access Centre - Ministry of Health of Ontario) in a
Home XX, one of several homes subsidized by the Ministry of Health.
These LTCFs are monitored by the Ministry and are regularly inspected.

I am willing to take fair responsibility for my mother including her
residence costs. I do not want inappropriate liability.

The following are questions and issues I would appreciate comments
from person with experience with the Ontario system.

1. The Home XX has named as a guarantor. No one from the CCAC or Home
xx ever mentioned that to me. Does she need a guarantor if I can prove
that she can pay?
2. Are these standard contracts for the LTCFs?
3. Does the Ministry inspect the contracts for fairness?
4. A clause says "the term Resident in this agreement includes the
Resident's Agent (me) as the context permits."
Why should I be responsible other than for the residence costs or
carrying out my duties according to the Power of Attorney?
5. How negotiable are these clauses?

I include the Schedule that deals specifically with the Guarantor and
contains the paragraphs I refer to below. I have underlines the words
that I object to.

6. I think Paragraph 2 is unfair.
7. I think Paragraph 3 is unfair. The cost is already covered in
another Schedule.
8. I think Paragraph 4 should be limited to the residence fees.
9. I think Paragraph 5 The first line "liability" should be limited to
residence costs.
10. I think Paragraph 6 The first line "any account" is too general.
11. I think Paragraph 7 be should be taken out.

SCHEDULE "A"
CONTINUING GUARANTEE By
xx Representative
(Print Name and Address of Guarantor}
TO AND IN FAVOUR OF
Home XX(CANADA) INC.

IN CONSIDERATION of the sum of one dollar [$1] and other good and
valuable consideration, the receipt and sufficiency of which are
acknowledged, the Guarantor(s) agrees with
Home XX as follows:

1.     Guaranteed Obligations
The Guarantor(s) irrevocably and unconditionally guarantees, as
principle debtor and not as surety, the due and punctual payment and
performance of all debts, liabilities and obligations (collectively
the "Guaranteed Obligations" of "Resident") to the Creditor, including
without limitation, the Obligations specified in the Resident's
Admission Agreement entered into between the parties of the same date
hereof, whenever, however or wherever incurred and any ultimate unpaid
balance thereof.
2.     Costs and expenses
The Guarantor(s) agrees to pay Home XX, upon demand, all out-of-pocket
costs and expenses (including, without limitation, legal fees on a
solicitor and client basis) incurred by or on behalf of Home XX in
connection with enforcing any of its rights against the Resident
and/or the Guarantor(s) in respect of the Guaranteed Obligations.
3.     Waiver
The Guarantor(s) agrees that Home XX may, without providing notice or
obtaining the consent of the Guarantor(s) and without exonerating in
whole or in part the Guarantor(s), amend, renew, extend, indulge,
release, vary the Service Charges or otherwise change the terms of the
Resident Admission Agreement as Home XX deems appropriate.
Resident Admission Contract
4.     Right to immediate payment
Home XX shall not be bound to seek or exhaust its recourse against the
Resident before being entitled to payment from the Guarantor(s) of the
Guaranteed Obligations under this Agreement and the Guarantor(s)
renounces all benefits of discussion and division.
5.     Payment on demand
The liability of the Guarantor(s) shall be payable immediately upon
written demand and such demand shall be conclusively deemed to have
been given when an envelope containing such demand, addressed to the
Guarantor(s), is delivered to the attention of the Guarantor(s) at the
address of the Guarantor(s) set forth in this Agreement or at such
other address as the Guarantor(s) may from time to time designate to
the Administrator or Home XX in writing or in accordance with Article
8 of the Resident Admission Agreement. The liability of the
Guarantor(s) shall bear interest from the date of such demand and both
before and after judgment, at the rate of eighteen (18%) per cent per
annum and Home XX will seek to recover any costs incurred in the
collection of outstanding accounts.
6.     Statement of accounts
Any account settled or stated by or between Home XX and the Resident,
or if any such account has not been so stated or settled prior to any
demand for payment, any account stated by Home XX shall, in the
absence of manifest error, be accepted by the Guarantor(s) as
conclusive evidence that the amount of the Guaranteed Obligations so
settled or stated is due and payable by the Resident to Home XX.
7.     Liability absolute
The liability of the Guarantor(s) shall be absolute and unconditional
irrespective of:
a)    The invalidity, unenforceability or illegality, in whole or in
part, of any agreements, instruments or other documents held by Home
XX to create, represent or evidence any Guaranteed Obligations;
b)    Any defence, counterclaim or right of set-off available to the
Resident whose obligations the Guarantor(s) is guaranteeing.
c)    Any other circumstances which might otherwise constitute, in
whole or in part, a defence available to the Guarantor(s), the
Resident or any other persons in respect of the Guaranteed Obligations
or the liability of the Guarantor(s).
Resident Admission Contract
Mary_Gordon@tvo.org - 08 Sep 2007 02:41 GMT
Carlos, what kind of problems are you anticipating? While I understand
your desire to avoid liability, Ontario is not exactly capital of
liability lawsuits, and this is a home subsidised and inspected by the
Ministry of Health and accessed via CCAC (i.e. vs. a for profit
private place).

I ask because....a good relationship with the staff and the
administration is really important - so if its going to be
adversarial, make it over something really worthwhile. It really won't
help your mother to get locked into any hostile squabble over small
stuff with the home.

As you know, I'm in Toronto, my MIL was in a similar facility, and
I've answered questions on AD for years now. I've never heard of
anyone in Ontario having issues regarding out of pocket expenses with
one of the publicly funded homes (i.e. what are you afraid of them
doing???).

Just asking.

M.
CarlosWA - 08 Sep 2007 03:23 GMT
Since I have worked all my life and I am retired I do not want
unnecessary risks. If problems have not been reported on this NG it
does not mean they have not happened or can happen. The LTCF is a for
profit one but subsidized by the Province and used exclusively for
CCAC placements. I do not have much experience in nursing homes but I
do on business. A contract should reflect the intention of the parties
and not be unfair. I think if we pay the residence costs and cooperate
with them they should offer good service. They get paid by the
residents and the Province. The payments from the Province come from
the residents of Ontario.

I already know from one source that those contracts are negotiable.
However, I am looking for information from more sources.

Thank you for your comments,
Carlos

>Carlos, what kind of problems are you anticipating? While I understand
>your desire to avoid liability, Ontario is not exactly capital of
[quoted text clipped - 17 lines]
>
>M.
Evelyn Ruut - 08 Sep 2007 02:55 GMT
Carlos, I think you really need to consult with a lawyer on this.   Just my
opinion.
Signature

Best Regards,

Evelyn

> Yesterday, I moved my mother to a LTCF in Ontario. I have Power of
> Attorney for both Personal care and Property. I had asked for the
[quoted text clipped - 110 lines]
> or the liability of the Guarantor(s).
> Resident Admission Contract
CarlosWA - 08 Sep 2007 03:08 GMT
I am following several paths of research. This is one of them and I am
consulting a  lawyer.

Carlos

>Carlos, I think you really need to consult with a lawyer on this.   Just my
>opinion.
Frederick G Young - 13 Sep 2007 07:41 GMT
Carlos,
i think you are under the impression that Residence fees are a single amount
that is all comprehensive.  Each nursing home has other costs that are
incurred by the resident such as dental checks, hair care, foot care,
ambulance services and transport back and forth to wherever the service is
provided. They have to be sure that in the event of the resident running out
of money that the cost of the service can be recovered. So I believe each
home has a contract that they require to have signed to ensure they can
recover money they use to provide the service. You can control how extensive
is the service you want your mother to have simply by reviewing it
beforehand with the home Administrator. These costs are examined by the
ministry through CCAC to ensure they are not exhorbitant. CCAC can withhold
it's subsidy if it considers the patient is not being treated fairly That's
the clout the ministry has. Every month you as the guarantor should recieve
a statement defining what costs have been incurred beyond the basic resident
fees. They are usually stated in an account known as the trust account. It
is this trust account that the home doesn't want to get stuck with should it
go in the red.

Hope this helped a little. My wife is in Sun Parlor home in Leamington and
they provide excellent care. However each home varies a little. Some just
meet CCAC's minimums, others go beyond them. It is a wise plan examine all
these things before committing the person to the home. If you are not happy
with the care or the general management of the home. Talk to the CCAC
representative. I found them very helpful.

Frederick
> Yesterday, I moved my mother to a LTCF in Ontario. I have Power of
> Attorney for both Personal care and Property. I had asked for the
[quoted text clipped - 110 lines]
> or the liability of the Guarantor(s).
> Resident Admission Contract
Evelyn Ruut - 13 Sep 2007 14:16 GMT
FREDERICK!

How nice to see you again.  How is June doing?  How are you doing?
Signature

Best Regards,

Evelyn

> Carlos,
> i think you are under the impression that Residence fees are a single
[quoted text clipped - 137 lines]
>> or the liability of the Guarantor(s).
>> Resident Admission Contract
sweetpickleNO@SPAMknology.net - 13 Sep 2007 22:47 GMT
Evelyn, my thoughts exactly.   Frederick, bring us up to date on June and on
you.
Gwen

> FREDERICK!
>
[quoted text clipped - 140 lines]
>>> or the liability of the Guarantor(s).
>>> Resident Admission Contract
Frederick G Young - 17 Sep 2007 20:06 GMT
Evelyn,
           Thanks for your good wishes. I have now managed to integrate my
life with the inescapable fact that June doesn't get any better.
   June is coming up to the end of her 5th year in long term care. She was
diagnosed in October 1996.  Her physical health is quite good considering
the fact that she was 85 last March.  Her mental health is not quite the
same. She cannot speak coeherently any longer and when she does manage say
anything it is incomprehensible. She is recieving excellent care, but as as
one might expect, it requires to be monitored to ensure that that it
continues to be so.  I don't know how the care givers manage to cope with
the day to day care of people who are adults, yet in all other things are
like infant children. June continues to come up with surprises. She doesn't
know my name or any of the individual family names, or for that matter, that
she has any family at all. In my case she seems to know that I am a special
person in her life relative to all the other people she meets in her small
world. When I go to see her and walk into her room she usually says " Where
have you been" as if I had just popped out for a few moments. That is about
the total extent of anything that passes between us for our entire time
together. As you can guess that makes visits extremely tedious. Most of the
time she just watches the flickering television screen without any idea of
what is going on from one frame to another. Meanwhile I sit by her and
either she or I fall asleep  <G>.  The drive from where I live in Milwaukee
to Leamington is over 440 miles, so as you can imagine my visits now are
spaced further apart and usually last about 3 days at most. More is just
more than I can take.  Shorter intervals are somewhat exhausting to myself.
At 83, even though I am blessed with reasonable health and vigor, my energy
resources are not quite what they used to be.

   I think that during the deterioration from Alzheimers there comes a time
when the person afflicted lives in a very small world. This in June was when
she started to develop a look in her eyes, as if she was looking through you
instead of at you. I know that as soon as I leave her and return I cease to
exist, and only exist again in her world when I reappear. So the cycle just
keeps repeating with every visit.  My daughter spoke to me about it when she
said " Don't let anything in your life be dislocated by the need to visit
Mom" So the adjustment I have made is to split my life into two parts. One
being to ensure that June is getting what she needs to ensure her life is as
good as it can be, and the other is to get on with living life to provide me
with what I require to make life as good as it can be.  This, and also do
both well. To that end I have done some travelling, met many interesting
people and seen many things. In a burst of exhuberance I even bought myself
a 250cc. Motor Scooter, took the Motorcycle driving test, and now I use it
for all the relatively short trips, but not the 440 miles to Leamington.  I
feel about 35 years younger when I am riding it, and while it took about a
month before my old riding skills came back, come back they did. Now taking
a run down to the store can be fun!  Naturally I wear a helmet and have also
added a Blaze Orange Jacket complete with reflective strips.  I think my
family were a bit apprehensive but they soon adjusted and I countered by
buying my daughter a 50cc model and now she's hooked <G> This has backfired
a little because I'm now the family scooter mechanic.

   So life never ceases to be free from surprizes. That is as it should be.
My daughter said something to me that I never realized. She said "Dad, you
seem to be able to remake yourself about every 10 years" I had never thought
about it like that before, but maybe that is not such a bad idea.

Frederick.

> FREDERICK!
>
[quoted text clipped - 140 lines]
>>> or the liability of the Guarantor(s).
>>> Resident Admission Contract
sweetpickleNO@SPAMknology.net - 17 Sep 2007 23:15 GMT
Frederick, it sounds as if you are doing the very best with your life for
the situation you are in.  Not doing things you enjoy won't help June at
all, and will only make you feel bad.  I can't imagine making that round
trip to see her very often.  I'm only 78 and I know I couldn't handle it.  I
enjoyed reading your report; it is most interesting.  Please don't wait so
long for the next one!
Gwen

> Evelyn,
>            Thanks for your good wishes. I have now managed to integrate my
[quoted text clipped - 201 lines]
>>>> or the liability of the Guarantor(s).
>>>> Resident Admission Contract
CarlosWA - 14 Sep 2007 13:17 GMT
Thank you Frederick. My concern was that the contract included the
word "liabilities" under the guarantor responsibilities. I have no
problem with guaranteeing the residence charges to my mom. A lawyer
has now explained the convoluted legal jargon and he says the contract
is OK. I will write a longer post with the results of my research for
the benefit of others when I have the time.

Carlos

>Carlos,
>i think you are under the impression that Residence fees are a single amount
[quoted text clipped - 137 lines]
>> or the liability of the Guarantor(s).
>> Resident Admission Contract
CarlosWA - 05 Oct 2007 15:40 GMT
I met with the Administrator fo the Nursing Home and she agreed to a
modification on the contract.

Where I signed as Guarantor I noted
"In signing this guranty, it is understood that I do not accept any
personal responsibility outside of the payment of the charges, fees,
or expenses incurred by the resident."

Also where I signed for the Resident I signed my name and added "as
agent."

I believe that now I have a fair contract.

Carlos

>Thank you Frederick. My concern was that the contract included the
>word "liabilities" under the guarantor responsibilities. I have no
[quoted text clipped - 146 lines]
>>> or the liability of the Guarantor(s).
>>> Resident Admission Contract
Evelyn Ruut - 06 Oct 2007 15:26 GMT
>I met with the Administrator fo the Nursing Home and she agreed to a
> modification on the contract.
[quoted text clipped - 10 lines]
>
> Carlos

Good.   :-)

Evelyn
 
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