Becoming dependent on caretakers in a nursing home does require major adjustments and a relinquishment of some control over everyday affairs. Any such heavy dependence on others naturally lends itself to potential abuse or mistreatment when there are not safeguards and protections in place. But under both federal and state law, there are many safeguards and protections that give nursing home residents the right to maintain some autonomy.

Whether you are contemplating admission to a nursing home or just know someone who resides in one, it’s a good idea to become familiar with residents’ rights under both North Carolina and federal law. (Click for summaries of state and federal regulations.) The federal nursing home regulations were recently expanded to give residents more rights.

Both sets of regulations cover privacy and communication, explicitly giving residents the right to have private phone access, mail access and the materials necessary to send and receive mail, as well as the right to have visitors of one’s choice at any reasonable hour. Other important topics addressed in nursing home regulations include choices about scheduling (including waking and sleeping times), when residents must receive notices of changes (including transfers or discharges), how grievances must be handled, and freedom from restraints and abuse.

The state summary of rights lists the right “to manage his/her own financial affairs unless other legal arrangements have been implemented.” It’s important to understand that this does not give agents named in powers of attorney the right to go beyond the authority given in that document or to restrict a resident’s access to visitors or communication with others. I sometimes hear from clients that family members acting under a power of attorney believe they can unilaterally decide which visitors the resident may receive. However, powers of attorney generally do not give agents that authority and nursing homes should not go against the resident’s wishes about visitor access.

One thing that should be considered carefully at the very beginning of a nursing home stay is the admission agreement, typically a lengthy and comprehensive document. As with any contract, it’s important to read this document closely and discuss any questions or concerns before signing it. Some facilities may not yet have updated their contracts to reflect current law. For example, nursing homes have traditionally asked for a cosigner, a third party such as a spouse or other family member, to agree to be financially responsible in these contracts.

However, facilities that accept Medicaid or Medicare are now prohibited by federal law from requesting or requiring such responsibility from a third party. They are also prohibited from requiring a waiver of the facility’s liability for loss of a resident’s personal belongings. Reviewing these agreements carefully before signing them and knowing one’s rights ahead of time can help with transitions into nursing homes so that they don’t have to feel like the beginning of the end.

Joint accounts can make perfect sense for seniors who depend on family members for help paying bills and other day-to-day tasks. Joint accounts can also help avoid the need for probate, an often-complex process that requires court involvement to carry out the will. 

Undoubtedly, joint bank accounts can make life easier for the right people: seniors and their trusted family members or caretakers. However, they can also make things easier for the wrong ones: people who want to exploit seniors and get access to their money. I hear this concern from a lot of my clients. Their son is in and out of rehab, or their daughter may be easily manipulated by an abusive spouse. Is it safe to add their name to the account? 

My clients are right to be cautious, because opening a joint account gives the joint owners virtually unlimited access. They can withdraw any amount of money, at any time, for any reason, without your permission. And the process is irreversible: Once you give someone access to your account, the only way to remove them is to close the account. (The same warning applies if you make someone a co-owner of your home with a new deed; you cannot change your mind and deed it back to yourself unless they agree to give back their interest.) 

Therefore, my advice to clients is always: Pick someone you can truly trust, and understand how joint accounts work so both you and your bank know what you want. 

If you want someone to have access to your account while you’re alive and receive full ownership of the account when you die, then you want a “joint account with a right of survivorship.” If you want this type of account, make sure the written agreement you sign with your bank clearly states that the account has a right of survivorship. 

If you want to give someone access to your account only after your death, then you want a “payable on death” account that names a beneficiary. You can set up a POD account if you are the sole owner of the account, or if the account already has a joint owner and you want the beneficiary to be a third party. Be aware, though, that this will create problems if your joint owners do not agree on the POD beneficiary. 

Finally, be aware that setting up a right of survivorship or POD account will not necessarily prevent a portion of the account from being used to pay your debts after your death if you have no other money or assets. 

So, when clients ask me about “adding a name” to an account, I tell them that joint accounts can definitely make life easier, but they are first and foremost a matter of trust.