What happens if Guardian refuses to sign Promissory Note for parents outstanding nursing home bill?

The reason NH likes to have the monies come to them is that way they get their SOC paid first. Daily rates vary by the facilities and even assisted livings charge by the amt of ADL's they are required to help with. Not the same with NH's. Daily rates include care, room and board, laundry but does not include any kind of rehab etc. No meds is included either. Good Luck

Like diavalon12 said, you need to to this as your mom's DPOA to the state Medicaid program directly. Mom should have gotten letters from the state with her Medicaid # and whatever else is the code to ID her in the state program. Send it via a certified letter with return registered receipt (this is the green postcard at the USPO - all this will run maybe $ 7.00 to do and well worth it) to the state with all moms info and state in short concise terms what the issue is. Keep this at 1 page. They (the Dept of human services, or Dept of Aging or whatever it is called in yur state) will get back to you and as it is a registered letter.... they cannot say we didn't get it. My mom's Medicaid was retro'd 6 months and my MIL was done almost 10 months later (and she died before being accepted but my SIL dogged the application through). All hope is not lost for you but you have to send letters out.

About the NH, I know your pain. My mom's first NH had radical changes within the first year she was there, like 3 different adminstrators, social workers left and not replaced, lots of crappy, disorganized business office staff. It is important that you keep details on all correspondence as this type of management style will probably find things to charge your for that are not covered by Medicaid or will totally screw up what they expect for her co-pay or add on things that would need to be paid privately (like cable or phone or "activities fees"). I moved my mom to another NH within her first year as the level of disorganization was just staggering and the care was not really bad but the better staff was leaving, so I moved her. If they are on Medicaid, it is pretty easy to move them and with no issue. Medicaid rules allow for them to move and without penalty. The state Medicaid pays the NH on a daily reinbursement rate for room & board. Now you want to make sure everything is kum-ba-ya for the new NH...they went and did an on site @ the old NH evaluation for my mom the day after I did the paperwork to have her move, and I moved her a couple of weeks later (delayed only because I live in another state). New NH allowed me the day before to get her room set up too. So I was able to have it all cute with photos up for her. Now if you move her, try to get the new NH all set up so that she can move right at the beginning of the month. Say you move her Nov 5th (Nov is a 30 day month), so that you will have mom's funds in her bank account (from her SS check and whatever else she gets as income) and can pay old NH for the 4 days she is in the old NH and then another check to the new NH for the rest of the days. So if mom has $ 1,800 a month for her Medicaid co-pay income, that would mean old NH gets $ 60.00 a day X 4 = $ 240.00 and new NH gets $ 1,560 for 26 days @ $ 60.00 a day. You don;t want to overpay the old NH as they sound like the type that will not send a check for any overage paid. The old NH may say that you have to pay the whole month if she moves out, but that is b.s. as the Medicaid regulations allow for them to move at their free will to another facility. If they are private pay, then the NH can enforce a full month to be paid contract but not if it is Medicaid.

The biggest hurdle in moving my mom was in getting her medications and I had to just be a determined bitch at the nurse's station to get them but did. The med's are usually in a 30 day blister pack & Medicaid does NOT pay it a second time in a month. If your mom is on a lot of med's, this could be quite alot of $$, so you have to get all her meds. Take some zip locks with you too......the old NH literally dumped pills on the countertop and had no containers available either. Pint size Zippies and a sharpie marker was in my purse, so no problems. Great expression on the nurse's face when I took those out too......priceless.

Oh also if you move her, be sure to get all her funds out of her NH trust account (if she is having the personal needs allowance kept @ the NH). Actually since this seems to be a not to be trusted NH, I would the next time at the NH, ask for her current balance in her trust account (if she is doing this) and them I'd take all of it out but maybe leave just enough for a hair salon visit. You don't want it to be the case, that you move her and that there was say $ 238.97 in the trust account and the NH never seems to be able to send you the money or that there is unsettled balance and they hold the trust account "hostage" against whatever they deem is unpaid. You do not have to have their personal needs allowance go into a trust account @ the NH. Of the 4 faciities I've dealt with for my mom & MIL, they all have pressed to have their income all go directly to the NH and then they put the allowance in for the resident. But you are not required to do this. Good luck.

You might consider doing this ourself. By doing so you will have control. There usually is a max amount of resources that she can have, such as here in California the max resources for one person is $2000.00 a married couple is deifferent.
Good luck to you.

Another Business Manager attempted to retro and for some apparent reason my mom was denied. The management and communications is terrible. There have been several business managers since 2011. They come and go

How long ago. You can file for 3 months retro.

The Representative from the Nursing Home Corporate Office informed me that it was the Business Office Manager at the time who delayed medicaid. It's very difficult to reach the owner. However your response is very helpful to me.

As the Guardian, you sign on her behalf, but that does not make you personally responsible for the debt. I would go directly to the head of the facility and report the business office manager's error. I would also file a complaint with the Joint Commission JCOHA at jointcommission.org if I was ignored.