Kentucky Supreme Court Ruling Protects Consumers from Forced Arbitration in Nursing Homes

For families navigating long-term care, a recent Kentucky Supreme Court decision offers a significant win. On August 14, 2025, the court ruled in Lexington Alzheimer’s Investors, LLC v. Norris that a spouse who signed a mandatory arbitration agreement on behalf of a loved one entering a nursing facility is not  bound unless she was explicitly authorized by law or a legal document to execute the agreement on his behalf. This decision could shield consumers from institutions that use arbitration clauses to limit their rights, especially in cases of negligence or abuse. Let’s break down this ruling and explore why it matters for long-term care and aging in place, alongside the broader push by consumer advocates to curb such agreements.

The Case: A Spouse’s Struggle for JusticeIn 2019, Sandra Norris became her husband Rayford’s conservator after his Alzheimer’s diagnosis, appointed by a Tennessee court. Seeking care for Rayford, Sandra admitted him to The Lantern, a private-pay personal care facility in Lexington, Kentucky. The facility required her to sign a mandatory arbitration agreement, a contract forcing any future disputes (like lawsuits) into private arbitration rather than open court. Sandra didn’t specify her signing capacity (e.g., as conservator) when she signed the agreement, and the Tennessee order wasn’t registered in Kentucky, leaving its legal effect unclear. Rayford lived at The Lantern until March 2020, during which Sandra alleged he suffered multiple falls, significant weight loss, and an infected bed sore, ultimately passing away in August 2020.
Sandra sued The Lantern for negligence, medical negligence, and wrongful death. The facility moved to compel arbitration, arguing Kentucky’s Living Will Directive Act (KRS § 311.631) gave Sandra authority to sign the agreement as Rayford’s spouse. Both the circuit court and Kentucky Court of Appeals disagreed, and the Supreme Court upheld their decisions.The Ruling: Arbitration Isn’t a Healthcare DecisionThe Kentucky Supreme Court clarified that the Living Will Directive Act allows a spouse to make healthcare decisions (e.g., consenting to or withdrawing medical treatments) only when a doctor determines the individual lacks decisional capacity. However, signing an arbitration agreement, a legal contract about how disputes are handled, doesn’t qualify as a healthcare decision. Since Sandra wasn’t Rayford’s legally recognized agent, guardian, or surrogate under a valid Kentucky order, and no physician had documented his incapacity, she lacked authority to bind him to arbitration.
The court also dismissed The Lantern’s reliance on the U.S. Supreme Court’s 2017 Kindred Nursing Ctrs. Ltd. P’ship v. Clark ruling, which struck down a Kentucky ruling that authority to bind a principal to arbitration must be explicitly stated in a power of attorney violated the Federal Arbitration Act.  The Kentucky court found its decision rested on a general contract principle (lack of authority), not a statute that discriminated against arbitration, meaning that its holding is consistent with federal law.Why This Case Protects ConsumersThis ruling is a victory for consumers, particularly those relying on institutional care for short or long-term care. Mandatory arbitration agreements often favor institutions by:

• Limiting public lawsuits, keeping negligence cases (like Rayford’s falls or bed sores) out of the spotlight.

• Restricting access to juries, which can award higher damages than arbitrators, who may lean toward businesses.

• Reducing transparency, as arbitration proceedings are private, not public court records.

By invalidating Sandra’s unauthorized signature, the court ensures families can pursue justice in court when care fails, rather than being funneled into a process that may favor the facility. For readers, this decision highlights the need to scrutinize admission contracts.Why Consumer Advocates Favor Limits on Arbitration Agreements

Consumer advocates, including groups like AARP and the National Consumer Voice for Quality Long-Term Care, have long pushed to restrict arbitration in nursing homes. Here’s why:

• Unequal Power Dynamics: Nursing homes often present arbitration agreements during admission, a stressful time when families may feel pressured to sign without understanding the consequences. Advocates argue this coerces consent, especially for vulnerable seniors or their caregivers.

• Lower Accountability: Studies show arbitration awards average significantly less than jury verdicts in nursing home cases, and facilities win 2–3 times more often in arbitration. This can let substandard care slide, as seen with Rayford’s alleged neglect.

• Hidden Abuses: Private arbitration hides patterns of neglect or abuse, preventing public awareness and systemic reform. For example, a 2023 report found 60% of nursing home arbitration cases involved unreported safety violations.

• Legal Barriers: Arbitration clauses can limit appeals or class actions, leaving families like Sandra’s with little recourse against corporate chains, which own 70% of U.S. nursing homes.

• Conflict of Interest: Arbitrators are often chosen by the facility or from a pool tied to the industry, raising bias concerns—unlike impartial judges in court.

Advocates push for federal or state laws requiring opt-in arbitration (not mandatory), clear disclosure, or bans in long-term care, arguing it protects seniors’ rights to fair legal recourse.Implications for Aging in PlaceFor families aiming to age in place, this ruling underscores the importance of legal clarity. If facility care is needed (e.g., as a backup to home care), ensure:

• Legal Authority: Review legal authority to execute agreements.  Although this situation probably worked out for the family, there may be others where the family will want to enforce an agreement.  The door swings both ways; facilities can invalidate agreements made without legal authority, just like a family can.  
• Review Contracts: Scrutinize admission agreements for arbitration clauses and clauses that enforce family responsibility for a person's debts (see, e.g.,  "Promissory Note Executed by Nursing Home Resident’s Daughter Is Not Illegal Third-Party Guarantee" and the discussion in that article regarding institutions seeking to unlawfully enforce filial responsibility).  Consult an elder law attorney to challenge unauthorized terms.
• Alternative Planning: Use Medicare Advantage plans with robust home-based benefits (e.g., telehealth, in-home PT/OT) to delay facility reliance, avoiding such disputes.
• Advocacy: Join family councils or groups like Ohio’s Area Agencies on Aging to push for consumer-friendly policies.

A Call to ActionThe Norris decision empowers consumers by rejecting forced arbitration when legal authority is absent. As nursing home litigation grows, this ruling could deter facilities from overreaching. For Ohio and Missouri families, it’s a reminder to plan ahead. Review your long-term care strategy with an elder law attorney. Don’t let institutions dictate your legal options; act now to protect your future.

Optimizing Aging in Place: Leveraging Medication Management to Reduce Hospitalizations

As the desire to age in place grows, ensuring safety and health at home becomes paramount for older adults. A recent study published in  Home HealthCare Now, and brought to my attention by McKnight's Home Care highlights a powerful strategy for improving aging-in-place outcomes: prioritizing medication evaluation and reconciliation. Conducted by Providence VNA Home Health in partnership with Washington State University College of Pharmacy, the study demonstrates how targeted medication management can significantly reduce hospitalization risks for high-risk home health patients, particularly those with heart failure. Here’s a closer look at the study’s findings and practical steps you can take to enhance your aging-in-place plan.

Key Findings from the StudyThe study, conducted between 2018 and 2020, focused on high-risk home health patients and examined the impact of medication evaluation and reconciliation—an interdisciplinary process involving clinicians and pharmacists to ensure accurate documentation and optimization of prescribed medications. The results were compelling:

• Reduced Hospitalizations: Among high-risk heart failure patients, 30-day hospitalization rates dropped from 12% to 9% following medication evaluation and reconciliation.
• Lower Rehospitalizations: The initiative reduced rehospitalizations by approximately two patients per month, underscoring its potential to improve long-term outcomes.
• Prevalent Medication Issues: Approximately 60% of patients had unreconciled medications upon admission to home health, and prior studies noted that up to 71% of heart failure patients face medication reconciliation challenges during transitions from hospital to home.
• Underutilized Practices: Despite their effectiveness, medication evaluation and reconciliation remain underused in home healthcare, highlighting an opportunity for improvement.

The study emphasizes that involving pharmacists in an interdisciplinary approach can address the complexities of medication regimens, ultimately enhancing patient safety and reducing costly hospital stays. For those aging in place, these findings point to actionable strategies to stay healthier and more independent at home.
Understanding Medication Reconciliation: What It Is, Who Does It, and How It’s Done? 

Medication reconciliation is a critical process in healthcare aimed at ensuring the accuracy and safety of a patient’s medication regimen, particularly during transitions in care (e.g., from hospital to home, or between healthcare providers). Below, we explore what medication reconciliation entails, who performs it, and how it is conducted, drawing on insights from the Providence VNA Home Health study and general healthcare practices.
Medication reconciliation is the process of creating and maintaining an accurate list of all medications a patient is taking, including prescription drugs, over-the-counter medications, supplements, and vitamins. The goal is to:

• Ensure accuracy: Verify that the medications a patient is taking match what is prescribed and intended.
• Prevent errors: Identify and resolve discrepancies, such as duplicate medications, incorrect dosages, or potential drug interactions.
• Optimize outcomes: Ensure medications are effective and safe, reducing risks like hospitalizations due to medication-related issues.

The Providence VNA Home Health study highlighted its importance, showing that medication reconciliation reduced 30-day hospitalization rates.Who Performs Medication Reconciliation?Medication reconciliation is typically a collaborative effort involving multiple healthcare professionals, depending on the care setting:

• Pharmacists: As seen in the Providence VNA study, pharmacists play a key role due to their expertise in medication management. They evaluate drug regimens for interactions, appropriateness, and adherence.
• Nurses: Home health nurses or clinicians often initiate reconciliation by collecting medication information from patients and comparing it to medical records.
• Physicians: Doctors review and approve the reconciled medication list, making adjustments as needed.
• Patients and Caregivers: Patients or their caregivers provide critical input by sharing details about what medications are actually being taken, including non-prescription items.
• Other Providers: In some cases, care coordinators or medical assistants may assist in gathering or documenting medication information.

In the study, an interdisciplinary approach involving clinicians and pharmacists was key to success, emphasizing the value of teamwork in complex cases, such as those involving high-risk patients with heart failure.How is Medication Reconciliation Done?Medication reconciliation follows a structured process to ensure thoroughness and accuracy. The steps typically include:

1. Collect a Comprehensive Medication History:
   • What Happens: A healthcare professional (e.g., nurse or pharmacist) gathers a complete list of the patient’s medications. This includes prescription drugs, over-the-counter medications, supplements, and vitamins, along with dosages, frequencies, and administration methods.
   • How It’s Done: The provider interviews the patient or caregiver, reviews medication bottles, and checks records from pharmacies, hospitals, or primary care providers. Tools like electronic health records (EHRs) or patient-reported lists are often used.
   • Challenges: Patients may forget to mention certain medications or supplements, as noted in the study where 60% of patients had unreconciled medications upon admission to home health.
2. Compare with Existing Records:
   • What Happens: The collected medication list is compared to existing records, such as hospital discharge summaries, primary care prescriptions, or home health orders.
   • How It’s Done: The healthcare team identifies discrepancies, such as medications listed in one record but not another, incorrect dosages, or medications no longer needed. Pharmacists may use software to flag potential interactions or errors.
   • Example from Study: The Providence VNA team found that patients with two or more unreconciled medications were at higher risk, underscoring the need for this step.
3. Resolve Discrepancies:
   • What Happens: Any inconsistencies are addressed through consultation with the patient’s healthcare team. This may involve clarifying prescriptions with the prescribing physician, discontinuing unnecessary medications, or adjusting dosages.
   • How It’s Done: Pharmacists or clinicians contact prescribers, discuss findings with the patient, and update the medication list. For example, a patient might be taking an outdated dose of a heart failure medication, which the team corrects.
   • Study Insight: The interdisciplinary approach in the study, involving pharmacists, helped resolve complex issues, contributing to reduced hospitalizations.
4. Create and Share an Updated Medication List:
   • What Happens: A finalized, accurate medication list is created, detailing each medication, dose, frequency, and purpose.
   • How It’s Done: The list is documented in the patient’s medical record, shared with the patient and caregivers, and communicated to all relevant providers (e.g., primary care physician, home health agency, or pharmacy). Patients may receive a printed or digital copy for reference.
   • Best Practice: The study emphasized thorough documentation to ensure continuity of care, especially during transitions like hospital-to-home.
5. Educate and Follow Up:
   • What Happens: Patients and caregivers are educated about the updated medication regimen, including how to take medications correctly and potential side effects to watch for.
   • How It’s Done: Nurses or pharmacists provide verbal or written instructions, answer questions, and may schedule follow-up visits to monitor adherence and address new issues. Tools like medication organizers or apps can support compliance.
   • Study Relevance: The study noted that reinforcing medication reconciliation practices improved outcomes, suggesting ongoing education is critical.

Practical Tips for Patients Aging in PlaceTo incorporate medication reconciliation into your aging-in-place plan:

• Keep an Updated Medication List: Maintain a current list of all medications and share it with every healthcare provider you see.
• Ask for Reconciliation During Transitions: Request that your home health agency or provider perform a medication reconciliation whenever you move between care settings.
• Engage a Pharmacist: Schedule a consultation with a pharmacist to review your medications, especially if you have multiple prescriptions or chronic conditions like heart failure.
• Use Technology: Apps like Medisafe or smart pill dispensers can help track medications and remind you of doses, reducing errors.
• Communicate Openly: Inform your healthcare team about all medications, including supplements, to ensure nothing is overlooked.

Why It Matters for Aging in PlaceThe Providence VNA study showed that medication reconciliation can significantly reduce hospitalization risks, particularly for high-risk patients. For those aging in place, this process minimizes medication errors, enhances safety, and supports independence by preventing health setbacks. By proactively managing medications with the help of healthcare professionals, you can create a safer, more sustainable home environment.

How to Improve Your Aging-in-Place PlanBased on the study’s insights, here are practical steps to incorporate medication management into your aging-in-place plan, along with additional medication-related guidance to ensure success:

1. Request Medication Reconciliation with Every Care Transition
   • What to Do: Work with your healthcare provider or home health agency to ensure a thorough medication reconciliation whenever you transition between care settings (e.g., hospital to home). This involves reviewing all prescribed and over-the-counter medications, supplements, and vitamins to eliminate discrepancies, such as duplicate prescriptions or outdated medications.
   • Why It Matters: The study found that unreconciled medications were common among 60% of patients, contributing to hospitalization risks. A reconciled medication list ensures you’re taking the right drugs at the right doses.
2. Partner with a Pharmacist for Regular Medication Reviews
   • What to Do: Schedule periodic consultations with a pharmacist, either through your home health provider or a local pharmacy. Ask them to evaluate your medication regimen for potential interactions, side effects, or opportunities to simplify your prescriptions.
   • Why It Matters: The study highlights the value of pharmacist involvement in reducing hospitalization rates. Pharmacists can identify issues like polypharmacy (taking multiple medications), which is common among older adults and can increase risks of adverse effects.
3. Use Technology to Track Medications
   • What to Do: Invest in a medication management app or a smart pill dispenser to track doses, set reminders, and share your medication list with caregivers or healthcare providers. Examples include Medisafe or PillPack, which can organize and deliver medications.
   • Why It Matters: Technology can reduce errors, such as missed doses or incorrect timing, which are common contributors to medication-related complications. This is especially helpful for those managing complex regimens at home.
4. Simplify Your Medication Regimen
   • What to Do: Ask your doctor or pharmacist if your medications can be consolidated (e.g., switching to combination pills or once-daily formulations). Also, inquire about deprescribing unnecessary medications.
   • Why It Matters: Simplifying regimens reduces the risk of errors and improves adherence, which is critical for aging in place. The study notes the complexity of medication regimens in home health, making simplification a key strategy.
5. Educate Yourself and Caregivers on Medication Safety
   • What to Do: Learn about your medications, including their purpose, side effects, and proper administration. Share this information with family members or caregivers involved in your care. Resources like the National Institute on Aging or AARP offer guides on medication safety.
   • Why It Matters: Knowledge empowers you to spot issues early, such as side effects or interactions, and ensures caregivers can support you effectively.
6. Create a Centralized Medication List
   • What to Do: Maintain an up-to-date list of all medications, including dosages, schedules, and prescribing doctors. Keep a physical copy in your home and a digital version accessible to healthcare providers or emergency responders.
   • Why It Matters: A centralized list streamlines communication during medical appointments or emergencies, reducing the risk of unreconciled medications, as seen in the study’s findings.
7. Advocate for Interdisciplinary Care
   • What to Do: If you’re working with a home health agency, ask if they offer pharmacist-led medication evaluations or interdisciplinary care teams. If not, explore partnerships with local pharmacies or telehealth services that provide these options.
   • Why It Matters: The study underscores that interdisciplinary collaboration, particularly with pharmacists, enhances outcomes by addressing complex medication challenges.

Additional Medication-Related GuidanceBeyond the study’s focus, here are other evidence-based strategies to strengthen your medication management plan:

• Monitor for Side Effects: Regularly discuss any new symptoms with your doctor, as they may be medication-related. For example, dizziness or fatigue could signal issues that need adjustment.
• Stay Hydrated and Follow Dietary Guidelines: Some medications, particularly for heart failure, require specific dietary or fluid intake considerations. Consult your doctor or pharmacist to align your diet with your prescriptions.
• Plan for Emergencies: Store medications in a clearly labeled, accessible location and ensure emergency contacts know where to find them. Consider a medical alert system that includes medication information.
• Review Over-the-Counter Medications and Supplements: These can interact with prescriptions, so include them in your reconciliation discussions to avoid unintended consequences.

ConclusionThe Providence VNA Home Health study underscores the transformative potential of medication evaluation and reconciliation for aging-in-place success. By reducing hospitalization risks and improving medication safety, these practices empower older adults to live independently with confidence. To optimize your aging-in-place plan, prioritize medication reconciliation, engage pharmacists, leverage technology, and advocate for interdisciplinary care. By taking these steps, you can minimize health risks, enhance your quality of life, and make aging in place a safer, more sustainable reality.