Health Law

How To Get Sued By a Nursing Home: Estoppel

By Attorney Richard Shea

Today we continue our magical mystery tour through the case of Glastonbury Health Care Center v. Esposito. This case shows how one Connecticut nursing home resident’s son made several big mistakes in pursuing Connecticut Medicaid eligibility for his mother. Those mistakes ultimately resulted in the Court rendering judgment against him personally for over $100,000 in nursing home bills. The Esposito case is an excellent example of what not to do for anyone in the process of admitting a parent or spouse into a Connecticut nursing home.

Glastonbury Health Care Center sued Carmine Esposito for breach of contract, negligence, promissory estoppel, and fraudulent misrepresentation to hold him responsible for over $100k in nursing home bills. Today we will review the claim for promissory estoppel.

A claim for Promissory Estoppel exists when “[a] promise which the promissor should reasonably expect to induce action or forbearance on the part of the promissee . . . and which does induce such action or forbearance is binding if justice can be avoided only by enforcement of the promise.” A critical element of promissory estoppel is the existence of a clear and definite promise which a promissor could reasonably have expected to induce reliance.

In this case, the court found that Carmine Esposito wanted Josephine’s care at Glastonbury Health Care Center to be paid for by Connecticut Medicaid. Carmine knew that a requirement of Connecticut Medicaid was that the assets of Josephine do not exceed $1,600.00. He knew that Glastonbury Health Care Center would not accept Josephine without her being approved for Medicaid. Carmine agreed to apply for Josephine’s Medicaid. He consented by his silence to accept the obligation of a responsible party (as defined in the admissions contract) to obtain and maintain Josephine’s eligibility for Medicaid. The Court concluded Carmine reasonably expected that Glastonbury Health Care Center would rely upon that conduct and promise to accept Josephine as a resident. Glastonbury Health Care Center did rely on Carmine’s conduct and promise. Carmine Esposito failed to obtain approval of Josephine’s application from April 1, 1998 to September 2000. As a consequence, Glastonbury Health Care Center lost Connecticut Medicaid payments for that period. Those facts establish the claim for promissory estoppel.

In response to the nursing home’s claim, Carmine responded that Glastonbury Health Care Center failed to exercise due diligence to sustain the truth as to Josephine’s eligibility for Medicaid. Relying on a 1982 case, the Court concludes that Glastonbury Health Care Center did not have a duty to exercise due diligence to determine that Carmine had made false promises.

In a second attempt to defeat the nursing home’s claim of estoppel, Carmine claimed that his silence during the nursing home admission process could not create the basis for the nursing home’s estoppel claim unless he had a duty to speak. The court concluded that since Carmine was seeking to have Josephine accepted by the nursing home as a Medicaid beneficiary, knew the nursing home would not accept Josephine without her Medicaid application being approved, and was apprised of his obligation to obtain and maintain her eligibility as a condition for her acceptance, he had the duty to object to that obligation. The court found that this duty to speak and Carmine’s failure to do so form the basis for estoppel.

This is the third example of Carmine Esposito’s big mistakes in applying for his mother’s Connecticut Medicaid benefits. His mistakes cost him over $100,000 of his own funds. A Connecticut Medicaid Attorney could have saved Carmine from this mess for a lot less than what the Court ordered him to pay the nursing home. A Connecticut Medicaid Attorney can help your family avoid Medicaid mistakes and being held personally responsible for nursing home bills.

Full post as published by Connecticut Medicaid & Estate Planning on April 19, 2009 (boomark / email).