Can a nursing home refuse to admit my parent if we don't sign the arbitration agreement?

Not a Medicare- or Medicaid-certified one. 42 CFR 483.70(m)(1) says the facility must not require a resident or representative to sign an agreement for binding arbitration as a condition of admission or as a requirement to continue receiving care, and it must explicitly tell you that. CMS surveyor guidance at tag F847 adds that facilities cannot refuse to admit anyone who has declined, and must not discharge a resident for failing to use arbitration. Assisted living is licensed by the states and sits outside this rule, so there the answer depends on state law.

How long do we have to cancel a nursing home arbitration agreement after signing it?

The federal rule requires the agreement itself to grant the right to rescind within 30 calendar days of signing (42 CFR 483.70(m)(3)). Calendar days means weekends and holidays count. The rule does not prescribe a form, so the practical approach is to read what the agreement says about how to rescind, do it in writing, date it, and keep proof of delivery. The requirement covers agreements entered into on or after September 16, 2019.

What happens if the facility's arbitration agreement doesn't follow the federal rule?

Two separate things. A state surveyor can cite the facility for a deficiency, usually at tag F847 or F848, and CMS expects the plan of correction for a systemic failure to include notifying residents who signed a noncompliant agreement and offering a compliant one. Whether a court will actually refuse to enforce a particular agreement is a different question. CMS said in the 2019 final rule that it does not purport to regulate the enforceability of any arbitration agreement, so enforceability is decided under the Federal Arbitration Act and state contract law, which is a question for an attorney licensed in that state.

Does arbitration apply to a sexual assault claim against a nursing home?

Not necessarily. The Ending Forced Arbitration of Sexual Assault and Sexual Harassment Act, now 9 U.S.C. 401 and 402, lets the person alleging a sexual assault dispute elect to take it to court even if a predispute arbitration agreement was signed. The statute's definition of sexual assault dispute expressly includes cases where the victim lacks capacity to consent. It applies to disputes or claims that arise or accrue on or after March 3, 2022.

Nursing Home Arbitration Agreement: What Signing Gives Up

In 2012 the Supreme Court looked at three nursing home contracts from West Virginia. Each one had been signed by a family member on behalf of a patient, and each sent disputes with the home to binding arbitration. Two of them, identical in the relevant parts, carved out one category: claims to collect late payments owed by the patient. Under those two, the home could still go to court to collect a bill. The family, suing over care, could not. That detail sits in the opening paragraphs of Marmet Health Care Center v. Brown, and it is a fair summary of why the arbitration page in an admission packet deserves more attention than it usually gets.

That page is often the fourth or fifth signature of the afternoon. Sometimes it is a separate document with its own title. Sometimes it is a paragraph inside the admission agreement. Either way, the federal rule for nursing homes is specific, it is short, and very little of it depends on how the facility chooses to describe the page to you.

What follows covers Medicare- and Medicaid-certified nursing homes, where a federal regulation applies. Assisted living is a different rulebook, and there is a short note on it near the end.

The rule is 42 CFR 483.70(m), and it has six parts

I pulled section 483.70 from the eCFR versioner API on 19 September 2026, for the text current as of 16 September 2026 (the most recent amendment to title 42 is dated 13 August 2026). The paragraph opens with a condition: "If a facility chooses to ask a resident or his or her representative to enter into an agreement for binding arbitration, the facility must comply with all of the requirements in this section."

So the rule does not ban arbitration agreements. It governs them. Here is what it requires, paraphrased closely, with the operative words quoted:

Paragraph	What it requires
(m)(1)	The facility "must not require" signing "as a condition of admission to, or as a requirement to continue to receive care at, the facility," and must "explicitly inform" you of your right not to sign
(m)(2)(i)	The agreement is explained "in a form and manner" you understand, "including in a language" you understand
(m)(2)(ii)	The resident or representative "acknowledges that he or she understands the agreement"
(m)(2)(iii)	The agreement provides for "a neutral arbitrator agreed upon by both parties"
(m)(2)(iv)	The agreement provides for "a venue that is convenient to both parties"
(m)(3)	The agreement must "explicitly grant" the right "to rescind the agreement within 30 calendar days of signing it"
(m)(4)	The agreement itself must "explicitly state" that signing is not a condition of admission or continued care
(m)(5)	No language that "prohibits or discourages" anyone from talking to surveyors, health department staff, or the long-term care ombudsman
(m)(6)	After a dispute is resolved through arbitration, the facility keeps the signed agreement and the arbitrator's final decision "for 5 years" and makes them available to CMS

Notice where the obligations land. Paragraphs (m)(1) and (m)(2) are things the facility has to do, in the room, when it hands you the page. Paragraphs (m)(3) through (m)(5) are words that must appear in the agreement. That split matters when you read the document, because the second group is checkable on paper in about two minutes. Look for the rescission sentence. Look for the not-a-condition sentence. If either is missing, the document itself fails the federal standard, whatever anyone said out loud.

Older articles cite paragraph (n). The letter moved in 2024

Search for this rule and a lot of what comes back, including letter templates, cites 42 CFR 483.70(n). That was correct for years. The eCFR version history for section 483.70 shows the arbitration paragraph at (n) in the 2019 text, still at (n) in the version dated 10 May 2024, and at (m) from the version dated 21 June 2024 onward. What moved it was the removal of the facility assessment paragraph, formerly (e), which now has its own section, 483.71. Every paragraph after it shifted up one letter. The words of the arbitration rule did not change.

The history before that explains why the rule looks the way it does.

2016. CMS's revised long-term care requirements included a flat ban: a facility "must not enter into a pre-dispute agreement for binding arbitration with any resident or resident's representative." You can still see that sentence in the eCFR snapshot for 1 January 2017.
7 November 2016. In American Health Care Association v. Burwell, a federal district court in the Northern District of Mississippi preliminarily enjoined enforcement of the ban. On 9 December 2016 CMS told state survey agencies not to enforce it (Survey and Certification memo S&C 17-12-NH).
18 July 2019. CMS published a final rule at 84 FR 34718 repealing the ban and replacing it with the requirements in the table above. It took effect 16 September 2019.

Two decisions inside that 2019 rule are easy to miss. CMS had proposed dropping the prohibition on making arbitration a condition of admission, and after comments it kept it. And it added the 30-day rescission right, which was not in the proposal at all. The rule states its reason for the second one directly: the 30 days give residents time "to reconsider" and to "seek legal advice, if he or she chooses to do so."

CMS also said the provisions are "only effective prospectively." Surveyor guidance repeats it: the guidance "is intended for the review of arbitration agreements entered into on or after September 16, 2019." A parent who signed in 2018 is in a different position, and that is a question for a lawyer, not this page.

What signing actually trades away

Surveyor guidance defines the thing plainly. A binding arbitration agreement is one where "the decision is final, can be enforced by a court, and can only be appealed on very narrow grounds." The same guidance, under tag F847, says parties subject to arbitration "give up their right to have some or all claims heard in court," that results "are typically not disclosed to the public," and that arbitrators "may not be required to follow federal or state rules of evidence."

In concrete terms, a predispute agreement decides in advance where a future disagreement gets resolved. CMS gives the example itself: if a resident signs at admission and months later alleges abuse covered by the agreement, "the resident cannot seek legal action through the traditional court system." The disputes these clauses reach, according to the same guidance, can run from "a financial disagreement" to "abuse, neglect, and/or wrongful injury or death."

So the practical list of what changes:

No jury. A single arbitrator or a small panel decides.
No public record of the proceeding or the result, in most cases. The facility has to keep the decision for five years for CMS inspection under (m)(6). That is not the same as publishing it.
Very limited appeal. The Federal Arbitration Act makes a covered arbitration agreement "valid, irrevocable, and enforceable, save upon such grounds as exist at law or in equity for the revocation of any contract" (9 U.S.C. 2).
Scope set by the drafter. Which claims are in, which are out, and who pays the arbitrator are all written by the facility. Two of the three Marmet contracts carved out the home's own collection claims; the third had no exceptions at all. Yours may or may not.

One federal exception applies regardless of what the agreement says. The Ending Forced Arbitration of Sexual Assault and Sexual Harassment Act, signed 3 March 2022 and codified at 9 U.S.C. 402, provides that at the election of the person alleging a sexual assault or sexual harassment dispute, "no predispute arbitration agreement ... shall be valid or enforceable" as to that case. The definition in 9 U.S.C. 401 covers nonconsensual sexual acts or contact "including when the victim lacks capacity to consent." For a resident with dementia, that last phrase is the one that matters. It applies to disputes or claims that arise or accrue on or after 3 March 2022.

Finding the clause when it is not labeled

The easy case is a separate document titled Resident and Facility Arbitration Agreement. The harder case is a paragraph halfway through the main contract, headed something like Dispute Resolution or Alternative Dispute Resolution Program.

CMS addressed this directly. Surveyor guidance says arbitration agreements "may not necessarily be a stand-alone document," that some facilities "embed the arbitration agreement within the admission agreement," and that in those cases "all of the requirements related to arbitration agreements still apply." It goes further: "residents must be allowed to sign an admissions agreement without consenting to the facility's arbitration agreement." And one of the interview questions surveyors are told to ask residents is whether, when arbitration was inside another document, they were told they could decline it "and second, how to exercise this right (crossing out, etc.)."

That parenthetical tells you something. CMS anticipates that the way to decline an embedded clause may be as crude as striking it out and initialing. If the packet gives you no mechanism at all, that is a fair question to put to the admissions coordinator, and to put in writing.

Search the PDF, or scan the paper, for these words: arbitration, arbitrator, waive, jury, dispute resolution, mediation, class action, AAA or JAMS or NAM (arbitration providers), Federal Arbitration Act. Then check each hit against this list:

Look for	Why
The sentence saying signing is not a condition of admission or continued care	Required by (m)(4). Its absence is a defect on the face of the document
The 30-day rescission sentence, and how to rescind	Required by (m)(3). Surveyors are told the facility "should have a process" for it, explained to you
How the arbitrator is chosen	(m)(2)(iii) requires a neutral arbitrator "agreed upon by both parties." A clause naming one provider with no choice is worth asking about
Where hearings happen	(m)(2)(iv) requires a venue convenient to both parties
Which claims are excluded, and whose	A carve-out for collection actions only runs one direction
Who pays the arbitrator's fees	Not addressed by 483.70(m). It is contract terms and state law
Anything about not contacting surveyors, the state, or the ombudsman	Barred by (m)(5)
Who else it binds: heirs, the estate, "all persons whose claim is derived through" the resident	Whether a wrongful death claim by family members is bound is a state law question, and states differ

Counting the 30 days, and sending the letter

The rescission right in (m)(3) runs "within 30 calendar days of signing." Calendar days include weekends and federal holidays. The clock starts on the signature date, which is one reason to write the date next to your signature yourself rather than leaving it to be filled in later.

The regulation does not say how rescission is delivered. Surveyor guidance says only that facilities "should have a process, that is also explained to the resident or their representative," and warns that "miscommunications or delays could deny the resident or representative the right to withdraw from the agreement within the 30-day period." So the agreement's own instructions govern the mechanics. Read them the day you sign, while the page is in front of you.

A rescission letter does not need to be elaborate. Something with these elements covers what the rule contemplates:

the resident's full name and the facility name and address
the title and date of the arbitration agreement being rescinded
a plain statement that the signer rescinds it under the 30-day right the agreement grants and 42 CFR 483.70(m)(3)
the signer's name, capacity (resident, or agent under a power of attorney dated such-and-such), signature, and the date

Send it the way the agreement specifies. If it specifies nothing, a method that produces proof of delivery is sensible: hand delivery with a dated receipt signed by staff, or certified mail with return receipt. Keep a copy in the same place as the admission packet.

Rescinding the arbitration agreement does not touch the admission agreement. Under (m)(1), continued care cannot depend on arbitration, and surveyor guidance says that "facilities must not discharge any resident for failure to use arbitration to settle a dispute." If a discharge notice follows a refusal or a rescission, CMS directs surveyors to "thoroughly investigate the basis for transfer or discharge" under F622. The federal discharge rules, and the six permitted reasons, are covered in the guide to involuntary discharge clauses.

Signing as someone else's agent

Much of the time the person holding the pen is not the resident. That raises a question the federal regulation does not answer: does the document that makes you an agent give you authority to agree to arbitration on your parent's behalf?

Surveyor guidance at F847 tells reviewers to confirm, "for residents who have a representative, there is evidence the representative has the legal authority to sign the binding arbitration agreement." Whether that authority exists is state law, read against the words of the specific power of attorney or proxy.

The Supreme Court limited how far states can go here. In Kindred Nursing Centers v. Clark, decided 15 May 2017, a wife and a daughter had each used a power of attorney to sign a nursing home arbitration agreement. Kentucky's high court held both agreements invalid because neither power of attorney specifically gave the agent authority to enter into an arbitration agreement, reasoning that access to the courts and a jury trial could be waived by an agent only if the document expressly said so. The Supreme Court held that this "clear-statement rule violates the Federal Arbitration Act by singling out arbitration agreements for disfavored treatment." Kentucky could still apply general rules about the scope of an agent's authority. It could not invent a special one for arbitration.

What that leaves you with: a financial power of attorney, a healthcare proxy, and a guardianship order each grant different authority, and which one covers an arbitration agreement depends on your state and on the document's words. The comparison of POA, proxy, and living will sets out what each one generally reaches. If you sign, write your capacity next to your name the same way you would on the responsible party line, so the record shows you signed as an agent and not personally.

There is a second layer for the resident who signs for themselves. Surveyor guidance says "additional evidence may be needed to establish that in fact the resident or their representative understood what he or she was signing," and that "it may not be sufficient that the resident or their representative signed the document." Where cognitive impairment is present, surveyors are told to check the medical record for decision-making capacity "at the time the agreement was offered, explained, and entered into."

A survey citation is not a court ruling

When a facility does not follow 483.70(m), two different systems can respond, and they do not answer to each other.

The survey system comes first. A state surveyor can cite F847 (entering into agreements: explanation, not-a-condition, rescission, communication with officials) or F848 (neutral arbitrator, convenient venue, five-year retention). The version of State Operations Manual Appendix PP I downloaded from CMS on 19 September 2026 marks both tags Rev. 225, issued 8 August 2024. Under that guidance, F847 noncompliance is "more than minimal harm," so the lowest severity level does not apply, and absent actual harm it "would likely be cited at severity level 2." For systemic problems, including "overt attempts to conceal arbitration agreements within other documents," CMS expects the plan of correction to include promptly notifying residents who signed a noncompliant agreement and offering "a compliant agreement." A citation lands on the public inspection report, and reading a Form 2567 shows where to find it.

Complaints go to the state survey agency, and the long-term care ombudsman can help with that for free. The federal Eldercare Locator at 1-800-677-1116 can connect you with the local ombudsman program.

The court system is separate. In the 2019 rule CMS wrote that it "does not purport to regulate the enforceability of any arbitration agreement." Surveyor guidance quotes the rule's statement that the provisions are not intended to "supersede or interfere with state laws or other state contract and consumer protection laws" except where those actually conflict. So a facility can be cited for a defective agreement and a court can still be asked to enforce it, or refuse to, under the Federal Arbitration Act and state contract law. Which way that goes for a specific document is legal advice, and it belongs with an attorney licensed where the facility is.

California puts extra requirements in statute, and assisted living has its own rules

States can add to the federal floor, within the limits of the Federal Arbitration Act. California writes its additions into statute in unusually specific terms. Health and Safety Code 1599.81, read 19 September 2026, requires that "all arbitration clauses shall be included on a form separate from the rest of the admission contract," that the contract "clearly indicate that agreement to arbitration is not a precondition for medical treatment or for admission," that medical malpractice arbitration be separated from other arbitration clauses with "separate signatures" for each, and that the attachment carry notice that the patient "may not waive his or her ability to sue for violation of the Patient's Bill of Rights."

The malpractice piece points to Code of Civil Procedure 1295, which requires the arbitration provision to be "the first article of the contract," sets out mandatory wording, and puts a notice immediately above the signature line "in at least 10-point bold red type" beginning NOTICE: BY SIGNING THIS CONTRACT YOU ARE AGREEING TO HAVE ANY ISSUE OF MEDICAL MALPRACTICE DECIDED BY NEUTRAL ARBITRATION. Section 1295(c) has its own 30-day rescission by written notice.

Most states have nothing that specific. The ombudsman is the free place to ask what yours requires.

Assisted living, memory care, and board and care homes are licensed by the states and are not covered by 42 CFR part 483. The federal rule is still a useful yardstick, and the residency agreement guide walks through measuring an assisted living arbitration page against it. But whether an assisted living community can make arbitration a condition of move-in is a state law question, and the answer should not be assumed from the nursing home rule.

Sources

42 CFR 483.70 — binding arbitration agreements at paragraph (m) in the current text. Retrieved through the eCFR versioner API on 19 September 2026 for the text current as of 16 September 2026; title 42 last amended 13 August 2026. Version history for the section compared at 1 January 2017 (the 2016 ban), 16 September 2019, 10 May 2024 (paragraph (n)), and 21 June 2024 (paragraph (m)).
84 FR 34718, 18 July 2019, CMS-3342-F, Revision of Requirements for Long-Term Care Facilities: Arbitration Agreements. Effective 16 September 2019. Background on AHCA v. Burwell (N.D. Miss., No. 3:16-cv-00233) and S&C 17-12-NH; the statements on prospective effect and enforceability. Read in the GPO text on 19 September 2026.
CMS State Operations Manual, Appendix PP, tags F847 and F848 (Rev. 225, issued 8 August 2024), including definitions, embedded agreements, interview probes, severity guidance, and plan of correction expectations. Downloaded 19 September 2026.
9 U.S.C. 2, 9 U.S.C. 401, 9 U.S.C. 402 — Federal Arbitration Act and the 2022 sexual assault and harassment exception (Pub. L. 117-90). Read 19 September 2026.
Marmet Health Care Center v. Brown, 565 U.S. 530 (2012), and Kindred Nursing Centers L.P. v. Clark, 581 U.S. 246 (2017). Read 19 September 2026.
Cal. Health & Safety Code 1599.81 and Cal. Code Civ. Proc. 1295. Read 19 September 2026.
Eldercare Locator, 1-800-677-1116, Administration for Community Living.

This page is general information, not legal, medical, or financial advice. See the terms.