WASHINGTON -- Many elderly people on Medicare are being told they must pay thousands of dollars in cash deposits as a condition of admission to nursing homes despite federal laws and rules that prohibit the practice.
Federal officials and consumer advocates say they have received complaints about the requests for such deposits nationwide. Thousands of people are affected, but the government cannot calculate the exact number because it has not kept track of the problem.
Elderly people often express irritation at the deposits, but generally pay because they are unaware of the law and do not want to antagonize nursing home personnel who will be responsible for their feeding, care and medication.
Federal health officials acknowledge that they have not adequately enforced or publicized the law, and they recently reminded the nursing home industry of the prohibition.
In a letter to the American Health Care Association, Kathleen A. Buto, policy director at the federal Health Care Financing Administration, reviewed the law and regulations.
Based on complaints from nursing home residents, their relatives and advocates, she said, "we believe that violations of these requirements may be widespread."
The association published a two-paragraph reminder about the rule in its newsletter last month.
Bess M. Brewer, a lawyer who represents Medicare recipients at the National Senior Citizens Law Center, said nursing homes often asked for deposits of $2,000 to $6,000.
"Nursing homes will tell you this is an isolated practice," Ms. Brewer said, "but that's not our experience. We have seen problems in almost every state."
In interviews, some nursing home administrators said they were unaware of the prohibition and others appeared to be confused about the law. Others said they needed the money and did not want to wait for Medicare.
William Toby Jr., acting chief of the Health Care Financing Administration, said, "If a nursing home is charging a fee up front, that's a clear violation of Medicare rules." Medicare officials said federal and state employees would check compliance in their annual inspections of nursing homes.