On February 19, 2026, the Mississippi Supreme Court ruled in Manhattan Nursing and Rehabilitation Center, LLC v. Hawkins that a wife who signed her husband’s nursing home admissions paperwork could not bind her husband to an arbitration agreement because it was not required for his admission to the facility and was therefore not a “health-care decision” the wife could make as a statutory healthcare surrogate. The Court affirmed the Hinds County Circuit Court’s order denying the facility’s motion to compel arbitration and stay the lawsuit.
Many residents of Mississippi nursing homes are admitted by a spouse or other family member. Such family members may act as a healthcare “surrogate” and are allowed to make healthcare decisions on behalf of the resident. During admission to a nursing home, arbitration language often appears in the packet as “optional.” After this decision, when arbitration is expressly optional (not a condition of admission or continued care), a family member acting only as a health care surrogate does not have authority to sign the arbitration agreement on the resident’s behalf.
The facts in this case were straightforward. Wydett Hawkins was admitted to Manhattan Nursing and Rehabilitation Center (“Manhattan”), a long-term care facility in Jackson, on November 17, 2021. His wife, Verna Hawkins, signed all admission paperwork, including an arbitration agreement. The arbitration agreement required “all claims, disputes, and controversies of any kind between the parties” related to the nursing home care to be resolved by binding arbitration, and it purported to bind the resident and other related parties including heirs and wrongful-death-type claimants. All parties agreed that signing the arbitration agreement was not “a condition of, admission to, or requirement to continue to receive care at [Manhattan].”
After Mr. Hawkins’s death, his wife, Verna Hawkins (who signed the arbitration agreement on his behalf), filed suit against Manhattan in state court, alleging negligent care. Manhattan and two nurses moved to compel arbitration; the trial court denied the motion.
The Supreme Court affirmed in a 4-3 opinion. The majority held that a healthcare surrogate’s authority is limited to “health-care decisions” and that an optional arbitration agreement does not fit that category. As the Court put it: “We find that admission to the facility was not contingent on execution of the arbitration agreement, thus it was not a healthcare decision.” Because arbitration here was explicitly optional and not a healthcare decision, the wife lacked authority as a surrogate to sign the agreement on her husband’s behalf, making the arbitration agreement unenforceable.
The dissent noted that the Court’s decision will be difficult for nursing homes to put in practice and that “the ability to enforce a valid arbitration agreement is virtually nonexistent.” Federal regulation prohibits Medicare and/or Medicaid certified nursing homes from requiring arbitration as a condition of admission (42 C.F.R. § 483.70(m)(1)). And if the arbitration agreement is optional (as it must be) and the resident is not able to sign the admission paperwork due to incapacity, then a healthcare surrogate’s signature on an arbitration agreement will not be enforceable. In practice, if a nursing home wants to continue to offer arbitration when the resident cannot sign, the facility should not assume the spouse or other family member has authority to sign an arbitration agreement. The nursing home should require the surrogate to provide valid authority (for example, a valid power of attorney that covers the decision, guardianship or conservatorship paperwork, or another legally sufficient authorization) before signing the arbitration agreement.
