Families often worry that a loved one will be involuntarily discharged from a nursing home, leaving family in a position of trying to care for someone with too many needs for family to be able to provide adequate care. Families particularly worry about loved ones who tend to be “difficult.”
However, under Federal law, there are only six legitimate reasons that a facility can discharge a patient:
(i) The transfer or discharge is necessary for the resident’s welfare and the resident’s needs cannot be met in the facility;
(ii) The transfer or discharge is appropriate because the resident’s health has improved sufficiently so the resident no longer needs the services provided by the facility;
(iii) The safety of individuals in the facility is endangered;
(iv) The health of individuals in the facility would otherwise be endangered;
(v) The resident has failed, after reasonable and appropriate notice, to pay for (or to have paid under Medicare or Medicaid) a stay at the facility. For a resident who becomes eligible for Medicaid after admission to a facility, the facility may charge a resident only allowable charges under Medicaid; or
(vi) The facility ceases to operate.
Sometimes a facility will use the first reason, that the resident’s needs cannot be met in the facility as justification to attempt to discharge a “difficult patient.” This reason only applies if the resident’s needs cannot be met in a nursing home generally – for example, if the resident needs placement in a locked unit and the nursing home does not have such a unit.
To make a legitimate discharge, the nursing home must give a written notice that lists the reason for the discharge, along with the facts that allegedly support the discharge. This notice generally must be given 30 days prior to the proposed discharge and the resident has an opportunity to appeal. The nursing home must propose a plan for a safe discharge from their facility. If the nursing home proposes to discharge to another similar nursing home then it is good evidence that the resident is appropriate for nursing home care and it would be an improper discharge. A resident should not hesitate to exercise his appeal rights.