Understanding Nursing Home Eviction for Non-Payment
Facing eviction from a nursing home can be a stressful and confusing experience for residents and their families. While facilities have a right to receive payment for services, federal and state laws protect residents from unfair or illegal involuntary discharge. Understanding these regulations is critical to navigating a non-payment dispute effectively and safeguarding a loved one's right to care.
Legal Grounds for Involuntary Discharge
Federal law, specifically the Nursing Home Reform Act, outlines only six valid reasons for involuntarily discharging a resident. Non-payment is one of these reasons, but it is heavily regulated. The law mandates that a facility cannot simply evict a resident as soon as a bill is overdue. Instead, non-payment as a reason for eviction only applies if:
- The resident has not paid a charge that is not in dispute.
- There is no pending appeal of a denial of benefits from a third-party payer like Medicare or Medicaid.
- The resident refuses to cooperate with the facility in obtaining funds, even when funds are available for payment.
This legal framework prevents arbitrary evictions, particularly for residents undergoing a transition in their payment source, such as from private pay to Medicaid.
The Mandated Discharge Process
For a nursing home to legally evict a resident, it must follow a precise and regulated process. Ignoring any step can render the eviction invalid. The process includes several key requirements:
- Written Notice: The facility must provide a written transfer or discharge notice to the resident and their legal representative. The notice must be in a language the resident understands.
- Adequate Time: The notice must be given at least 30 days in advance of the planned discharge date. Exceptions for shorter notice exist only in emergency situations, such as a resident's needs posing an immediate threat to the health or safety of others.
- Comprehensive Information: The notice must include the specific reason for the discharge, the effective date, the location to which the resident will be transferred, an explanation of the resident's right to appeal, and the contact information for the Long-Term Care Ombudsman Program.
- Discharge Planning: The facility must also create a written discharge plan to ensure a safe and orderly transition for the resident. This plan must be developed by the interdisciplinary team and consider the resident's needs and preferences.
Special Protections for Medicaid Residents
Residents who are on or applying for Medicaid have extra layers of protection against eviction for non-payment. A nursing home cannot discharge a resident if a Medicaid application is pending, nor can they evict a resident whose Medicaid benefits have been denied while an appeal of that denial is underway. Facilities that accept Medicaid are prohibited from forcing a resident to leave simply because their payment source has shifted from private funds to Medicaid. This is a common tactic, often called 'Medicaid dumping,' that is illegal under federal law. Furthermore, even if a facility chooses to stop participating in the Medicaid program, it cannot discharge existing Medicaid residents.
How to Appeal a Nursing Home Eviction
If you or a loved one receive a transfer or discharge notice, it is crucial to act quickly and appeal the decision. The appeal process is your legal right to challenge the eviction and remain in the facility while the appeal is pending. Here's a step-by-step guide to the appeals process:
- Don't Panic and Don't Move: Do not move out of the facility based solely on the notice. Filing an appeal legally allows you to stay while the hearing is pending.
- Request an Appeal: The notice must contain instructions on how to request a hearing. You can submit a written or verbal request to the appropriate state agency, such as the Office of Administrative Hearings.
- Contact the Ombudsman: Reach out to the local Long-Term Care Ombudsman Program. These advocates are trained to assist residents with disputes, including wrongful evictions.
- Gather Evidence: Collect all relevant documentation, including copies of the eviction notice, your admission contract, financial statements, and correspondence with the facility. If the eviction is related to a Medicaid issue, gather all paperwork related to the application or denial.
- Attend the Hearing: An administrative law judge (ALJ) will oversee the hearing, which is often held over the phone or at the facility. Both you (or your representative) and the nursing home will have a chance to present evidence and witness testimony.
The Role of Legal and Advocacy Support
Navigating an eviction dispute can be complex, and seeking professional help is highly recommended. Legal and advocacy support can make a significant difference in the outcome. A qualified elder law attorney or a representative from the Long-Term Care Ombudsman Program can:
- Review the discharge notice for legal compliance.
- Represent you at the hearing.
- Negotiate with the facility on your behalf.
- Identify and correct any procedural violations by the facility.
A Comparison of Payment Scenarios
| Payment Source | Rules Regarding Non-Payment Eviction | Resident Protections | What to Do If Facing Eviction |
|---|---|---|---|
| Private Pay | Facilities can evict for non-payment if a bill is undisputed and overdue after reasonable notice. | Standard 30-day notice, right to appeal, and discharge planning. | Pay the bill, negotiate a payment plan, or seek legal counsel. |
| Medicare | Eviction for non-payment cannot occur while a Medicare claim or appeal is pending. | Facility must provide notice and assist in finding an alternative payment source if Medicare coverage ends. | If coverage is ending, apply for Medicaid immediately. Appeal any claims denial. |
| Medicaid | Illegal to evict if a Medicaid application is pending or an appeal of a denied application is underway. A facility cannot terminate a resident if it leaves the Medicaid program. | Strongest protections against eviction, including the right to stay during appeals. Cannot be discharged for switching from private pay to Medicaid. | Notify the Ombudsman and your state's Medicaid office. File an immediate appeal. |
| Combination | Rules are complex and depend on which portion of the bill is unpaid (e.g., co-pay). | Protections based on the specific third-party payer involved (Medicaid/Medicare). | Seek legal advice immediately to understand your rights regarding the specific payment type in dispute. |
Conclusion
While a nursing home can evict a resident for non-payment, the process is not simple or immediate. Strict federal and state laws govern involuntary discharges to protect residents from abuse and wrongful eviction. By understanding your rights, acting quickly, and seeking support from legal experts or the Long-Term Care Ombudsman, you can effectively challenge a discharge notice and ensure your loved one receives the care they deserve.
For more information on residents' rights, contact your local Long-Term Care Ombudsman program, or consult resources from a trusted organization like the National Consumer Voice for Quality Long-Term Care: https://theconsumervoice.org/.
