Under federal and state law, a nursing home resident is protected against involuntary transfer or discharge, often called eviction. A facility cannot simply force a resident to leave due to a complaint, a high level of care needs, or because their payment source changes from private pay to Medicaid. However, there are limited, legally-valid circumstances where an involuntary discharge is permissible. Understanding these reasons, and the proper procedures a facility must follow, is crucial for protecting resident rights.
Valid and Unlawful Reasons for Nursing Home Discharge
There are only six legally permissible reasons for a nursing home to involuntarily discharge a resident, as defined by federal regulations. Any discharge attempted outside of these reasons is illegal.
Lawful Reasons for Involuntary Discharge:
- Health improvement: The resident's health has improved to the point that they no longer require the level of care provided by the nursing home.
- Resident's welfare needs cannot be met: The transfer or discharge is necessary for the resident's welfare, and their needs cannot be met by the facility after reasonable attempts at accommodation. The facility's own inadequate staffing is not a valid reason.
- Health or safety risk: The resident endangers the health or safety of other individuals in the facility. This must be a documented risk that cannot be eliminated or reduced by a reasonable accommodation.
- Non-payment: The resident has failed to pay for their stay after receiving reasonable and appropriate written notice. This cannot occur while a Medicaid application is pending or if there is a dispute over payment.
- Facility ceases operation: The nursing home is closing.
Unlawful Reasons for Involuntary Discharge:
- Complaint filing: A resident cannot be discharged for complaining about the nursing home or its care.
- Change in payment status: Moving from private pay to Medicaid is not a valid reason for eviction. Facilities that accept Medicaid must have a bed available for qualified residents.
- Demanding care needs: A facility cannot evict a resident simply because they require a higher level of care or are perceived as “too demanding”.
- “Hospital dumping”: This illegal practice occurs when a nursing home refuses to readmit a resident after a hospital stay, often claiming no bed is available. Federal regulations specify readmission rights for residents, including Medicaid recipients.
The Discharge and Appeals Process
Even when a valid reason for discharge exists, a nursing home must follow a strict protocol. A verbal notice is never sufficient; all notifications must be in writing.
Comparison Table: Discharge Notification vs. Appeal
| Feature | Written Discharge Notice | Resident's Right to Appeal |
|---|---|---|
| Provider | Nursing home | Resident or representative |
| Timing | Generally, 30 days before discharge (except in emergencies) | Filed immediately after receiving the discharge notice |
| Required Content | Reason for discharge, effective date, location of transfer, appeal instructions, ombudsman contact | Written request for a hearing sent to the appropriate state agency |
| Effect | Starts the clock for the resident to prepare or appeal | Halts the eviction process until a hearing decision is made (unless imminent danger) |
| Decision-Maker | Nursing home (but based on legal reasons) | Administrative Law Judge or state hearing officer |
How to Fight an Improper Discharge
If you believe a nursing home's discharge notice is unlawful, you have the right to fight it. The most critical step is to not move out and to file an appeal immediately.
- Request an Appeal Hearing: Upon receiving a written discharge notice, follow the instructions to request an appeal hearing. The facility cannot legally remove the resident while the appeal is pending, except in rare cases of documented imminent danger.
- Contact the Long-Term Care Ombudsman: These state-appointed advocates are available for free to assist residents with disputes, including involuntary discharges. They can explain resident rights, help with the appeals process, and mediate with the facility.
- Seek Legal Assistance: An elder law attorney can provide expert guidance, assess the validity of the discharge, represent the resident in an appeal hearing, and, if necessary, take legal action against the facility for wrongful eviction. Advocacy groups like Justice in Aging also offer valuable resources.
- Document Everything: Keep detailed records of all communication with the nursing home, including dates, names of staff, and copies of any notices received. Documentation is essential for building a strong case.
- Utilize the Discharge Plan: A facility is legally required to create a comprehensive discharge plan, including a safe and appropriate transfer location, before a resident can be moved. This plan must ensure the resident's needs are met and cannot involve an unsafe placement, like a homeless shelter.
Conclusion
While a resident can, in limited circumstances, be involuntarily discharged from a nursing home, federal and state laws provide significant protections against improper evictions. A facility must have a legally valid reason, such as non-payment or the ability to no longer meet the resident's needs, and must provide a proper written notice and discharge plan. Residents are not powerless; they have the right to appeal the decision and should immediately seek help from a Long-Term Care Ombudsman or an elder law attorney to protect their rights and well-being. Knowledge of these legal rights is the first and most important step in challenging a wrongful discharge.
