Understanding Resident Rights and the Discharge Process
For many residents, a nursing home stay is temporary, intended for rehabilitation after a hospital visit. Once they feel better, the desire to return home is natural. Federal and state laws grant nursing home residents specific rights, including autonomy over their care and the right to leave. However, simply walking out without following the proper protocol, known as leaving Against Medical Advice (AMA) or elopement, can have serious consequences for both the resident and the facility.
The Voluntary Discharge Process
For residents with full mental capacity, the process of leaving voluntarily is their right. A voluntary discharge occurs when the resident, or their authorized representative, gives written or verbal notice of their intent to leave. While this is a resident-initiated decision, it is not a spur-of-the-moment action. The facility is still required to carry out a discharge plan, a process that can take several weeks.
This planning is crucial for a safe transition. It involves coordinating services like home health care, ordering medical equipment, and arranging follow-up appointments. By working with the facility's discharge team, residents can ensure they have the necessary support systems in place before returning home, minimizing the risk of complications or readmission.
Leaving Against Medical Advice (AMA)
A resident with the capacity to make their own decisions can choose to leave a skilled nursing facility even if the medical team believes it is unsafe. In this case, the facility will ask the resident to sign an AMA form. This document acknowledges that the resident understands and accepts the potential risks of leaving, releasing the facility from liability for any negative health outcomes.
Consequences of an AMA discharge can include:
- Loss of Insurance Coverage: Leaving AMA can lead to a loss of Medicare or other insurance coverage for the current admission, as the stay was not completed according to the medically-approved plan.
- Disruption of Care: Prescriptions, medical equipment orders, and home health services may be delayed or not provided if the discharge is not planned. This can lead to a lapse in crucial medical care.
- Higher Readmission Risk: Patients who leave AMA have been shown to have higher rates of hospital readmission, often for the same condition.
- Difficulty with Re-entry: Returning to the nursing home after an AMA discharge can be complicated and may depend on facility policy and new medical assessments.
The Dangers of Elopement
Elopement is a far more serious situation than a planned AMA discharge. It occurs when a resident, often with cognitive impairment such as dementia or Alzheimer's, leaves the facility without authorization or necessary supervision. Elopement is not a legal exercise of rights; it is a critical safety failure on the part of the facility, which has a duty to provide adequate supervision.
The risks associated with elopement are severe, and can include:
- Falls and traumatic injuries
- Exposure to extreme weather
- Being struck by a vehicle
- Dehydration and malnutrition
- Fatal outcomes
When a resident is identified as being at high risk for elopement, the facility should have specific safety protocols, including secure doors, wander management bracelets, and a comprehensive plan to prevent unauthorized departures. Families who suspect negligence after an elopement incident can and should seek legal counsel.
The Role of Guardianship and Capacity
For a resident with a legal guardian or one deemed to lack the capacity for medical decision-making, the process of leaving is not up to them alone. The guardian is responsible for making decisions on the individual's behalf, based on their best interests. A nursing home cannot hold a mentally competent person against their will, as this is a form of kidnapping and is illegal. However, if a resident has been professionally assessed and deemed to lack capacity, particularly due to a condition like advanced dementia, the care facility is responsible for their safety and can prevent them from leaving unsupervised. This is different from being held against one's will; it is part of the duty of care for a vulnerable person.
Comparison of Discharge Types
| Feature | Voluntary Discharge | Leaving Against Medical Advice (AMA) | Elopement |
|---|---|---|---|
| Decision Maker | Resident (or representative) | Resident with capacity | Unsupervised resident with cognitive impairment |
| Risks | Minimal if planned properly | Increased health risks, loss of insurance, potential readmission | High risk of serious injury or death |
| Process | Involves formal discharge planning and notice | Requires signing a waiver acknowledging risks | Unplanned, unsupervised departure |
| Legal Status | Resident right under federal law | Resident right (with capacity) | A safety incident, potentially involving negligence |
| Facility Liability | Released from liability by process | Released from liability via AMA form | Potentially liable for negligence |
Conclusion
While the answer to "can someone just leave a nursing home?" isn't a simple yes, the short answer is that a mentally competent resident does have the right to leave. The crucial difference lies in the process. A planned, voluntary discharge ensures a safe and supported transition, while an AMA discharge carries significant personal risks. For residents with cognitive impairments, leaving is considered a dangerous elopement, and the facility is responsible for prevention. Understanding the resident's rights, capacity, and the proper procedures is the key to a safe and informed decision regarding departure from a nursing home. Advocacy organizations like the National Long-Term Care Ombudsman Resource Center can provide invaluable support and information.
