Introduction
For families of those living with dementia, securing a stable and caring environment is a top priority. However, the possibility of an unexpected discharge can be a source of significant stress. While memory care facilities are designed to support residents with cognitive decline, there are specific circumstances under which they can, and must, ask a resident to leave. It is important for families to be aware of the rules governing these involuntary discharges, their rights, and the steps they can take to ensure a loved one's well-being.
Valid Reasons for Involuntary Discharge
While rules vary by state, facilities typically must adhere to a strict set of regulations before issuing a discharge notice. Some reasons are more common than others, and it is crucial to understand the legitimacy of each claim.
Non-Payment of Fees
One of the most straightforward reasons for eviction is the failure to pay for services. The resident agreement or contract will outline the financial terms, and facilities can terminate the contract if payments are not made within the agreed-upon timeframe. Most states require a written notice and give the resident a period to rectify the non-payment.
Exceeding the Facility's Level of Care
Memory care is a specialized form of assisted living, but it does not provide the same level of medical supervision as a skilled nursing facility. As dementia progresses, a resident's medical needs can increase beyond what the facility is licensed or staffed to provide. This could include needing extensive one-on-one assistance, requiring medical procedures, or becoming a bed-bound patient. When a resident's needs exceed the facility's capacity, the facility must initiate a discharge to a more appropriate setting.
Endangering Health or Safety
A facility has a responsibility to protect the health and safety of all its residents and staff. A resident who displays a pattern of behavior that is harmful or offensive to others, such as physical violence, verbal threats, or inappropriate conduct, may be asked to leave. This also applies to residents who pose a significant safety risk to themselves, for example, due to elopement attempts or frequent falls despite safety interventions.
Resident Violates Facility Policies
Upon admission, residents and their representatives sign an agreement outlining facility policies. Violating these rules—such as smoking in non-designated areas, refusing to adhere to a treatment plan, or breaking community guidelines—can be grounds for eviction, provided it is a material violation and is outlined in the contract.
Facility Closure
If a facility closes its operations permanently, all residents will be discharged. In such cases, the facility is required to provide advance notice and assist with the transition to a new community.
The Eviction Process: What to Expect
If an eviction notice is issued, families should be prepared for a specific procedure. Understanding the timeline and requirements can help you respond effectively.
- Written Notice: In most cases, a facility must provide a written notice stating the reason for the discharge. The notice period, typically 30 to 90 days, varies by state and should be detailed in the resident contract.
- Detailed Justification: The notice must provide a clear, detailed explanation of the basis for the termination. If it concerns a change in medical needs, the facility should provide supporting rationale from clinical assessments.
- Resident Rights Information: The notice should inform the resident and family of their right to appeal the decision. It will also provide contact information for the state's Long-Term Care Ombudsman Program, an advocate for residents' rights.
- Discharge Planning: The facility is responsible for creating a safe discharge plan. This means they cannot simply send the resident home if it is an unsafe environment. They must assist in finding an appropriate alternative placement and coordinate the move to ensure a smooth transition.
Comparison: Eviction Rights in Different Care Settings
The rules governing involuntary discharge are not uniform across all senior care settings. It's important to differentiate between memory care and other facilities.
| Feature | Memory Care / Assisted Living | Skilled Nursing Facility (Nursing Home) |
|---|---|---|
| Regulation | Primarily regulated by state laws. | Subject to both state and stricter federal regulations (e.g., via Medicare/Medicaid participation). |
| Discharge Flexibility | Generally have more flexibility and wider latitude in what constitutes grounds for discharge. | Must adhere to more specific federal criteria for evictions, which are fewer in number. |
| Primary Goal | To provide a supportive residential environment with assistance for daily living and memory-specific needs. | To provide a higher level of medical care and skilled nursing services. |
| Resident Rights | Resident rights, and recourse for challenging evictions, are determined largely by state law and the resident contract. | Residents have federal protections under the 1987 Nursing Home Reform Law, which emphasizes dignity and self-determination. |
How to Challenge an Unfair Discharge
If you believe the discharge is unjust or improper, you have options to appeal the decision.
- Review the resident agreement: Scrutinize the contract for any clauses related to involuntary transfers or termination. Understand the facility's documented policies.
- Meet with management: Request a meeting with the facility administrator to discuss the issues and explore potential solutions. Can new services or accommodations be arranged to address the concerns?
- Get a second medical opinion: If the discharge is based on an increased level of care needed, seek an independent medical evaluation to verify the facility's claim.
- Contact the Long-Term Care Ombudsman: The ombudsman program is a state-level resource dedicated to protecting the rights of long-term care residents. They can mediate disputes and trigger investigations.
- Seek legal counsel: An elder law attorney can review the contract, understand state-specific protections, and represent your interests if the dispute escalates.
- File an appeal: In many states, residents have a formal appeals process to contest a discharge. Filing an appeal in a timely manner can often delay the move-out date.
Proactive Prevention Strategies for Families
While it is impossible to prevent dementia from progressing, families can take steps to minimize the risk of an unexpected discharge.
- Thoroughly Vet Facilities: Before admission, ask about the facility's specific discharge policies. What constitutes a reason for discharge? What happens if care needs increase? Get answers in writing.
- Maintain Open Communication: Stay in regular contact with staff. Ask for updates on your loved one's condition and behavior. Addressing minor issues before they become major problems is key.
- Be Financially Diligent: Ensure payments are made on time and that you understand all potential fees. Keep meticulous financial records to avoid payment-related disputes.
- Develop a Long-Term Plan: Understand that memory care may not be the final destination. Acknowledge the progressive nature of dementia and discuss with the facility and medical professionals what the next steps might be if a higher level of care is required.
Conclusion
While the prospect of a loved one being discharged from memory care is frightening, it is not an arbitrary process. Facilities must follow specific legal and contractual guidelines. By understanding the legitimate reasons for involuntary discharge, knowing the process, and being aware of your rights and resources, you can better protect your family member. For questions or assistance, the Administration for Community Living provides information on the Long-Term Care Ombudsman Program.
