Understanding the Grounds for Involuntary Discharge
Involuntary discharge, often referred to as eviction, is a serious and regulated matter in the nursing home industry. Federal regulations, which apply to all nursing homes that accept Medicare or Medicaid, state that a resident can only be transferred or discharged for one of six very specific reasons. A facility cannot arbitrarily decide to evict a resident, and must follow a detailed legal process.
The Six Legally Permissible Reasons for Discharge
- The facility cannot meet the resident's needs. This applies when the resident's medical condition or care requirements have changed to the point where the nursing home can no longer provide appropriate care. This must be documented by a physician, and the facility cannot use its own inadequate care as a reason for eviction.
- The resident's health has improved. If a resident's medical condition has improved sufficiently that they no longer require the level of care provided by a nursing facility, they may be discharged. This requires a physician's documentation and a proper discharge plan.
- The resident poses a danger to the safety of others. This can apply if a resident's behavior, documented by staff and potentially a physician, threatens the physical safety of other residents or staff. Facilities must first consider if reasonable accommodations can mitigate the threat.
- The resident's presence endangers the health of others. This can include residents with contagious diseases or other health risks that cannot be managed effectively within the facility's setting without endangering the wider population.
- Non-payment for a stay. A resident can be discharged for failing to pay their bill. However, this is only valid if the facility has provided reasonable and appropriate notice. A resident cannot be discharged for non-payment while a Medicaid application is pending or an appeal of a denial is underway.
- The facility ceases to operate. If a nursing home closes, all residents will need to be transferred to new facilities. The facility must develop a clear closure plan and provide residents with proper notice.
The Crucial Role of the Discharge Notice
Even with a valid reason, a nursing home cannot simply tell a resident to leave. They must provide a formal, written notice of transfer or discharge. This notice is a cornerstone of resident protection and must contain specific information to be legally valid.
Mandatory information in a discharge notice:
- The specific reason for the transfer or discharge.
- The effective date of the transfer or discharge.
- The precise location the resident will be moved to, ensuring it can meet their needs.
- A detailed explanation of the resident's right to appeal the decision.
- Information on how to request an appeal hearing.
- The name, address, and phone number of the state's Long-Term Care Ombudsman.
Except in emergency situations where a resident's health or safety is immediately at risk, the notice must be given at least 30 days before the proposed discharge date.
How to Challenge an Eviction
Receiving a discharge notice can be frightening, but it does not mean the process is over. Residents have the right to appeal the decision and challenge the facility's claims. The appeal process is your legal recourse to prevent a wrongful eviction.
The Appeals Process
- Don't panic and don't move out. Your first step is to stay put. If you request an appeal within a specific timeframe (often 10 days of receiving the notice), you cannot be moved until a decision is reached.
- Request a hearing. The notice will contain information on how to request an administrative hearing with the appropriate state agency. Submit this request as soon as possible.
- Gather documentation. Collect all relevant medical records, care plans, and any communication with the nursing home regarding your care or the discharge notice.
- Seek assistance. Contact the state's Long-Term Care Ombudsman or a legal aid service specializing in elder law. These organizations can provide guidance, advice, and even representation.
Understanding Illegal and Improper Discharges
Not all nursing home discharge attempts are legal. Certain practices are explicitly prohibited under federal law, and residents and their families should be aware of these red flags.
Comparison of Valid vs. Invalid Discharge Reasons
| Valid Reasons (Under Federal Law) | Invalid Reasons (Often Illegal) |
|---|---|
| Needs exceed facility's scope | "Hospital dumping" (refusing readmission after hospitalization) |
| Resident's health has improved | Resident's Medicare coverage ends (facility must provide time for new payment source) |
| Safety or health risk to others | Retaliation for resident or family complaints |
| Documented failure to pay (with notice) | Medicaid application pending |
| Facility closes its operations | Resident deemed "too difficult" or demanding |
| Resident requests transfer | Resident's refusal of a medical treatment (unless poses risk) |
What to Do If You Receive a Discharge Notice
Upon receiving a discharge or transfer notice, immediate action is necessary to protect your rights. The steps you take next can significantly impact the outcome.
- Review the notice carefully. Read every detail to understand the stated reason and deadline for appeal.
- Document everything. Keep a record of all communications with facility staff, dates, and names. Save a copy of the notice and any other correspondence.
- Contact an advocate. The Long-Term Care Ombudsman is a free service available in every state to help residents resolve complaints and disputes with nursing homes. Their contact information should be on the notice, but you can also find it through the National Long-Term Care Ombudsman Resource Center.
- Consult with legal aid. Seek out legal assistance from an elder law attorney or a legal aid organization, especially if you believe the discharge is improper. They can help you prepare for a hearing and represent your case.
- Inform family and representatives. If you have a designated representative, ensure they are aware of the situation and involved in the next steps.
Conclusion
While the prospect of being involuntarily discharged from a nursing home is unsettling, residents and their families are not without powerful legal protections. The process is heavily regulated, and a facility cannot evict a resident without a valid reason and proper documentation. By understanding the six legal grounds for discharge, the requirements for a proper notice, and the right to appeal, residents can confidently stand up for their rights and ensure they receive the care and respect they are entitled to under the law.
