Understanding Voluntary Discharge: Your Right to Leave
For a resident with the legal right to make their own decisions, leaving a nursing home is a fundamental right. A voluntary discharge happens when the resident or their authorized representative communicates the intent to leave the facility. The key factor is that the decision is resident-initiated, not facility-initiated.
Legal Capacity and Decision-Making
The ability to self-discharge depends heavily on a resident's legal capacity to make healthcare decisions. If a resident has been deemed legally incompetent by a court, a designated representative—such as a legal guardian or someone with power of attorney—must make the discharge decision on their behalf. If the resident is legally competent, they have the right to make this decision themselves, regardless of medical advice.
The Role of Discharge Planning
Even in a voluntary discharge, the nursing home is still legally required to complete adequate discharge planning. This means the facility must work with the resident and their family to ensure a safe transition. This includes:
- Assessing the resident’s needs upon leaving.
- Arranging for necessary care, such as home health services or other residential placements.
- Providing a safe and appropriate discharge location.
- Educating the resident or family on continuing care needs.
The Difference Between Voluntary and Involuntary Discharge
It is critical to distinguish between a resident's choice to leave and a facility’s decision to evict or transfer a resident. The two processes are governed by entirely different sets of regulations and legal protections.
| Feature | Voluntary Discharge | Involuntary Discharge |
|---|---|---|
| Initiating Party | Resident or legal representative | Nursing home facility |
| Legal Foundation | Federal right to choose care | Federally regulated reasons |
| Notice Period | Can be flexible; often 10-30 days policy | Minimum 30-day written notice required |
| Reason Required | No specific reason needed | Must cite one of six specific reasons |
| Resident's Recourse | Right to leave; ensure planning is adequate | Right to appeal the decision |
Navigating Involuntary Discharge and Eviction Protections
The Nursing Home Reform Law of 1987 established strong protections against arbitrary and improper involuntary transfers or discharges (often called eviction). These rules apply to any nursing home that accepts Medicare or Medicaid payments, which includes most facilities. A facility cannot simply evict a resident without a valid reason and following a strict procedure.
Six Legally Permitted Reasons for Involuntary Discharge
A nursing home may only involuntarily transfer or discharge a resident for one of the following six reasons:
- The resident’s needs cannot be met by the facility.
- The resident's health has improved, and they no longer require nursing home services.
- The resident's presence endangers the safety of others in the facility.
- The resident's presence endangers the health of others in the facility.
- The resident has failed to pay for their stay.
- The facility ceases to operate.
The Appeals Process
If a nursing home believes it has grounds for an involuntary discharge, it must provide a written notice at least 30 days in advance. This notice must include information about the resident's right to appeal the decision to the state, along with contact details for the local Long-Term Care Ombudsman Program. A resident can challenge the facility's decision and, in most cases, cannot be discharged while the appeal is pending.
The Implications of Leaving Against Medical Advice (AMA)
In some cases, a resident may wish to leave the nursing home even when their doctor or the facility staff believes it is medically unsafe. This is referred to as leaving Against Medical Advice (AMA). While a competent adult has the right to make this choice, it has important consequences:
- Documentation: The facility will document the resident's decision and have them sign an AMA form to protect the facility from liability.
- Insurance Coverage: Leaving AMA can affect or terminate insurance coverage for the nursing home stay. Residents should contact their insurance provider to understand the full implications.
- Continued Care: The resident or their family becomes responsible for arranging and paying for any necessary follow-up care.
What to Do If a Resident Lacks Capacity
If a resident lacks the legal capacity to make their own decisions, a legally appointed representative must step in. This could be a person with a durable power of attorney for healthcare or a court-appointed legal guardian. This individual is responsible for advocating for the resident's wishes and ensuring that discharge planning is appropriate and safe.
How the Long-Term Care Ombudsman Can Help
For residents and families, navigating the complexities of discharge can be overwhelming. The Long-Term Care Ombudsman Program is a valuable resource. These state-certified advocates are trained to assist residents with a wide range of issues, including concerns about discharge and transfers. They can provide information, assist with appeals, and mediate disputes between residents and facilities.
If you have questions about your rights or need assistance with a discharge issue, it is highly recommended to contact your local ombudsman. Find your local ombudsman via the National Long-Term Care Ombudsman Resource Center.
Essential Steps for a Successful Voluntary Discharge
To ensure a smooth transition when you or a loved one wants to leave a nursing home, follow these steps:
- Communicate Intent: Inform the facility's social worker or administrator of your decision to initiate a voluntary discharge. Providing written notice is often a good practice.
- Participate in Discharge Planning: Work with the facility to create a discharge plan. Ensure arrangements are made for necessary medications, equipment, and follow-up care.
- Review the Plan: Carefully review the discharge plan to ensure it addresses all care needs and identifies a safe, appropriate destination.
- Confirm Legal Capacity: If the resident's capacity is in question, ensure the legal representative is fully involved and prepared to make decisions.
- Address AMA Concerns: If leaving AMA, understand the risks, inform the doctor, and sign the necessary paperwork after confirming the insurance implications.
- Secure Medical Records: Request copies of all medical records to ensure continuity of care with new providers.
Conclusion: Empowering Residents and Families
The ability to exercise control over one's own healthcare and living situation is a cornerstone of resident rights. Whether planning a voluntary departure or challenging a facility's attempt at involuntary discharge, understanding the legal framework is your most powerful tool. By following the proper procedures and seeking support from resources like the Long-Term Care Ombudsman, residents and families can navigate the discharge process with confidence and ensure a safe and respectful transition. The right to release yourself from a nursing home is a protected right, and knowing how to assert it is key to a positive outcome.
