Understanding the Voluntary Discharge Process
Removing a resident from a nursing home can be a simple or complex process, depending on the resident's cognitive ability and the circumstances of their departure. For a smooth transition, it is vital to understand the difference between voluntary discharge and leaving against medical advice (AMA), as well as the roles of the resident and their legal representatives.
For Mentally Competent Residents
A mentally competent resident has the legal right to decide to leave a nursing facility on their own, provided it does not endanger their safety or the safety of others. The nursing home cannot legally force a lucid resident to stay. Such a resident should inform the facility, participate in discharge planning, and is entitled to an orderly transfer with their belongings and funds returned.
For Residents Lacking Capacity
If the resident lacks the mental capacity for decision-making, a court-appointed legal guardian or someone with a valid Power of Attorney (POA) for healthcare must act on their behalf. This legal representative initiates the discharge process and works with the nursing home's discharge planning team to create a safe transition.
The Importance of Comprehensive Discharge Planning
Regardless of who initiates the discharge, the nursing home is legally obligated to develop a written discharge plan. This crucial plan involves a multi-disciplinary team and should address post-discharge living arrangements, necessary home modifications, a comprehensive medication list, follow-up appointments, required medical equipment, and communication with future care providers.
Comparing Voluntary and Against Medical Advice (AMA) Discharges
| Feature | Voluntary Discharge | Leaving Against Medical Advice (AMA) |
|---|---|---|
| Resident's Mental Capacity | Resident is often mentally competent or the decision is made by a legal representative with medical consensus. | The resident is mentally competent but chooses to override the medical team's recommendation. |
| Facility Cooperation | Full cooperation from the facility to ensure a safe and proper transfer according to established procedures. | Facility staff may document the resident's decision and potential risks to protect against liability. |
| Discharge Planning | Collaborative process involving the resident, family, and facility to create a detailed, safe plan. | A hurried process, where the facility may not provide extensive support or may simply document the resident's wishes. |
| Financial Implications | Standard billing procedures apply. A change in payment source (e.g., from Medicare to Medicaid) does not necessitate immediate discharge. | Does not typically void insurance coverage, but can lead to higher long-term costs due to readmission. |
| Potential Risks | Minimal risk, provided the discharge plan is followed carefully. | Higher risk of readmission, worsening health, or even death, particularly if follow-up care is neglected. |
Navigating Legal and Financial Considerations
Important legal and financial points include protection against eviction for nonpayment while awaiting Medicaid eligibility and the right to appeal involuntary discharge or denial of readmission. Federal law also requires nursing homes to have bed-hold policies for residents temporarily hospitalized.
What to Do If the Nursing Home Resists Discharge
If a nursing home resists a discharge request, demand a formal written notice of transfer or discharge detailing the reason and your right to appeal. You can also contact a Long-Term Care Ombudsman for mediation, file a complaint with the State Health Department, or consult an elder law attorney for legal guidance.
Conclusion: Planning a Safe and Informed Transition
To successfully check someone out of a nursing home requires understanding the resident's mental capacity, following the formal discharge planning process, and knowing the legal protections available. A well-coordinated plan is essential for a safe transition, especially considering the higher risks associated with leaving against medical advice. Utilizing available resources and advocates can help ensure the best outcome for the resident. For additional resources on residents' rights, contact the National Ombudsman Resource Center.
