Understanding your right to a voluntary discharge
As a resident in a nursing home, you retain the right to make decisions about your care, including the right to refuse treatment and leave the facility. Federal law protects residents of facilities that accept Medicare and Medicaid from involuntary transfers or discharges, giving you the power to initiate a voluntary departure. A 'voluntary' discharge means the resident or their representative verbally or in writing expresses their intent to leave.
While facilities must ensure your safety, they cannot hold a competent adult against their will. A competent adult is someone who is of legal age and has the capacity to make sound, informed decisions. In cases where a resident is deemed incapacitated by a court, a legally appointed representative, such as a power of attorney, must make the discharge decision.
The steps for initiating your discharge
- Inform the facility of your intent to leave. You should provide a clear, written statement to the nursing home administrator or social worker, informing them of your decision. While verbal notice is often the first step, a written notice is essential for creating a formal record. In your statement, include the date you wish to leave. Although a notice of up to 30 days is common for facility-initiated discharges, a voluntary departure may proceed more quickly depending on facility policy.
- Request a discharge planning meeting. Once you've notified the staff, you can request a discharge planning meeting. A comprehensive discharge plan is legally required for all nursing home residents leaving the facility. This meeting should include you, your family or representative, and the facility's interdisciplinary team. The purpose is to ensure a safe and smooth transition out of the facility, outlining everything you need for post-discharge care.
- Prepare for a discharge against medical advice (AMA). If your healthcare team believes it is unsafe for you to leave, they may document your departure as 'Against Medical Advice' (AMA). They will likely ask you to sign an AMA form. You do not have to sign this document, but your departure will still be recorded as AMA. Signing the form is typically for the facility's liability protection, stating you understand the potential health risks involved with leaving early. It is crucial to have an open conversation with your care team about these risks before leaving.
- Confirm the discharge plan and final arrangements. Before you go, the nursing home is required to help coordinate your final departure. This includes arranging a safe and orderly transfer, gathering your personal belongings, and transferring any personal funds held by the facility. The facility must ensure that any essential equipment, medications, and follow-up care have been planned for.
Comparing voluntary and involuntary discharge
Understanding the differences between a voluntary and involuntary discharge can help you navigate your rights and the process effectively.
| Feature | Voluntary Discharge (Resident-Initiated) | Involuntary Discharge (Facility-Initiated) |
|---|---|---|
| Initiator | The resident or their legal representative. | The nursing home facility. |
| Reason | Personal choice, family preference, or desire to move to an alternative setting. | Can only occur for specific reasons defined by law, such as improved health, nonpayment, endangering others, or facility closure. |
| Notice Period | Can be requested at any time, but facility policy may require advance notice. Discharge planning still applies. | Typically requires a written 30-day notice, except in emergencies. |
| Appeal Rights | Generally no formal appeal process, as you are initiating the move. | You have the right to appeal to the state's administrative hearing office to contest the discharge. |
| Discharge Plan | Still required by law to ensure a safe transition from the facility. | Required by law to ensure a safe transition for the resident. |
The role of the Long-Term Care Ombudsman
If you or your family encounter resistance from the nursing home staff or have concerns about your rights, a Long-Term Care Ombudsman can provide invaluable assistance. These independent advocates are available in every state to help residents and their families resolve complaints and understand their rights. They can help you navigate facility policies and ensure that your voluntary discharge request is handled appropriately. You can find your local ombudsman program by calling the Eldercare Locator at 1-800-677-1116.
Important considerations and what to expect
Before finalizing your discharge, it is important to consider all aspects of your future care. If you are leaving against medical advice, understand that insurance providers typically will not deny payment for your stay, but you could face additional medical costs if you are readmitted due to complications. Have a solid plan for your living situation and ongoing medical needs, including setting up home health services, securing durable medical equipment, and arranging for transportation. This ensures that your transition is as seamless and safe as possible, minimizing risks associated with an early departure. Open communication with your family and a clear, documented plan are your best tools during this process.
Conclusion
Discharging yourself from a nursing home is a protected right for any competent adult. The process requires informing the facility in writing, participating in a discharge planning session, and understanding the potential implications of leaving against medical advice. In all cases, facilities are legally obligated to facilitate a safe and orderly departure. Utilizing the resources of a Long-Term Care Ombudsman and carefully planning your post-discharge care are critical steps to ensure a successful transition. By understanding your rights and the process involved, you can regain control over your healthcare and living arrangements with confidence.
Note: Specific state laws may vary, so always confirm local regulations or consult an elder law attorney for personalized advice.
Helpful resource: For additional guidance on patient rights and discharge planning, the National Consumer Voice for Quality Long-Term Care is an excellent resource: The National Consumer Voice for Quality Long-Term Care.
