Understanding Your Rights to Discharge
Federal law, specifically the Nursing Home Reform Law of 1987, protects residents from being involuntarily transferred or discharged without a valid reason. This law applies to any facility certified by Medicare and/or Medicaid. The facility must develop a comprehensive written discharge plan with input from the resident, their representative, and the resident's physician. There are six specific reasons a facility can initiate an involuntary discharge:
- The resident’s health has improved and they no longer require nursing facility services.
- The transfer or discharge is necessary for the resident's welfare and their needs cannot be met in the facility.
- The safety of others in the facility is endangered by the resident.
- The health of others in the facility would be endangered.
- The resident has failed to pay after appropriate notice.
- The facility is ceasing its operation.
The Difference Between Voluntary and Involuntary Discharge
It is important to know the difference between these two types of release. A voluntary discharge, or resident-initiated discharge, is when the resident or their legal representative formally requests to leave. An involuntary, or facility-initiated, discharge happens when the nursing home moves to discharge the resident for one of the specific reasons outlined by federal law. In either case, the facility is required to prepare a safe and orderly transition.
The Step-by-Step Process for a Safe Release
Following a clear, structured process is the best way to ensure a smooth and safe transition home from a nursing home. The process often begins upon admission, with the care team discussing the potential for return home. Here are the key steps to follow:
- Formally Notify the Facility: Inform the nursing home's social worker or discharge planner of your intent to leave. This starts the official discharge planning process.
- Engage the Care Team: Work with the interdisciplinary team, which may include doctors, nurses, and therapists, to assess your needs for a safe return home.
- Secure Physician Approval: Your attending physician must sign off on the discharge plan, confirming that the move will not endanger your health. If you are leaving against medical advice, this step is different.
- Create a Comprehensive Discharge Plan: This plan must detail your living location, necessary care, and follow-up medical instructions. It should cover all aspects of your care post-release.
- Coordinate Services: Arrange for any required services, such as home health aides, physical therapy, or meals-on-wheels, to be in place on or before your release date.
- Arrange for Equipment: Ensure all necessary medical equipment, like a hospital bed, wheelchair, or oxygen tanks, is ordered and ready at your home.
- Gather Paperwork: Collect all necessary medical records, prescriptions, and legal documents. The facility is required to transfer these to you or your next provider.
Leaving Against Medical Advice (AMA)
If a resident has decision-making capacity, they have the right to refuse care and leave the nursing home against medical advice (AMA). This situation has a specific protocol that both the resident and the facility must follow. The nursing home must inform the resident and their legal proxy of the potential risks of leaving AMA. While the facility cannot physically prevent a competent resident from leaving, it must document the entire process carefully.
What to Expect During an AMA Release
- Right to Leave: A competent adult resident has the legal right to leave, even if their doctor advises against it. The facility cannot physically restrain them.
- Waiver Form: You or your representative will likely be asked to sign an “Against Medical Advice” form. Refusal to sign should be documented by staff.
- Documentation: Staff will thoroughly document the conversation and the decision in your medical chart. This is a critical legal step for the facility.
- Notification of APS: In some cases, especially if there are concerns about self-neglect or the resident's capacity to make decisions, the facility may notify Adult Protective Services (APS).
Creating a Comprehensive Discharge Plan
The goal of a comprehensive discharge plan is to ensure continuity of care and a safe transition. Your team will assess what services are needed to support your independence and health outside the nursing home. This may include:
- Home Health Care: Visits from nurses, physical therapists, occupational therapists, or home health aides.
- Medical Equipment: Durable medical equipment (DME) such as a hospital bed, grab bars, shower chair, or mobility aids.
- Medication Management: A clear schedule, new prescriptions, and education on any new medications.
- Follow-Up Appointments: Scheduled appointments with primary care physicians or specialists.
- Caregiver Education: Training for family caregivers on how to assist with daily tasks, medication, or treatments.
Alternatives to Consider After Release
Beyond returning to a family home, various care settings can provide a suitable living arrangement, depending on the resident's needs. A comparison of these options is helpful for making an informed decision.
Comparing Post-Nursing Home Care Options
| Care Type | Primary Support Provided | Environment | Best For |
|---|---|---|---|
| Home Health Care | Medical services, therapy, personal care | Personal residence | Individuals who can manage living at home with some support |
| Assisted Living | Help with daily activities, medication management | Community-based, private rooms | Individuals needing help with daily tasks but not 24/7 skilled nursing |
| Adult Foster Care | Personal care, meals, supervision | Small, home-like setting | Individuals preferring a family-style, high-staff-ratio environment |
| Continuing Care Community | Multiple levels of care on one campus | Tiered, independent to full nursing care | Individuals who want to age in place with varying levels of need |
What to Do If a Discharge is Denied
If the nursing home denies your voluntary discharge or issues an involuntary discharge that you believe is unfair, you have the right to appeal. The facility must provide written notice at least 30 days in advance (except in emergencies), detailing the reason for discharge and information on how to file an appeal. Your state's Long-Term Care Ombudsman is an excellent, free resource to help you navigate this process and advocate for your rights. You can find your local ombudsman by calling the Eldercare Locator at 1-800-677-1116 or by visiting the official program's website National Consumer Voice for Quality Long-Term Care.
The Appeals Process at a Glance
- Receive Written Notice: You will receive a document detailing the facility’s decision.
- Contact the Ombudsman: Immediately contact your local Long-Term Care Ombudsman for assistance and guidance.
- File a Hearing Request: Request an administrative hearing within the timeframe specified in the notice, usually 30 days.
- Wait for a Decision: The facility cannot discharge you while the appeal is pending, unless staying would endanger the health or safety of others.
A Checklist for a Smooth Transition
To ensure all bases are covered, use this checklist during your discharge process:
- Notify Social Worker: Officially inform the nursing home's discharge planner or social worker of your intent to leave.
- Review the Care Plan: Participate actively in planning meetings to ensure your post-release needs are met.
- Confirm Physician's Order: Ensure your attending physician approves the discharge plan.
- Coordinate Post-Discharge Care: Secure services for home health, equipment, and transportation.
- Educate Family/Caregivers: Make sure anyone helping you understands their role and responsibilities.
- Verify Medications: Confirm you have all necessary prescriptions and a transition supply of medications.
- Organize Transportation: Arrange for safe and appropriate transportation home.
- Get Final Paperwork: Obtain copies of your medical records and the full, finalized discharge plan.
Conclusion
Getting released from a nursing home is a multi-step process that hinges on clear communication, thorough planning, and a strong understanding of your rights. Whether you are ready to return home or need to coordinate a different care setting, engaging proactively with the facility and leveraging available resources like the Long-Term Care Ombudsman will help ensure a smooth and safe transition.
