Understanding Voluntary Discharge
A voluntary discharge is a resident's decision to leave a nursing home, provided they are mentally competent or their legal representative makes the decision. This differs from an involuntary discharge initiated by the facility. The resident or their representative typically provides written or verbal notice of their intent to leave, and the nursing home must engage in discharge planning for a safe transition.
The Importance of Discharge Planning
Discharge planning is crucial even in voluntary cases. The nursing home team works with the resident and family to:
- Assess post-discharge needs, such as home health or rehabilitation.
- Create a care plan detailing medications, therapies, and appointments.
- Confirm a safe living situation.
- Provide referrals to community resources.
- Coordinate transportation.
The Role of a Resident's Competency
A resident must be competent to make a voluntary discharge decision or have a legal representative act for them. The representative participates in planning to ensure the resident's best interests. A nursing home cannot generally refuse a competent resident's discharge but must follow procedures to ensure safety.
Comparison: Voluntary vs. Involuntary Discharge
The key differences between voluntary and involuntary discharge are highlighted in the table below:
| Feature | Voluntary Discharge | Involuntary Discharge (Eviction) |
|---|---|---|
| Initiating Party | Resident or legal representative. | Nursing facility. |
| Resident's Consent | Requires informed consent. | Against resident's will. |
| Reasons for Discharge | Resident's choice. | Legal grounds like non-payment or endangering others. |
| Notice Period | Varies, discharge planning required. | Typically 30-day written notice. |
| Appeals Process | Generally not applicable. | Resident can appeal. |
| Financial Implications | Coordinated handling of payment changes. | Often triggered by changes in payment status. |
What Happens After Voluntary Discharge
After notice and planning, the facility facilitates a safe departure. The resident receives a discharge summary with their medical status and post-discharge plan. This may include arranging home health or equipment. Staying engaged in this process ensures arrangements are confirmed. The care plan guides recovery, and contacting resources ensures continuity of care.
Conclusion
A voluntary discharge is a resident's right, allowing them to leave a nursing home on their terms. It requires the resident to be competent or have a legal representative making the decision. Discharge planning by the nursing home ensures a safe transition, including developing a care plan and coordinating logistics. Unlike involuntary discharge, it's resident-initiated and doesn't involve an appeal. Proactive engagement with staff is key for a well-coordinated departure.
Can a nursing home refuse a voluntary discharge?
A nursing home generally cannot refuse a voluntary discharge from a mentally competent resident. The resident has a right to leave, but they and the facility must follow proper procedures to ensure a safe and orderly transition. If the resident is deemed incompetent, their legal representative makes the decision.
What is a legal representative in the context of discharge?
A legal representative is a person, such as an agent under a Power of Attorney for Healthcare or a court-appointed conservator, who is legally authorized to make decisions on behalf of a resident who is no longer capable of making their own decisions.
Is written notice required for a voluntary discharge?
Depending on the facility's policies and state regulations, a formal, written notice may be required. It is important to communicate the intent to leave clearly and document all communication to avoid potential misunderstandings.
Does Medicare cover the cost of a new facility after a voluntary discharge?
Medicare coverage is based on eligibility and medical necessity, not the reason for discharge. If a resident voluntarily leaves a skilled nursing facility, they will need a new qualifying hospital stay of at least three days to restart a new Medicare benefit period for skilled nursing services, unless they re-enter a facility within 30 days of stopping care.
What if a resident decides to leave against medical advice (AMA)?
If a competent resident leaves against medical advice, the nursing home must still follow discharge procedures to ensure a safe transition. However, leaving AMA may affect insurance coverage for continued care and may absolve the facility of responsibility for potential negative health outcomes.
What role does the Long-Term Care Ombudsman play in voluntary discharge?
The Long-Term Care Ombudsman is an advocate for residents' rights and can be a valuable resource during the discharge process. While their notification is often legally mandated for involuntary discharges, they can also provide assistance and information for voluntary departures.
What is a “bed-hold” and how does it relate to voluntary discharge?
A bed-hold is a period during which a nursing home reserves a resident's bed, typically during a temporary hospital stay. It is less relevant for a permanent voluntary discharge, as the resident is not planning to return. A facility may charge for bed-hold days, and Medicaid may not cover this cost.
What is a voluntary discharge from a nursing home?
A voluntary discharge from a nursing home is when a resident, or their authorized legal representative, decides to leave the facility and communicates this intent to the nursing home. This is a resident-initiated action, unlike an involuntary discharge, which is initiated by the facility.
Key Takeaways
- Resident-Initiated Action: A voluntary discharge is started by the resident or their legal representative, giving them control over the decision to leave.
- Competency is Key: The resident must be mentally competent to initiate a voluntary discharge, or the decision must be made by a designated legal representative.
- Discharge Planning is Required: The nursing home must still engage in proper discharge planning to ensure a safe and orderly transition for the resident.
- Ensuring a Safe Transition: The discharge plan is designed to ensure the resident has a safe place to go and the necessary care and resources are in place after they leave.
- Differs from Involuntary Discharge: Unlike an involuntary discharge (eviction), which is initiated by the facility, a voluntary discharge is a decision made by the resident and does not involve an appeals process.
- Affects Medicare Coverage: Voluntarily leaving a skilled nursing facility may require a new qualifying hospital stay to restart Medicare coverage for subsequent skilled care.
