Understanding Involuntary Discharge
Federal law protects nursing home residents from involuntary transfer and discharge under the Nursing Home Reform Law of 1987. A facility must have a valid, legal reason to remove a resident. Understanding these rights is crucial to prevent illegal evictions, sometimes called "patient dumping".
The Six Legal Reasons for Nursing Home Eviction
Federal law specifies only six circumstances under which a nursing facility can legally discharge a resident against their will. Other reasons may be challenged.
Non-payment for care
A facility can discharge a resident for failure to pay, but proper notice is required. If a resident's payment method changes, they cannot be evicted while appealing for benefits like Medicaid. Facilities also cannot discharge residents based solely on a Medicare coverage notice without a formal discharge notice.
Health improved, no longer needs care
Discharge is permitted if a resident's health has improved to the point where they no longer require skilled nursing facility services. This determination is based on the resident's care plan and medical assessment.
Resident's needs cannot be met by facility
A facility may discharge a resident if it can no longer meet their documented medical needs. However, a facility cannot use insufficient staffing or resources as a reason if the resident's needs are within the typical scope of nursing home care. For complex needs, the facility must show it attempted reasonable accommodations.
Endangering the safety of others
Discharge is possible if a resident's behavior endangers others' safety. Facilities must first attempt reasonable accommodations, particularly for residents with mental health conditions.
Endangering the health of others
A resident can be discharged if their presence threatens the health of others. This might apply to managing contagious diseases, but not to discharging a resident for refusing treatment.
The facility ceases to operate
All residents are discharged if a nursing home permanently closes. The facility must follow specific procedures and provide ample notice to help residents find new homes.
The Nursing Home Discharge Procedure
Involuntary discharge involves a specific legal process. Skipping any step can be grounds to contest the eviction.
- Written Notice: Generally, a facility must provide written notice 30 days before discharge, with exceptions for urgent situations.
- Required Information: The notice must state the reason, effective date, transfer location, and details on the right to appeal.
- Appeals Process Information: The notice must include how to appeal and contact information for the state's Long-Term Care Ombudsman.
- Discharge Plan: A written discharge plan detailing post-discharge care must be provided.
- Safe Transfer: The facility must ensure a safe transfer to an appropriate location; discharging to an unsafe setting like a homeless shelter is illegal.
Common Illegal Eviction Tactics
Illegal evictions often stem from financial reasons or a facility's inability to provide care. "Patient dumping," refusing to readmit a resident after hospitalization, is illegal. Other tactics include pressuring residents to leave or falsely claiming they need a higher level of care.
Table: Legal vs. Illegal Discharge Scenarios
| Scenario | Legal Action? | Explanation |
|---|---|---|
| Evicting a resident for non-payment after 15 days of notice | Yes | Failure to pay is a valid reason, assuming proper notice and procedure are followed. |
| Evicting a resident because they are transitioning from Medicare to Medicaid | No | This is illegal financial discrimination. The resident has the right to remain while appealing benefits. |
| Discharging a resident to a homeless shelter | No | Facilities must ensure the resident is transferred to a safe and appropriate location that can meet their needs. |
| Evicting a resident because their dementia-related behavior is challenging | Maybe | Only if the behavior endangers others AND the facility has made reasonable attempts to accommodate and manage it first. |
| Refusing to readmit a resident who was hospitalized | No | Residents often have the right to return to their bed, especially if it was held, and can appeal this refusal. |
| Discharging a resident after a doctor certifies they no longer need skilled care | Yes | If a resident no longer needs the level of care provided by the facility, it can be a valid reason for discharge. |
How to Contest and Appeal an Eviction Notice
Receiving a discharge notice is concerning, but residents have a strong right to appeal, which can often stop or reverse the eviction.
- Do Not Move Out: Stay in the facility. Appealing within the timeframe (usually 20 days) grants the right to remain until a hearing decision.
- File a Formal Appeal: Request an administrative hearing immediately with the state agency listed in the notice. Contact the Long-Term Care Ombudsman if information is missing.
- Gather Evidence: Collect the discharge notice, care plans, communications, and evidence that needs can still be met.
- Seek Advocacy: The local Long-Term Care Ombudsman provides free, expert help. An elder law attorney can also provide legal counsel.
Preventing Involuntary Discharge
Proactive steps can reduce the risk of wrongful eviction. Maintain clear communication with staff and document all interactions, including care plan meetings and financial discussions. Ensure the care plan is current to reflect needs. Consider a family council to raise concerns collectively. Early assistance from advocates or legal help is beneficial. Knowing your rights is the best way to ensure a stable environment.
For more on resident rights and fighting evictions, refer to the National Consumer Voice for Quality Long-Term Care.
Conclusion
Federal and state laws offer significant protection against involuntary nursing home discharge. Eviction is only legal for a few specific reasons and requires strict procedures. Understanding these rights, documenting information, and using the appeals process are vital defenses against improper evictions. The Long-Term Care Ombudsman is an essential resource. Being informed and proactive is key to ensuring residents receive the stable care they deserve.
