I Got a Nursing Home or Assisted Living Discharge Notice

If This Is a Nursing Home

Nursing homes that take Medicare or Medicaid must follow federal rules on transfer and discharge.

They can’t simply make someone leave because they want the bed.

The rules allow a discharge only for certain reasons. The facility generally has to give written notice explaining the reason, where the person would go, and how to appeal. The notice usually has to come at least 30 days ahead, though there are exceptions, such as an emergency.

Ask:

“What specific reason are you using for this discharge, and where’s that written in the notice?”

Then ask:

“What’s the appeal deadline, and how do we file it?”

If the resident files a timely appeal through the process listed on the notice, they may have the right to remain while the appeal is pending. Ask the ombudsman what applies in this case and file before the deadline.

If This Is Assisted Living

Assisted living rules come mainly from each state, not federal law.

Notice requirements, permitted reasons for discharge, and appeal or hearing rights can vary.

Still contact the Long-Term Care Ombudsman.

Ask:

“What rights does an assisted living resident have here when the facility wants them to leave?”

If the facility says the move is required by its policy or admission agreement, ask the ombudsman what the rules require before assuming the facility has the final word.

Before You Sign Anything Agreeing to Leave

A facility may ask for a move-out agreement, discharge agreement, or other paperwork.

You can say:

“I’m not agreeing to the discharge today. I need time to review the notice and speak with the ombudsman.”

You can still take part in care planning while questioning the discharge. The important thing is not to sign an agreement to leave before you understand what it means.

If the Person Was Sent to the Hospital

Pay close attention if the facility sends the person to the emergency room or hospital and then says they can’t come back.

For a nursing home resident, an emergency hospital transfer doesn’t automatically end the right to return. If the nursing home decides the person can’t come back, it still has to follow the federal transfer and discharge rules.

Ask the facility:

“Are you refusing to readmit them? If so, please give us the decision and the reason in writing.”

Then call the Long-Term Care Ombudsman.

If the person is still in the hospital, tell the hospital discharge planner that the nursing home is refusing to take them back.

Don’t let a hospital trip quietly become a permanent discharge without asking what rights apply.

There Still Has to Be a Safe Plan

Don’t accept “family will figure it out” as the plan.

Before the person leaves, ask:

• Where are they expected to go?
• Has that place actually agreed to accept them?
• Who will provide the care they need there?
• What medications and equipment will go with them?
• Who’s arranging transportation?
• What follow-up care is already arranged?
• What happens if the proposed placement falls through?

If the plan doesn’t seem safe, say so clearly.

Say:

“I don’t believe this discharge plan is safe. Please document that concern and tell me who’s reviewing it.”

If the Reason Is Unpaid Bills

Don’t assume unpaid charges mean the person has to leave right away.

Ask:

• what’s owed
• what dates the charges cover
• what insurance or benefits have been billed
• whether a Medicaid application is pending
• whether Medicaid or another payer denied coverage
• what notice and appeal rights apply

A pending Medicaid application isn’t automatically the same as refusing to pay. If an application is still being processed, tell the ombudsman.

If Medicaid or another payer is still deciding the claim, ask what the facility has submitted, what’s still missing, and whether the discharge is being treated as nonpayment before that process is finished.

Say:

“Is this discharge because of unpaid charges? What has been billed, what’s still pending, and what rights do we have before the person has to leave?”

If Medicaid may pay for long-term care, see I Need Help Applying for Medicaid Long-Term Care →

Before moving, gifting, retitling, or transferring money to try to qualify for Medicaid, see I Need Legal Help →

If the Facility Won’t Resolve It

Start with the Long-Term Care Ombudsman.

If the problem involves a nursing home and still isn’t resolved, contact the State Survey Agency that investigates nursing home complaints.

For assisted living, ask the ombudsman which agency oversees the facility.

If a deadline is close, legal advice may also be needed.

See I Need Legal Help →

Before You Rely on the Plan

Make sure you know:

• the exact discharge date
• the reason being used
• the appeal or challenge deadline
• whether an appeal has actually been filed
• what happens while it’s being reviewed
• where the person would go
• whether that place has actually agreed to accept them