Involuntary nursing home discharges and transfers are a legitimate problem in the United States. According to the States’ Long-Term Care Ombudsman Programs (LTCOP), one of the top 5 complaints they receive is inadequate discharge planning or improper evictions from nursing home facilities. In fact, the LTCOP attempts to resolve approximately 14,000 complaints of this sort annually. While the reasons for involuntary nursing home discharges and transfers vary, it may be due to residents requiring a higher level of care than the nursing home feels equipped to handle, or more commonly, the end of Medicare coverage.
There are only six legal reasons a nursing home resident can be forced to leave a nursing home. These are discussed below, but outside of these reasons, a resident cannot be evicted. Unfortunately, many nursing home residents, nor their families, are aware of the rights of a nursing home resident. Through an awareness of these rights, and an awareness of how to respond if one’s rights are violated, illegal discharges and transfers can be minimized and / or prevented.
The main focus here is on involuntary nursing home discharges, but the following information is also relevant to involuntary nursing home transfers.
To fully understand the topic of nursing home discharges and evictions, it is important to define these terms. There are two types of nursing home discharges; voluntary and involuntary. If the nursing home resident agrees that they should leave the nursing home, this is a voluntary discharge. If they do not agree, and instead think they should continue to receive nursing home care, this is an involuntary discharge. An involuntary discharge is also called an eviction. Other terminology used in place of involuntary discharge is inappropriate discharge, illegal discharge, and improper discharge.
Some nursing homes attempt to involuntarily discharge a resident who runs out of Medicare coverage.It is also important to have a good grasp on Medicare and Medicaid’s coverage of nursing home care to better understand illegal nursing home discharges. Nursing homes may attempt to involuntarily discharge a resident who runs out of Medicare coverage or evict a resident on Medicaid to free up a bed for a higher paying resident. (Nursing homes receive higher pay from private pay residents, as well as those on Medicare).
Medicare, federal health insurance for persons 65+ years old, will cover short-term skilled nursing care in Medicare approved (certified) nursing homes. Coverage is limited to 100 days following an illness / injury that required a 3-day hospitalization. Medicare will pay 100% of the cost for the first 20 days. For days 21 – 100, Medicare will continue to pay a portion of the cost, but in2024, the nursing home resident will pay a coinsurance of $204 / day. For seniors who have Medicare Supplemental Insurance (MediGap), their insurance generally covers this cost. Learn more about Medicare’s coverage of nursing home care here.
As long as a resident has a pending application for Medicaid, they cannot be forced to leave the nursing home.
Note that a Notice of Medicare Non-Coverage (NOMNC) is not the same thing as a discharge notice. A NOMNC is simply a notice from a nursing home that states one’s Medicare coverage is ending. Upon receipt of this notice, a resident who still requires nursing home care, but cannot afford to pay out of pocket, can apply for Medicaid. As long as a resident has a pending application for Medicaid, they cannot be forced to leave the nursing home. Read about qualifying and applying for Medicaid.
Medicaid, a state and federal program that provides health insurance for low-income persons, will cover long-term nursing home care. Nursing Home Medicaid, also called Institutional Medicaid, is an entitlement program in all 50 states and the District of Columbia. This means that anyone who meets the eligibility requirements will receive nursing home coverage. Unlike with Medicare, coverage is not limited to a specific timeframe. Rather, Medicaid will pay for nursing home care indefinitely as long as eligibility criteria continues to be met. See state specific eligibility criteria for Nursing Home Medicaid here.
Did You Know? Medicaid pays nursing homes less than Medicare does per day. Some facilities do not want to accept the lower payment from Medicaid, which leads to illegal evictions.
The Nursing Home Reform Act (NHRA) of 1987 set federal guidelines to protect the rights and safety of nursing home residents, which includes protecting against illegal evictions and transfers. For nursing homes to receive payment from Medicare and / or Medicaid, they must comply with these guidelines. Based on the NHRA, there are only six reasons that a nursing home can legally evict / transfer a nursing home resident. They are as follows:
1) The needs of the nursing home resident are greater than the facility is able to provide, and a transfer / discharge is necessary for the resident’s well-being. Note that as part of a nursing home admission, an assessment of the individual’s needs is completed. Therefore, it should be unusual for a nursing home to turn around and say they are unable to meet one’s needs after admission. Nursing homes are also required by law to adjust their staffing as needed to ensure the best individualized care as possible.
2) The nursing home resident is not paying for nursing home care after “reasonable and appropriate notice” and has not applied for Medicare or Medicaid. There is no national standard as to what is considered “reasonable and appropriate notice”. Instead, this is state specific. For example, in Connecticut, a resident who pays out of pocket and has not paid for a minimum of 15 days can legally be evicted. Note that as long as a resident has a pending application for Medicaid, they cannot be forced to leave. An exception exists if the nursing home residence does not accept Medicaid as payment.
3) The resident has regained their health to the point where nursing home services are no longer necessary. This commonly means a resident will be discharged to their home, the home of a loved one, or an assisted living residence.
4) The resident’s presence in the nursing home jeopardizes the health of other residents.
5) The resident’s presence in the nursing home jeopardizes the safety of other residents.
6) The nursing home facility closes.
When a facility is discharging a resident, there are certain procedures that must be followed.
• The nursing home facility must provide a written notice of discharge to the resident and their family or legal guardian / representative. To be very clear, this notice cannot be given verbally. The written notice must include the following information, and if it is not included, the eviction notice is not valid.
-The reason for discharge and what the facility has done to try to resolve / handle it.
-To where (the location) the resident will be discharged.
-The right and instructions to appeal and contact information of the Long-Term Care Ombudsman in one’s area.
• The written notice must be received a minimum of 30 days (but may be up to 60 days) prior to the discharge date. The only exception is in the case of an emergency.
• A summarization of the nursing home resident’s physical and mental status must be prepared.
• A discharge plan must be written up by the nursing home. Via this plan, the nursing home must make certain the nursing home resident has a place in which to move (near family and loved ones, if possible), and summarize the care and / or services the individual will receive following discharge.
The end of Medicare coverage is not sufficient cause for involuntary nursing home discharge. Legally, the resident must be given a reasonable amount of time to come up with another source of payment, such as private pay or Medicaid. Commonly, nursing home residents who are not ready to be discharged when Medicare coverage ends, apply for Nursing Home Medicaid. As long as a Medicaid application is pending, the resident cannot be legally discharged from the nursing home for non-payment. Even if a Medicaid application is denied, if an appeal is in process, the resident cannot be forced to move. One exception exists, and this is if the nursing home residence does not accept Medicaid as a form of payment. This is only the case in approximately 10% of nursing homes.
What to do in this situation: Determine if the eligibility requirements for Medicaid are met. If they are met, apply for Nursing Home Medicaid immediately, and if not, consult with a professional Medicaid Planner for assistance in meeting Medicaid’s criteria.
The nursing home resident needs to be given a reasonable amount of time to come up with another payment source. If a senior no longer has the funds to pay, it is likely they will need to apply for nursing home Medicaid. If a Medicaid application is pending, a nursing home resident cannot be evicted.
What to do in this situation: First, determine if the eligibility criteria for Nursing Home Medicaid are met. If the nursing home residents meets the criteria, apply for Medicaid immediately. If the requirements are not met, seek the counsel of a professional Medicaid Planner for assistance in determining how to meet the criteria.
A nursing home resident can be involuntarily transferred legally if the nursing home cannot meet their needs. However, a nursing home may claim they cannot meet a resident’s needs, but in reality, do have the capability to meet their needs. If this is the case, an involuntary transfer is illegal. If a nursing home is trying to transfer a resident based on an inability to meet their needs, it must be reported what needs are not able to be met, how the nursing home tried to meet these needs, and what services the nursing home in which the resident will be transferred will provide in order to meet the resident’s needs. Note that sometimes a nursing home will try to use this type of eviction when a resident is “difficult”, such as exhibiting troublesome behaviors due to Alzheimer’s disease or a related dementia.
What to do in this situation: File an appeal with the state Long-Term Care Ombudsman. As long as there is a pending appeal, a nursing home resident cannot be forced to move out of the facility.
The Nursing Home Resident Protection Amendments (NHRPA) of 1999 makes it illegal to involuntarily transfer or discharge a patient when a nursing home withdraws from accepting Medicaid-funded residents. While they no longer have to accept new Medicaid-funded residents, they cannot kick out the ones they already have.
What to do in this situation: Contact the state Long-Term Care Ombudsman to file an appeal. Until a hearing decision has been made, a resident of a nursing home facility cannot be forced to leave.
In this situation, which is called “hospital dumping”, a nursing home resident is admitted to a hospital and when it is time for discharge, the nursing home claims their bed is no longer available. Legally, a nursing home is required to hold a resident’s bed, generally for a week or two, upon hospitalization. The exact length of time varies by state. For residents on Medicaid, despite the length of hospitalization, the nursing home must readmit the individual as soon as a Medicaid certified bed is available.
What to do in this situation:Persons on Medicaid should be persistent on readmittance and keep checking if there are available beds. If the nursing home residence makes it clear that they do not plan to readmit the individual, file a complaint with the state Long-Term Care Ombudsman. Persons not on Medicaid can also file a complaint.
If a nursing home resident is being pressured to leave, has been threatened with being evicted, or has received a written notice of discharge and does not feel they are ready to be discharged, there are steps that can be taken.
Don’t Move the Nursing Home Resident
The nursing home resident and their family should not panic and move the nursing home resident out of the facility. Remember, the nursing home must provide a written discharge notice a minimum of 30 days prior to the effective discharge date.
File an Appeal
An appeal should be filed with the Long-Term Care Ombudsman in the state in which the nursing home resident is being involuntarily discharged or has been threatened to be evicted. The appeal can be filed by the nursing home resident, their family, or their representative. Find a Long-Term Care Ombudsman Program in your area here. An appeal should be filed as quickly as possible following the receipt of a discharge notice. A nursing home resident cannot be discharged as long as there is a pending appeal. Note that hearing procedures differ based on the state in which one resides. For instance, the hearing may be held at the nursing home or it may be done via telephone.
Apply for Nursing Home Medicaid
For persons who have run out of Medicare coverage or can no longer pay privately for nursing home care, an application for Medicaid should be filed. A person who has applied for Medicaid and is waiting for approval cannot be forced out of a nursing home. Even if a resident has been denied Medicaid coverage, if an appeal for coverage is filed, they cannot be forced to move out of the nursing home during this time. Learn how to apply here. Persons can also take a Medicaid Eligibility Test to see if they might meet the eligibility criteria.
Consult an Elder Law Attorney
For persons who find themselves in the position of an illegal nursing home discharge, it can be highly helpful to contact an elder law attorney.