(The pdf for the issue in which this article appears is available for download: Bifocal, Vol. 41, Issue 3.)
By Robyn Grant and Lori Smetanka
A disturbing trend is becoming increasingly evident across the country: The eviction of vulnerable nursing home residents from their facilities, often without notice, preparation, or a safe and appropriate place to go. Consider the following cases reported by long-term care ombudsmen:
After raising concerns about an increase in the price of sodas in the nursing facility machines, and then asking a physician assistant who came to see him to leave his room, Mr. T was forcibly removed from his nursing home and discharged. He appealed the discharge and won but the nursing home refused to follow the hearing officer’s order to permit him to return. At the new nursing home where he was sent, he became increasingly distressed, depressed, anguished, and anxious. He worried that he would never be able to return to his former nursing home.
Mr. R received a notice of discharge, but the facility failed to notify his sister, who had power of attorney, the ombudsman, the Department of Health or the appeals officer as required by state and federal regulations. The nursing home social worker drove him to a motel and booked a room for him for three nights only, after which he was to check out. The resident had no money, no medication, no phone, and no one to help him transfer to/from his chair -- assistance he needed since one of his legs had been amputated.
Residents receiving Medicare rehabilitation in facilities belonging to one particular corporation were unexpectedly discharged when Medicare coverage ended. They were not given the option of remaining in the facilities and paying privately or through Medicaid if they still needed nursing home level of care. Shockingly, these residents were discharged to homeless shelters, storage units (in
the middle of summer heat), unlicensed boarding homes where they reported they were assaulted and/or robbed, and even driven to and left in other cities.
Under federal law and regulation, there are only six permissible reasons for the transfer or discharge of a resident:
- The resident’s welfare and needs cannot be met in the facility
- The residents’ health has improved sufficiently so the resident no longer needs the services provided by the facility
- The safety of individuals in the facility is endangered due to the clinical or behavioral status of the resident
- The health of individuals in the facility is endangered
- The resident has failed, after reasonable and appropriate notice, to pay for (or to have paid under Medicare or Medicaid) a stay at the facility
- The facility ceases to operate
Regulations also mandate that residents be given written notice within certain time frames, have the right to appeal, and must be discharged in a safe and orderly way to a location that can meet their needs.