The U.S. Department of Health and Human Services Office of the Inspector General (OIG) issued a report on March 29, 2024 entitled “Concerns Remain About Safeguards To Protect Residents During Facility-Initiated Discharges From Nursing Homes” that found that in 107 of the 126 facility-initiated discharge cases it reviewed, “nursing homes discharged residents for allowable reasons; however, our review raises concerns about nursing homes’ understanding of and compliance with notice and documentation requirements for facility-initiated discharges.”
The OIG found that nursing homes sometimes fell short in providing required documentation, such as documentation
that the receiving facility could provide services that meet residents’ needs. Nursing homes often failed to notify residents of their discharges and frequently omitted required information in notices, which may have compromised residents’ rights and abilities to plan for safe transitions. Even when nursing homes provided the resident with a facility-initiated discharge notice, only about half sent a copy of the notice to the Ombudsman, as required, potentially impeding the Ombudsman’s ability to effectively advocate for residents. The OIG also found that nursing homes struggled to identify facility-initiated discharges, which may present CMS and State survey agencies with challenges in overseeing these discharges during the survey process.
The OIG report recommended that CMS provide a standard notice template to help nursing homes provide complete and accurate information to residents facing discharge and Ombudsmen, and that CMS require nursing homes to systematically document facility-initiated discharges in information available to CMS and States to enhance oversight.
CMS did not explicitly state its concurrence or nonconcurrence with the OIG’s two recommendations.
CMS defines a facility-initiated discharge as a discharge that “the resident objects to, or did not originate through a resident’s verbal or written request, and/or is not in alignment with the resident’s stated goals for care and preferences.” Nursing homes can appropriately discharge residents if the discharge is for an allowable reason and the nursing home adheres to Federal requirements.
Nursing homes may only initiate the discharge of a resident for six reasons, four of which need clinical support to validate the reason. CMS requires nursing homes to include specific documentation in the medical record in cases of facility-initiated discharges.
The four reasons that require clinical support specific to the reason for discharge are:
- The transfer or discharge is necessary for the resident’s welfare and the resident’s needs cannot be met in the facility;
- The transfer or discharge is appropriate because the resident’s 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 would otherwise be endangered.
The other two reasons for facility-initiated discharge, which do not require clinical support are:
1. 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. Non-payment applies if the resident does not submit the necessary paperwork for third party payment or after the third party, including Medicare or Medicaid, denies the claim and the resident refuses to pay for his or her stay. For a resident who becomes eligible for Medicaid after admission to a facility, the facility may charge a resident only allowable charges under Medicaid; or
2. The facility ceases to operate.
See 42 CFR § 483.15(c)(1)-(2).
CMS requires nursing homes to provide written notice to residents of facility-initiated discharges generally 30 days prior to the discharge.
If you or a loved one were wrongfully discharged from a nursing home, or the nursing failed to provide proper notice regarding discharge, you should promptly find a nursing home claim lawyer in your state who may investigate your improper nursing home discharge claim for you and file a claim against the nursing home on your behalf or behalf of your loved one, if appropriate.
Visit our website to be connected with medical malpractice attorneys (nursing home injury attorneys) in your U.S. state who may assist you with your nursing home claim, or call us toll-free in the United States at 800-295-3959.
Turn to us when you don’t know where to turn.
