Table of Contents
Definition of “Discharge” and “Eviction”
Medicare & Medicaid Coverage of Nursing Home Care
Reasons for an Illegal Eviction
Private Pay Resident No Longer Has the Funds
Nursing Home Claims it “Cannot Meet the Needs of the Resident”
Nursing Home No Longer Accepts Medicaid
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 six legal reasons a nursing home resident can be forced to leave a facility. Outside of these reasons (covered below), 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 how to respond if one’s rights are violated, illegal discharges and transfers can be minimized and / or prevented.
While our main focus is on involuntary nursing home discharges, the following information is also relevant to involuntary nursing home transfers.
Understanding the Definition of Discharge and Eviction
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, this is an involuntary discharge, also called an eviction, inappropriate discharge, illegal discharge, or improper discharge.
Medicare & Medicaid Coverage of Nursing Home Care
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
Medicare, federal health insurance for persons 65+ years old, will cover short-term skilled nursing care (up to 100 days) in Medicare approved (certified) nursing homes. For qualifying individuals, Medicare will pay 100% of the cost for the first 20 days. For days 21 – 100, Medicare will pay a portion of the cost, but in 2025, the nursing home resident will pay a coinsurance of $209.50 / day. For seniors who have Medicare Supplemental Insurance (MediGap), their insurance generally covers this cost. More on Medicare’s coverage of nursing home care.
Note: 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
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 What Reasons Can a Nursing Home Legally Evict?
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.
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: 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: 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 for 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.
Common Reasons for Illegal Nursing Home Discharges
Medicare Coverage is Ending
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, apply for Nursing Home Medicaid immediately, and if not, consult with a Professional Medicaid Planner for assistance in meeting Medicaid’s criteria.
Private Pay Resident No Longer Has the Funds
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 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.
Nursing Home Claims it “Cannot Meet the Needs of the Resident”
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 to which the resident will be transferred will provide in order to meet the resident’s needs. Note: 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.
Nursing Home No Longer Accepts Medicaid
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 current residents.
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.
After Hospitalization, there is No Bed Available
In this situation, called “hospital dumping”, a nursing home resident is admitted to a hospital and when it is time for discharge, the facility claims their bed is no longer available. However, every nursing home has a bed-hold policy. These rules, set by state law, address if a facility is required to hold a resident’s bed during temporary hospitalization, the number of days one’s bed must be held (if any), and if Medicaid will make “bed hold payments”. Facilities may also allow a resident to pay out-of-pocket to reserve their bed. Regardless of state-specific and facility-specific rules, federal law requires that Medicaid beneficiaries (despite the length of hospitalization) be readmitted to the nursing home as soon as a Medicaid certified bed is available.
What to do in this situation: Check a facility’s bed-hold policy to ensure they are adhering to the rules. Based on federal law, this policy should have been provided at the time the resident was initially admitted to the nursing home and again at the time of hospitalization. Medicaid recipients 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.
What A Resident / Family Can Do
If a nursing home resident is being pressured to leave, has been threatened with eviction, 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 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 with eviction. 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. 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: 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. 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.