Patients requiring full-time nursing care can suffer from debilitating or deteriorating physical and mental conditions. Families may have no choice but to place a loved one in a licensed care facility. Even though nursing homes, rehabilitation centers, and assisted living providers charge thousands of dollars each month for their services, insurers sometimes refuse to pay. If such refusal occurs and a patient exhausts their long-term care benefits or suffers from deteriorating health, these facilities may attempt to discharge your loved one unlawfully.
While a care facility could force a patient to leave, it can only do so under certain circumstances. Nursing homes must abide by the patient care contract and local regulations before forcing a discharge. A nursing home lawyer might help patients and their families appeal an unlawful transfer or removal.
Overview of Discharge and Transfer Regulations Applicable to Care Facilities
Every state health authority has specific rules related to the forced transfer or discharge of patients from licensed healthcare facilities. You should consult with a local patient’s rights attorney about the laws in your jurisdiction.
However, most states do not permit unauthorized discharges and adhere to the following rules and procedures:
- Care facilities must inform patients and their families in writing about their discharge policies and procedures.
- Patients and legal guardians should receive at least 30 days’ notice of a pending transfer or discharge.
- Facilities have the right to discharge or transfer a patient without official notice if they pose a risk of harm.
- Patients or their legal guardians may appeal an involuntary discharge to a local regulatory authority.
- Patients may remain in the care facility, pending the outcome of the appeal.
- If applicable, a medical team at the facility must confirm that the care home can no longer provide the patient with the care and accommodations necessary to meet their needs, or that the patient no longer needs treatment.
- The nursing or assisted living home must first have reasonably attempted to find an alternative to discharge or transfer.
- The patient unlawfully refuses to pay for care costs and exhausted or otherwise lost health insurance benefits.
Again, these laws differ based on the patient’s condition, the care facility’s license, the contract between the patient and the facility, and the statutes of the state where the patient receives care. Healthcare providers must cite the specific reason for the transfer or discharge, such as safety concerns or the patient falling into arrears, and abide by the procedures governing those types of removals.
Four Main Reasons Nursing Homes Might Force Patients to Leave
Care facilities may discharge or transfer patients for one or more of the reasons listed below. Nursing home administrators, independent doctors, social workers, and insurance adjusters might need to review and certify a discharge. At the same time, patients and their families might challenge the facts cited in support of the release, request medical records, and appeal the removal. Consider speaking with a legal professional if you received a pending discharge or transfer notice.
Recovery and Unnecessary Care
Many nursing facilities seek to quickly rehabilitate and discharge patients to make room for new arrivals. Because most care homes have more prospective patients than available beds, sometimes facilities release patients prematurely. A facility’s administration will claim that a resident’s health sufficiently improved and that they no longer require in-patient care. An administrator might instead recommend outpatient rehabilitation or initiate a 24-hour discharge.
When nursing homes claim a patient’s health has adequately improved, they must typically provide evidence of medical progress upon request. A team of therapeutic professionals should review any proposed discharge plans and conduct physical examinations of the patient. Most care facilities must also work with local social workers to ensure residents have a safe place to continue recovering. Patients may appeal this decision with a regional health authority, demand a Medicare/Medicaid review, request their medical records, and retain an independent physician to conduct a medical examination. While under appeal, a patient is allowed to remain in the facility.
Inability to Provide Care for Worsening Conditions
Not every assisted living facility has a dementia unit, provides hospice services, or maintains the equipment necessary to provide advanced medical care. If nursing homes cannot provide care for patients’ worsening conditions, they may seek to transfer them to another facility. Families should consult the patient care contract and diagnosis codes relative to admission. Independent doctors may help families determine whether a care home cannot provide the patient with necessary care or simply seeks to skirt its legal obligations.
Ordinarily, you cannot force a facility to provide long-term care for a condition it did not initially agree to treat. However, care homes must stabilize worsening patients and work with family members to find suitable alternative care. If a facility decided to treat a patient for dementia but claims it cannot provide adequate services, consider voluntarily transferring the patient to another care home and discussing your legal remedies with a local attorney.
Safety Concerns
It is not unusual for a patient that necessitates long-term nursing care, especially if they are struggling with a mental disability, to lose track of reality. They may attack a nurse in confusion or harm other patients while attempting to leave the facility. In such cases, care homes may initiate discharge or transfer proceedings to protect others’ safety.
Before doing so, the facility must first take steps to prevent the patient from harming themselves or others. These steps might include transferring the patient to a solitary unit, providing specialized supervision, or administering certain mental health drugs. If these measures adequately protect staff members, the facility cannot discharge patients for behaviors related to a medical condition.
Forced removal from a care home often becomes an issue when no other facility will take the patient. In such cases, an attorney may examine the medical records and reason for discharge. Families could challenge a safety-based removal by claiming the facility knew about the underlying condition and did not exhaust all possible treatment remedies. Patients may also invoke local appeals procedures in such cases. Care homes cannot release a patient without giving families prior notice of discharge and an opportunity to appeal. However, the facility administration can contact law enforcement if the patient committed a sex crime or violent physical assault. Speak with a local attorney if an incident resulted in a police report.
Non-Payment
Unfortunately, care homes may remove some patients for non-payment. Most states carefully regulate such discharges. Nursing facilities should first appeal insurance denials, help patients apply for Medicaid, and give residents time to come up with a payment.
Care facilities are not allowed to discharge patients for non-payment if:
- The patient filed an appeal with their medical insurance company.
- The patient just applied for Medicare, Medicaid, or state aid.
- The facility did not correctly bill health insurers.
- The patient disputes the charges owed.
- The patient has no funds to pay for necessary care.
The law generally only permits discharge for financial reasons when patients or legal guardians refuse to cooperate with insurers, commit fraud during the admissions process, or have assets but refuse to pay undisputed care costs. Long-term care comes with substantial fees, and a nursing home could seek a patient’s assets to pay medical bills. Experienced attorneys can often help families develop specialized estate plans for loved ones needed long term care, review medical and billing records for healthcare fraud, or otherwise represent families during the insurance appeals process.
Appealing a Discharge or Forced Transfer with a Local Regulatory Authority
Most states protect vulnerable adults by strictly regulating forced discharges and transfer procedures. Legal professionals can challenge a discharge if nursing home administrators failed to provide proper notice of removal, did not give a clinical reason for their decision, refused to readmit patients after hospital stays, or did not provide supporting medical evidence.
If this process fails, a lawyer could help legal guardians prepare an appeal. Families should consider appealing immediately, as this delays the discharge. Patients may then request additional time to gather and submit evidence challenging the removal or transfer.
Appeals agencies frequently seek the following proof in unlawful medical discharge cases:
- Medical records from the treating care home
- Administrative notes, such as notes from social workers and staff
- The original admission contract
- Medical billing paperwork, including diagnosis codes and insurance submissions
- Relevant insurance documents
- Examination reports and opinions from an independent medical examination
- Any pertinent communications from the care facility, such as letters or voice messages,
- Medical records from other healthcare providers, including notes from a recent hospital stay
- Sworn statements from the patient, private caregivers, and family members related to the patient’s condition
- Financial statements and tax returns, if available
- Copies of any pending applications for Medicaid/Medicare or an insurance appeal
Appeals for medical-based removals, including safety incidents, typically go through the local health department, while appeals based on insurance denials go directly to a public or private insurer. In cases involving suspected medical malpractice, nursing home abuse, or healthcare fraud, families might consider submitting evidence to a medical licensing agency, malpractice insurer, or financial fraud department. Care homes cannot discharge patients during the appeals process, and families may request their cooperation in submitting timely medical records and care contracts to a state health agency.
Bringing Legal Action Against a Nursing Home or Assisted Living Facility
If a patient loses an appeal on the merits, the care home may request that families remove their loved one within a set time frame. The patient may work with a lawyer to petition for judicial review at this stage. Judges will examine an administrative appeal based on the evidence to determine whether an agency’s removal decision complied with applicable law. A lawsuit might give families the additional time to contemplate their options or overturn an agency’s discharge decision.
Requesting a Protective Order for a Vulnerable Adult
In cases where patients lost an appeal but have no viable care options upon discharge, legal guardians can work with counsel to petition the courts for a protective order. This legal process might also include opening mental health or guardianship proceedings. Such legal measures could prevent nursing homes from prematurely discharging medically vulnerable patients.
Breach of Contract
Long-term medical admissions typically require both the patient (or legal guardian) and the facility to agree on the terms of care. These care contracts often include provisions requiring patients to pay medical costs, as well as contain details about the patients’ medical conditions and expected treatment. If a care facility accepts a patient but fails to provide agreed-upon services, the patient’s family might transfer their loved one to an alternative care facility and recover damages for out-of-pocket costs from a liable healthcare provider.
Medical Malpractice
No matter the reason for removing your loved one from a care facility, nursing homes must provide quality healthcare to patients in their charge. They may not refuse to provide essential services due to lack of payment or discharge a patient when it would put the patient in unreasonable danger. Lying about the nature of a patient’s condition or otherwise refusing to provide services might constitute medical malpractice.
Qualified medical and nursing home malpractice attorneys can help patients and families sue nursing homes for failing to provide essential care or contributing to patients’ illnesses. Families might also speak with a local nursing home lawyer about any signs of nursing home abuse or neglect, including bedsores, unexplained bruising, broken hips, and malnutrition.
Healthcare Fraud
Some nursing facilities look for reasons to discharge difficult patients, especially vulnerable older adults in need of dementia care. Medical staff may lie about a patient’s condition to force a transfer, give a patient’s bed away during a hospital stay, or attempt to discharge a patient too early.
Sometimes, care facilities include false statements in medical records. They may lie about performing general checkups or fabricate symptoms and behaviors to support a medical discharge. Consider working with a nursing home lawyer attorney with experience reviewing medical records for evidence of malpractice, billing fraud, or illegal alteration in all forced discharge cases.
If you received notice that a care home wishes to discharge a loved one, you have options. You might work with local counsel to appeal the removal, review the patient’s medical records, and demand an independent medical examination. A plaintiff’s lawyer might also help you apply for Medicaid benefits or file a lawsuit for nursing home neglect. Reputable medical malpractice lawyers typically accept these cases on a contingency fee basis and do not charge for care home discharge consultations.
