Transfer and Discharge continues to be one of the top complaints that ombudsmen report encountering, and these cases can be complex and extremely time consuming. The threat of transfer or discharge from a nursing home can be both frightening and stressful for residents and their families. Too often, a facility may respond to resident’s difficulties or increasing need for care or repeated questions or complaints from family members by transferring or discharging the resident. The Nursing Home Reform Law of 1987 protects residents from involuntary transfer and discharge.
Webinar: Involuntary Transfer/Discharge: A Growing Problem We Can Do Something About (July 2013)
This webinar hosted by the National Consumer Law Center (NCLC) detailed the transfer and discharge provisions of the Nursing Home Reform Law and provided strategies and resources on handling transfer discharge cases. Presenters included Lori Smetanka, Director of the National Long-Term Care Ombudsman Resource Center (NORC); Eric Carlson, Directing Attorney at the National Senior Citizens Law Center (NSCLC); and Mary Ann Parker, attorney for the D.C. Long-Term Care Ombudsman Program/Legal Counsel for the Elderly.
Involuntary Transfer and Discharge Factsheet (March 2007)
This factsheet produced by the National Consumer Voice for Quality Long-Term Care gives consumers details on what the law says about transfer/discharge, notification, time limits, bedholds and readmission, appeals, etc.
Allowable Reasons for Involuntary Transfer or Discharge - Outline of the Law
This resource produced by Eric Carlson with the National Senior Citizens Law Center outlines the six circumstances under which a nursing facility can conduct an involuntary transfer or discharge under the federal Nursing Home Reform Law.
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Let Me Return Home Toolkit - Minnesota Ombudsman Program (November 2016)
This toolkit was developed by the Minnesota Ombudsman Program and shows how the program has approached the systemic problem of residents not being allowed to return to their skilled nursing facility (SNF) following a transfer to a hospital. This work was in response to an increase in calls from hospital discharge planners. The program is also developing materials for a provider audience. The curriculum is entitled: Let Me Return Home or LMRH. Below are materials that comprise the LMRH-NH toolkit that the ombudsman program has worked on since 2013.
Phase 1: Development of training materials and resources for hospital discharge planners.
Phase 2: Improve regional ombudsman advocacy skills through co-training with the Department of Human Services Nursing Facility Rates and Policy and connecting with legal partners to create a letter to facility administrators summarizing the regulation and seeking collaborative dialogue to resolve the issues.
Involuntary Discharge from Nursing Homes and Assisted Living (November 2015)
Involuntary Transfer or Discharge Toolkit (November 2010)
This guide developed by the Illinois Long-Term Care Ombudsman Program offers Ombudsmen information and guidance for assisting residents when a facility is threatening to issue a notice of involuntary transfer /discharge or after a notice of involuntary transfer/discharge has been issued. The toolkit contains information on state and federal regulations and federal laws and also offers Ombudsmen suggestions about what to do in discharge situations.
Model Resident Transfer and Discharge Plan for Nursing Homes and Community Resident Facilities (November 2004)
This model discharge plan developed by the District of Columbia Department of Health is intended to ensure the safe and orderly removal of residents and protect residents' rights in the event of a transfer or discharge. The plan is followed whenever a resident is transferred or discharged voluntarily or involuntarily, and includes provisions on adequate notice, resident assessment and staff training.
District of Columbia Transfer and Discharge Law (May 2011)
Paschall v. DC Department of Health (April 2005)
This ruling gave Administrative Law Judges in the District of Columbia the authority to readmit a resident into a facility if the reason for transfer or discharge given by the facility was ruled invalid.
Role of the Long-Term Care Ombudsman in Involuntary Transfer/Discharge (May 2011)
This memorandum from Alice Hedt, the Maryland State Long-Term Care Ombudsman, detailing how Maryland LTCOs assist individuals receiving an involuntary discharge notice from a facility, the services ombudsmen are able to provide, ombudsmen representation in hearings and legal services ombudsmen use or refer to for assistance in hearings.
Nursing Home Discharges, Transfers and Room Changes: Know Your Rights
This brochure produced by the State of Nevada Division for Aging Services details residents' rights in state and federal law in the event of a discharge, transfer or room change. It also relates how the Long-Term Care Ombudsman Program can assist residents in these situations.
Guidance from the Nevada Office of the State Long Term Care Ombudsman Program - Discharge Notices
This guidance was provided by the Nevada State Long-Term Care Ombudsman to assist Skilled Nursing Facilities in understanding discharge notifications.
Webinar - Involuntary Transfer/Discharge: A Growing Problem We Can Do Something About
This webinar hosted by the National Consumer Law Center (NCLC) detailed the transfer and discharge provisions of the Nursing Home Reform Law and provided strategies and resources on handling transfer discharge cases.
Webinar - Involuntary Transfer and Discharge from Nursing Homes: Prevention, Advocacy, and Appeals
The webinar discussed strategies and best practices for preventing and advocating for residents facing involuntary discharge from a nursing home, and considered how those strategies, best practices change/stay the same if the resident is in assisted living.
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Nursing Home Transfer and Discharge Notice (Florida)
This sample form from the state of Florida is required for those transfers or discharges initiated by the nursing home facility, and not by the resident or by the resident’s physician or legal guardian or representative.
Notice of Involuntary Transfer or Discharge and Opportunity for a Hearing (Illinois)
Sample notice of involuntary transfer or discharge and opportunity for a hearing from the state of Illinois.
Notice of Discharge or Transfer from a Nursing Facility or Relocation Within a Nursing Facility
(District of Columbia)
Sample notice of transfer, discharge or relocation to be completed by the provider, which includes information on appeals rights, contact information for the Long-Term Care Ombudsman Program and a request for hearing form. The DC Health Regulation and Licensing Administration sends these forms to nursing facilities with the cover letter linked below:
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Guidance for Successful Resident Transitions in Oregon Assisted Living and Residential Care Communities
This guidance developed by the Oregon Department of Human Services is intended to improve residential care and assisted living service providers’ understanding of Oregon regulatory standards that govern resident moves to and from an assisted living facility (ALF) or residential care facility (RCF) community.
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Involuntary Transfer and Discharge: Hot Topic Issues (October 2013)
This session from the 37th annual Consumer Voice conference discusses strategies and best practices for preventing and advocating for residents facing involuntary discharge from a nursing home. Considers how those strategies, best practices change/stay the same if the resident is in assisted living. Reviews best practices for supporting residents and families, identifying legal support, appealing discharge notices, and more.
The South Carolina LTCOP developed a program to assist residents that are moving out of a facility by providing them with boxes, bags or luggage for their belongings. The SLTCO spoke with various organizations and the Chief of Staff spoke to a nonprofit organization that agreed to donate 50 emergency relocation bags each year. The bag contains a bible, jacket, pillow, underwear, socks, a sweat suit, hygiene products, Depends, blanket, towels, cup and a laundry bag. This program has made a tremendous impact on the residents and they are appreciative of the fact that others care about their welfare. Residents are now able to move to another facility with dignity. (2013)
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