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Specialized Information for:
Nursing HomesAssisted Living/Board & Care Home and Community Based Services
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Specialized Information for:
Nursing HomesAssisted Living/Board & Care Home and Community Based Services
Complaints regarding facility-initiated transfers and discharges continue to be one of the top complaints that Ombudsman programs receive nationwide. These complaints can be complex and extremely time consuming and the threat of transfer or discharge from a long-term care facility can be traumatic for residents and their families.
Representing Residents During Nursing Facility Discharge Appeal Hearings: The Basics (June 2022)
The purpose of this fact sheet is to provide a basic overview about residents’ rights in appealing nursing facility discharges and tips for Ombudsman program advocacy considerations before, during, and after an appeal hearing.
Protecting Residents from Inappropriate Evictions in Residential Care Communities (RCCs) (October 27, 2021)
This webinar discussed federal and state legal tools and advocacy strategies to defend residents of residential care communities (RCCs) from inappropriate evictions. Eric Carlson of Justice in Aging provided an overview of common state laws that may be utilized for eviction protection and explained how the Home and Community-Based Services (HCBS) Rule requires protections against inappropriate eviction for residents living in residential settings funded by Medicaid HCBS programs (e.g., RCCs). Attendees also heard about state and local advocacy strategies to address evictions of residents in RCCs. Amanda Scott, Idaho State Long-Term Care Ombudsman, and Molly Davies, Vice President of Elder Abuse Prevention and Ombudsman Services, WISE & Healthy Aging, California Long-Term Care Ombudsman program, shared their work.
Webinar Materials
Enhancing Your Advocacy Toolbox: Protecting Residents from Nursing Facility-Initiated Discharges (January 2021)
Complaints regarding nursing facility-initiated discharges have been the most common type of complaint received by the Long-Term Care Ombudsman program for the last nine years. To assist Ombudsman programs when working with residents facing a facility-initiated discharge, the National Ombudsman Resource Center produced the resource, Enhancing Your Advocacy Toolbox: Protecting Residents from Nursing Facility-Initiated Discharges. This resource blends pertinent federal nursing home requirements and surveyor guidance with action steps for Ombudsmen to consider. We encourage Ombudsman programs to use this resource as a basic guide for using federal regulations and guidance to address common issues related to facility-initiated discharges.
Charts with resolution strategies, action steps, and the legal basis to address common discharge reasons
Transfers and Discharges - These materials can be used in training by and for Ombudsman program representatives, for members of resident and family councils, and community education.
Advocacy Tools and Successful Practices to Protect Residents from Nursing Facility-Initiated Discharges (September 25, 2019)
View the slides as a PDF and PowerPoint with presenter notes.
Handouts
For the last seven years, complaints regarding nursing facility discharges have been the top complaint received by Long-Term Care Ombudsman programs. Presenters provided an overview of the Ombudsman Learning Collaborative to Protect Residents Against Nursing Facility-Initiated Discharges project; showed how to use federal nursing home regulations and surveyor guidance to address three common complaints about discharge; shared examples of legal services and Ombudsman program collaboration; and highlighted available resources.
Presenters: Robyn Grant, Director, Public Policy and Advocacy, National Consumer Voice for Quality Long-Term Care; Eric Carlson, Directing Attorney, Justice in Aging; Jamie Freschi, NORC Consultant
Enhancing Your Advocacy Tool Box: Protecting Residents from Nursing Facility-Initiated Discharges Webinar (July 12, 2019)
View the slides as a PDF.
Handouts
Complaints regarding nursing facility-initiated discharges have been the top complaint received by Long-Term Care Ombudsman Programs (LTCOPs) for the last seven years. This webinar discussed new ways to apply the federal nursing home regulations and surveyor guidance in advocacy to address common complaints involving nursing facility-initiated discharges. Additionally, presenters highlighted successful practices identified during the Ombudsman Learning Collaborative to Protect Residents Against Nursing Facility-Initiated Discharges project and share available consumer education resources.
Speakers: Robyn Grant, Director, Public Policy and Advocacy, Consumer Voice and Jamie Freschi, NORC Consultant
NOTE: This webinar was part of the Ombudsman Learning Collaborative to Protect Residents Against Nursing Facility-Initiated Discharges project and was open to State Ombudsmen, representatives of the Office, and legal assistance providers in the seven project states (DC, OH, OK, LA, MS, NV, and PA).
Involuntary Transfer and Discharge Factsheet
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, bed holds and readmission, appeals, etc.
Involuntary Transfer and Discharge Brochure
OIG Report Analyzes Facility-Initiated Discharges in Nursing Homes
The Department of Health and Human Services Office of Inspector General (OIG) has released a report entitled Facility-Initiated Discharges in Nursing Homes Require Further Attention. The OIG report surveyed State Ombudsmen across the country and analyzed CMS administrative data to determine the number of nursing homes that received a deficiency related to facility-initiated discharge. Officials from ACL and CMS Regional Offices as well as five State Ombudsmen were interviewed.
State Operations Manual Appendix PP – Guidance to Surveyors for Long-Term Care Facilities §483.15 Admission, Transfer, and Discharge Rights
This resource is an excerpt from CMS's State Operations Manual (SOM) which provides guidance to surveyors of long-term care facilities on interpreting the requirements. Visit the CMS website to find the full State Operations Manual (SOM).
CMS Memo - An Initiative to Address Facility Initiated Discharges that Violate Federal Regulations (January 22, 2018)
This memo is from CMS to State Survey Agency Directors. Federal regulations allow facilities to initiate discharges of residents only in specific instances. Despite these protections, discharges which violate Federal regulations continue to be one of the most frequent complaints made to State Long-Term Care Ombudsman Programs. CMS has begun an initiative to examine and mitigate facility-initiated discharges that violate federal regulations. CMS is examining State survey agency’s intake and triage practices for these type of discharge complaints, developing examples of inappropriate and appropriate discharges for surveyors, identifying best practices for nursing homes, developing training, and evaluating enforcement options for these types of violations. Civil Money Penalty (CMP) Reinvestment Projects Assistance. CMS is encouraging States to pursue CMP-funded projects that may help prevent facility-initiated discharges that violate federal regulations.
Jimmo Settlement Agreement Webpage (August 2017)
CMS has launched a webpage on the Jimmo Settlement Agreement. The Jimmo Settlement agreement clarified that the Medicare program covers skilled nursing care and skilled therapy services when a beneficiary needs skilled care in order to maintain function or to prevent or slow decline. Specifically, the Jimmo Settlement required manual revisions to restate a "maintenance coverage standard" for both skilled nursing and therapy services. The Jimmo Settlement may reflect a change in practice for those providers or others who have erroneously believed that the Medicare program covers nursing and therapy services only when a beneficiary is expected to improve. The new Jimmo Settlement Webpage provides background on the settlement, links to resources and Frequently Asked Questions.
CMS S&C Memo - Copies of Transfer/Discharge Notices
CMS issued a Survey and Certification memo (17-27-NH) on May 12, 2017 that provides clarification regarding copies of transfer and discharge notices to a representative of the Office of the State Long-Term Care Ombudsman and information regarding the new definition of SQC (substandard quality of care) and implementation of the provisions regarding SQC. Additional CMS S&C memos are posted to their website.
CMS Sends Letter to California Regarding Enforcement of Appeal Decisions of Involuntary Transfers and Discharges
CMS sent a letter to the California Department of Health Care Services reminding the state that they must "establish a system for adjudicating residents' appeals of involuntary transfers and discharges from nursing facilities in compliance with federal standards." The letter came in response to a letter AARP sent to the U.S. Department of Health & Human Services Office of Civil Rights regarding the failure of the California Health and Human Services Agency to enforce administrative decisions under the Nursing Home Reform Act.
View Ombudsman program materials on transfer/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
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.
Involuntary Discharge from Nursing Homes and Assisted Living (November 2015)
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.
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. This session also considers how to apply and adapt those strategies and best practices if the resident is in assisted living.
Transfers and Discharges - These materials can be used in training by and for Ombudsman program representatives, for members of resident and family councils, and community education.
Involuntary Transfer and Discharge Brochure
Involuntary Transfer and Discharge Factsheet
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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