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Transfer/Discharge

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. 

 

NORC Resources


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.  

 

Consumer Voice Resources


State Operations Manual, Appendix PP – Guidance to Surveyors for Long-Term Care Facilities, 483.15 Admission, Transfer, Discharge Rights excerpts

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

 

Information from CMS


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 here

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.

 

Ombudsman Program Examples


View Ombudsman program materials on transfer/discharge


 

Additional Resources


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.

 

Information to Share with Consumers


Involuntary Transfer and Discharge Brochure

Involuntary Transfer and Discharge Factsheet

 

Archive


View archive here

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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