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Transfer, Discharge and Transitions

This issue page provides information on involuntary and voluntary transfer and discharges from nursing homes.

Involuntary Transfer and Discharge


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 attempting to transfer or discharge a resident.

The Nursing Home Reform Law of 1987 prohibits nursing homes from transferring or discharging a resident unless it can establish one of the permissible reasons for transfer/discharge exist. 

Those reasons include:

  • the nursing home cannot provide adequate care for the resident;

  • the resident's health has improved to the point that he or she no longer needs nursing home care;

  • safety of individuals in the facility is endangered;

  • the resident has failed to pay for care; or

  • the facility ceases to operate.

Many of the permissible reasons for transfer or discharge can be addressed through assessment and care planning, making transfer or discharge unnecessary.

If a resident is to be transferred or discharged, the facility must provide adequate notice to the resident and the resident's family member, guardian, or legal representative, in writing, at least 30 days in advance.

Adequate notice includes:

  • the reason for the transfer or discharge;
  • the specific location to which the resident will be moved;
  • the date of transfer or discharge;
  • information about the right to appeal the decision to discharge the resident; and
  • contact information for the State Long-Term Care Ombudsman.

Contact the Long-Term Care Ombudsman Program with concerns about a notice of discharge.  For an Ombudsman in your community, click here.

Resources

  • Transfer/Discharge Fact Sheet and Brochure

  • Consumer Voice, in partnership with Justice in Aging and the Center for Medicare Advocacy, developed a series of briefs which take a closer look at the revised nursing facility regulations.

    • Involuntary Transfer and Discharge - This brief explains the minor changes in transfer and discharge regulations, which include narrowing the facility’s ability to base a transfer/discharge on a supposed inability to meet the resident’s needs, by requiring increased documentation by the resident’s physician. The regulations also limit transfer/discharge for nonpayment.

    • Return to Facility After Hospitalization - This brief explains bed hold rights when a resident returns to a facility after a hospitalization.  The brief provides information on advance notification of bed hold rights and residents' rights if they return to a facility after a bed hold period has been exceeded.

  • Transfer/Discharge in Residents' Rights

  • Discharge Planning Checklist from CMS

  • Webinar: Involuntary Transfer/Discharge: A Growing Problem We Can Do Something About (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 from Nursing Homes: Prevention, Advocacy, and Appeals (2015)
    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. The presenters also reviewed best practices for supporting residents and families, identifying legal support, appealing discharge notices, and more.  Lori Smetanka, director of the National Long-Term Care Ombudsman Resource Center (NORC) presented, along with Eric Carlson, Co-Directing Attorney, National Senior Citizens Law Center and Mary Ann Parker, Attorney, DC Long-Term Care Ombudsman Program.

  • National Ombudsman Resource Center Transfer/Discharge Issue Page

  • Need more information on transfer/discharge? Contact your local ombudsman.

Voluntary Discharge or Transfer from a Nursing Home


There’s no place like home. Many consumers want to age in place and sustain their independence, dignity, and freedom of choice.  Many consumers feel that care at home gave them more choices, kept them active in the community, and was generally better than care in a nursing home. In addition to consumer preference, government has made the case that in-home care is less expensive than care in an institutional setting and has created options for those who wish to receive services in their home and community.  However, consumers may encounter several obstacles when transitioning from a nursing home back into their home like finding affordable housing, transportation, care in their home, and a support system.

To help promote a successful transition out of a nursing home, start the planning well in advance.  Identify tips for a successful transition, and access a checklist that reviews, step by step, what to do before, during and after the move out of the nursing home, by accessing the Consumer to Consumer Tip Sheet.

Click here to access additional Consumer Voice resources on voluntarily transitioning from a nursing home.