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On nursing home discharges

Friday, December 11, 2009

On behalf of the more than 400 volunteer long-term care ombudsmen statewide who advocate for improved quality of life and care for residents, I am writing to share a concern about a growing trend in Florida's nursing homes: the improper transfer or discharge of nursing home residents. Proper resident transfer and discharge processes are crucial to protecting the safety and ensuring the well-being of elders who live in nursing homes.

When a nursing home initiates the transfer or discharge of a resident who has lived there at least 30 days, facility staff must provide the resident with a written 30-day notice of the transfer or discharge, unless certain conditions exist.

Under state and federal law, a resident may only be discharged for one of six specified reasons, including if he or she falls behind in payment, if he or she is endangering him/herself or others or if the facility is unable provide adequate care for the resident's needs. Both endangerment and a facility's inability to care for the resident must be documented in the resident's medical record. This documentation for discharge may be completed only by the facility's medical director or the resident's physician. If this authorization occurs, the resident and her legal representative must then be given proper notice of the facility's intent to discharge the resident.

If the resident falls behind on his or her payments, the nursing home has the duty to assist the resident in enrolling in the appropriate Medicaid or Medicare programs to cover the costs. If a resident is still behind in payment after the assistance is provided, then the facility may discharge the individual with a written 30-day notice.

A copy of all discharge notices must be sent to the local long-term care ombudsman office. This notice gives ombudsmen the opportunity to review cases and facilitate communication between a resident and facility, ensuring that residents receive the treatment and respect they deserve and that their right to challenge an improper transfer or discharge is protected.

Residents should never be threatened with a transfer or discharge. Such threats violate federal and state law and should be reported to the ombudsman and/or to the Agency for Health Care Administration.

All residents have the right to request a hearing to appeal a discharge. If a resident has reason to believe he or she has grounds for such an appeal, the Long-Term Care Ombudsman Program encourages these individuals to file a request for hearing within 10 days of receiving the notice. Acting within the 10-day window allows a resident to remain in the current facility until the hearing is concluded. An ombudsman volunteer can assist in the hearing process as well as represent residents at the hearing. If you have concerns about a transfer or discharge notice, or any other issues concerning a long-term care facility resident, call us toll-free at 1-888-831-0404 or visit us online at

Brian Lee is state ombudsman for the Florida Department of Elder Affairs, the primary state agency responsible for administering human services programs for Florida's elder population. E-mail:

This story appeared in print on page A13

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