Discharge from a nursing home may be initiated by the resident, his or her family or by the physician.
Notice of Intent to Leave the Facility
If the resident or legal decision maker initiates the discharge, advance notice should be given to the nursing home. Consult the contract signed at admission to determine the number of days in advance you must notify the nursing home of a discharge. If proper notice is not given, the resident may be required to pay for additional days after the move. Regardless of the reason for discharge, the nursing home social worker is responsible for assisting the resident and family throughout the discharge process.
Reasons for Discharge
The resident (or his or her family) may initiate discharge for a number of reasons, including:
- The resident's condition improves and nursing home care is no longer needed.
- The resident wishes to return home or to the home of a family member or friend (and his or her needs can be met in that setting).
- The resident's condition improves and he or she moves to an assisted living facility.
- The resident wishes to move to another nursing home.
The nursing home may initiate discharge if:
- The resident's condition improves, nursing home care is no longer needed, and assisted living or another community placement is more appropriate.
- The resident's condition worsens and his or her needs for care exceed that which the nursing home can provide.
Involuntarily discharge by the nursing home can occur in some specific cases, if:
- The nursing home can no longer provide the care needed.
- The resident's health has improved enough that nursing home care is no longer necessary.
- The resident has become a danger to him or herself or the health, safety and welfare of others.
- The nursing home bills are not being paid.
- The nursing home closes.
The social worker should help the resident who wishes to return home to arrange any services needed in the home. Such services may include home health services, Meals on Wheels or adult medical day services. The resident and family should ask for any assistance they may need from the social worker. The nursing staff can provide guidance and training for family members, if needed. The doctor and nursing staff must complete a detailed written discharge summary (a copy of which should be sent to the resident's primary physician) and provide prescriptions for all current medications. In addition, the nursing home should provide a three-day supply of medications to the resident.
Discharge to Another Facility
If a resident is moving to a different facility - an assisted living facility or another nursing home - the nursing home staff must send a detailed written discharge summary and any medical forms requested by the receiving facility. The nursing home staff (usually the social worker) is responsible for assisting with, or arranging for, a wheelchair van or ambulance if transportation is needed.
The nursing home staff is responsible for packing the resident's personal belongings. If the family wishes to do so they should inform the staff. If the fiscal office has been managing a personal needs bank account for the resident, it is important to see that the necessary forms to close the account are completed before discharge.
If a nursing home decides to transfer or discharge a resident, it must follow specific regulations when issuing the involuntary transfer or discharge notice. Except in emergency situations, the discharge notice must be issued in writing at least 30 days before the proposed transfer or discharge. The transfer or discharge notice must:
- State the reason for the discharge
- Include a statement that the resident has the right to request a hearing
- Provide the name, address and the phone number of
- The Maryland Department of Aging
- The local ombudsman program
- The Legal Aid Bureau
- Other agencies that may provide assistance to individuals who need legal counsel
- Provide, for nursing home residents with developmental disabilities, the address and phone number of the agency responsible for the protection and advocacy of developmentally disabled individuals
- Provide, for nursing home residents who are mentally ill, the address and phone number of the agency responsible for the protection and advocacy of mentally ill individuals
- Notify the resident of the right to consult with an lawyer
Nursing home residents have the right to appeal an involuntary discharge. The discharge notice must provide the address for requesting a hearing before an administrative law judge. The resident, legal decision maker or interested family member or friend may request a hearing.
If, at the hearing, the judge agrees that the discharge is appropriate, the resident must leave the facility on the day set by the judge. If the judge does not concur with the discharge, the resident may remain at the facility.