How to Write a Nursing Home Resident’s Discharge Notice and Stay Out of Hot Water!

If you have recently accepted a new facility, one of the first things you need to do is review their discharge policy and the discharge letter/notification they are using – if they are using one at all.

Many facilities do not have a standard template for an involuntary discharge letter.  When they do send a letter, it is usually generated by the Business Office Manager or Social Services Director who usually hasn’t had access to and doesn’t know what is required in the federal regulations.

I have also come across many facilities who were enforcing involuntary discharges for reasons other than are allowed in the regs and they were not doing the legwork to ensure it was a safe discharge.  Some of these cases resulted in survey citations including immediate jeopardy tags.

If you’ll review the watermelon book, you’ll find an interesting section on admissions, transfers, bedhold policies, and discharge rights in tags F201-208.

Under federal law (42 U.S.C 1396r(c)(2)(A); 42 CFR 483.12), you may only discharge a resident involuntarily for 1 of the 6 reasons listed below:

  1. Their bill for services at the facility has not been paid after reasonable and appropriate notice to pay.
  2. It is necessary for their welfare and their needs cannot be met in the facility.
  3. Their health has improved sufficiently so that they no longer need the services provided by the facility.
  4. The safety of individuals in the facility is endangered.
  5. The health of individuals in the facility would otherwise be endangered.
  6. The facility ceases to operate.

That’s it!  Those are the only reasons you can discharge a resident involuntarily.  In the involuntary discharge notice itself, you must list the following:

  • The reason for the discharge.
  • The effective date of the discharge.
  • The location to which the resident is transferred or discharged.
  • A statement that the resident has the right to appeal the action to the State.
  • The name, address, and telephone number of the State long term care ombudsman.
  • For nursing facility residents with developmental disabilities, the mailing address and telephone number of the agency responsible for the protection and advocacy of developmentally disabled individuals established under Part C of the Developmental Disabilities Assistance and bill of Rights Act
  • For nursing facility residents who are mentally ill, the mailing address and telephone number of the agency responsible for the protection and advocacy of mentally ill individuals established under the Protection and Advocacy for Mentally Ill Individuals Act.

The advocacy information is almost always missing in the letters I’ve seen.  You have to record in the clinical record the reason for the discharge as well as notify the resident and responsible party of the reasons for the discharge in writing and in a language they can understand.  Your physician should also write a statement stating the reason for discharge if it was due to any medical condition and also state that the resident can be adequately cared for in the new setting, whether it be with or without home care assistance, community services, etc.

Click here for a free .pdf download of a sample involuntary discharge letter template.  Feel free to modify it for your own use.  Also, be sure to check with your State for any state-specific requirements.

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