Notice of Transfer/Discharge of Nursing Home Residents

The Department of Health (DOH) has issued a Dear Administrator Letter (DAL) clarifying a number of different requirements related to the transfer and discharge of residents from the nursing home. The letter outlines the circumstances that allow for the resident to be discharged/transferred. They are as follows:

1. The transfer or discharge is necessary for the resident’s welfare and the resident’s needs cannot be met in the facility;
2. The transfer or discharge is appropriate because the resident’s health has improved sufficiently so the resident no longer needs the services provided by the facility;
3. The safety of individuals in the facility is endangered due to the clinical or behavioral status of the resident;
4. The health of individuals in the facility would otherwise be endangered;
5. The resident has failed, after reasonable and appropriate notice, to pay for (or to have paid under Medicare or Medicaid) a stay at the facility. Nonpayment applies if the resident does not submit the necessary paperwork for third party payment or after the third party, including Medicare or Medicaid, denies the claim and the resident refuses to pay for his or her stay. For a resident who becomes eligible for Medicaid after admission to a facility, the facility may charge a resident only allowable charges under Medicaid; or
6. The facility ceases to operate.

In circumstances 1 and 2, DOH requires that the resident’s physician document information about the basis for transfer or discharge. Additionally, for circumstance 1, the inability to meet the resident’s needs, the documentation made by the resident’s physician must include:

• The specific resident needs the facility could not meet;
• The facility efforts to meet those needs; and
• The specific services the receiving facility will provide to meet the needs of the resident which cannot be met at the current facility.

The DAL underscores the need for nursing homes to determine prior to admission whether they can properly meet the needs of the resident they plan to admit:

"Facilities are required to determine their capacity and capability to care for the residents they admit, so in the absence of atypical changes in residents’ conditions, it should be rare that facilities who properly assess their capacity and capability of caring for a resident then discharge that resident based on the inability to meet their needs. Therefore, facilities should not admit residents whose needs they cannot meet based on the facility assessment."

Additional clarifications are provided related to notification to the State Long Term Care Ombudsman Program and the timing of those notices. In terms of Resident-Initiated Transfers and Discharges, the DAL states the following:

"Discharges following completion of a skilled rehabilitation stay may not always be a resident-initiated discharge. In cases where the resident may not object to the discharge, or has not appealed it, the discharge could still be involuntary and must meet all the requirements of the regulation. For example, it is not permissible to discharge a resident because they have completed short-term rehabilitation and now require long term placement. In New York State, all beds in a nursing home are dually Medicare and Medicaid certified; therefore, there is no delineation between a short-term rehabilitation bed and a long-term care bed. Discharging for this reason is prohibited."

The DAL also provides contact information for the Ombudsman Program by county and a Frequently Asked Questions (FAQ) document regarding discharge notices to the Ombudsman Program.

Members should review their policies and procedures to ensure that they align with the current requirements. Additionally, they should review with their Medical staff the requirement for physician documentation for residents discharged or transferred in the specific circumstances described in the DAL.

Contact: Elliott Frost, efrost@leadingageny.org, 518-867-8832