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Nursing Homes: When and How to Move Residents to a Higher Level of Care

Chris Murray
Posted on: August 9, 2019 by Chris Murray

Nursing homes have a duty to provide safe accommodations and expert medical care to their residents. Across the country, millions of seniors and at-risk individuals receive care at nursing home facilities. Unfortunately, nursing homes are often limited in the amount and complexity of medical services they can provide to residents. If a resident should need a higher level of care, it is imperative that the nursing home has adequate transfer and discharge protocols in place. Nursing home insurance is only one part of a comprehensive risk management plan, and failure to move residents to a higher level of care when needed represents one of the biggest professional liability exposures nursing homes face in their operations. This guide can help nursing home managers and staff understand their responsibilities by providing details on when and how to transfer residents for the purposes of a higher level of medical care.

Transfers and Discharges: The Basics

It is important to understand that nursing homes have specific legal obligations and rights when it comes to transferring and discharging residents. Residents also have numerous rights granted under state and federal regulations – each designed to protect residents from unexpected and unwarranted discharges. 

Transfers and discharges are typically done to provide better or more complex medical care for a given nursing home resident. Legal reasons why a nursing home would transfer or discharge a patient include:

  • To provide care for a resident’s needs that cannot be met within the existing nursing home facility.
  • Discharging a resident if his or her condition has improved, making service at the facility no longer necessary.
  • To mitigate specific health or safety risks of a resident concerning fellow residents or facility staff members.
  • If the resident has not paid for services or has become unable to continue payment for care. 
  • If the facility should cease operation. 

Even with protections in place, unlawful or illegal discharges have plagued the nursing home industry. In 2015 alone, over 9000 complaints of illegal discharges were reported to the Centers for Medicare and Medicaid Services (CMS), the U.S. agency tasked with overseeing the nation’s nursing home facilities. 

A Higher Level of Care: Necessitating Transfers

Nursing homes do a lot for their residents, and this typically includes basic medical care and monitoring. With the aging population of residents that depend on nursing homes for their care, however, those facilities may not be able to adequately provide the level of care needed. In these cases, nursing homes must transfer patients or discharge them to another facility so they may receive the medical care and treatment they need. 

To enhance the protection afforded by nursing home insurance, nursing homes, and long-term care facilities should develop a discharge/transfer protocol, which often includes an individualized discharge “plan” for residents who must receive medical care outside the nursing home facility. 

A written discharge plan should include:

  • The reason for the transfer or discharge.
  • The date of the transfer or discharge as proposed by nursing home staff.
  • The location to where the resident will be transferred or discharged – typically a hospital, hospice, or intensive care facility.
  • Provisions for a hearing to contest the transfer or discharge.
  • Information about the reservation of bed space and readmission to the nursing home when higher care levels are no longer needed.
  • Contact information for a long-term care Ombudsman or nursing home regulatory agency.

Nursing home residents have many rights, and these rights include the ability to contest a transfer or discharge. For the most part, transfers and discharges go smoothly, with residents being provided a discharge plan in order to receive the best medical care possible. By protecting residents with transfer protocols, nursing home facilities can help to reduce the risks associated with professional liability claims. Nursing home insurance is only one part of the picture; by reducing the potential for legal claims, these facilities can continue to provide safe and adequate care for the people who need it most. 

About Caitlin Morgan

Caitlin Morgan specializes in insuring assisted living facilities and nursing homes and can assist you in providing insurance and risk management services for this niche market. Give us a call to learn more about our programs at 877.226.1027.

Posted in: blog Nursing Home