Mary Madison, RN, RAC-CT, CDP
Clinical Consultant – Briggs Healthcare
“Nursing homes can legally discharge residents for certain reasons (known as facility-initiated discharges). Facility-initiated discharges that do not comply with regulations (i.e., inappropriate facility-initiated discharges) can be unsafe and a traumatic experience for the resident; media reports have highlighted the rise in these discharges. For example, the police found one resident on the streets after a nursing home discharged the resident to an unlicensed boarding house without notifying the resident’s family. In addition, State Ombudsmen have cited “discharge/eviction” as the top complaint from 2013 through 2019. Given concerns about inappropriate facility-initiated discharges and the risk to vulnerable nursing home residents, efforts to reduce these discharges warrant (OIG) examination.”
“The magnitude of facility-initiated discharges in nursing homes remains unknown. Many challenges exist to identifying and addressing inappropriate facility-initiated discharges, including that neither ACL (Administration for Community Living) nor CMS collect data on the number of facility-initiated discharges, and many State Ombudsmen do not count or track the notices they receive. Nursing homes must send facility-initiated discharge notices to State Ombudsmen, but ACL does not collect data on these. State Ombudsmen reported facing challenges while responding to facility-initiated discharges, such as nursing homes sending facility-initiated discharge notices that lack required information. Moreover, the COVID-19 pandemic exacerbated challenges. In addition, Ombudsmen, CMS, and State agencies may differ in their perspectives on regulations and enforcement of facility-initiated discharges. Following CMS’s initiative to review and take appropriate enforcement action in cases of noncompliance with facility-initiated discharge requirements, State agencies cited many more nursing homes for not complying with notice requirements for discharges in 2018. CMS has not yet determined the trends and outcomes of its initiative. (OIG) findings raise concerns about weaknesses in the safeguards to protect nursing home residents from harm that may result from inappropriate facility-initiated discharges.”
Agency comments on the OIG recommendations are found in Appendix A. Be sure to review the CMS Administrator letter to OIG found on pages 28 through 30.
I strongly encourage you to review this OIG study with your team and colleagues. Is your facility/community processing facility-initiated discharges properly??