A nursing facility’s obligation and responsibilities relating to resident discharge and re-admission practices
As you may recall from a well-publicized matter in the past year, BroadlawnsMedicalCenter filed a lawsuit against GrangerNursing & RehabilitationCenter alleging that the facility had improperly discharged a resident and refused to re-admit a resident following hospitalization. Granger denied Broadlawns’ allegations and asserted that the resident’s treating physician had not authorized the readmission of the resident. Following negotiations, Granger and Broadlawns have reached an amicable resolution, and the lawsuit has been dismissed.
While this matter has been resolved, the lawsuit should serve as a reminder of a nursing facility’s obligation and responsibilities relating to resident discharge including re-admission practices.
All nursing facilities are subject to the discharge procedures contained in 481 I.A.C. 58.40. ( In addition, nursing facilities that participate in the Medicaid/Medicare programs are subject to the discharge provisions contained in 42 C.F.R. 483.12 (F201 –F203). (
Prior to initiating a transfer of a resident, the facility must first provide 30-day written notice to the resident pursuant to the requirements set forth in 481 I.A.C. 58.40. and 42 C.F.R. 483.12(a)(4). This notice affords the resident the option of appealing the proposed transfer.
Both state and federal regulations provide for an expedited transfer process. Pursuant to 58.40(1)(c), the 30-day requirement shall not apply if an emergency transfer or discharge is mandated by the resident’s health care needs and is in accord with the written orders and medical justification of the attending physician. Emergency transfers or discharges may also be mandated to protect the health, safety, or well-being of other residents and staff from the resident being transferred.
Even in the circumstances of an emergency discharge, written notice must still be given to the resident pursuant to 58.40(1)(n), which requires that the resident must still be given a written notice prior to or within 48 hours following transfer or discharge.
In circumstances where a resident has been hospitalized and the treating physician has authorized readmission back to a nursing facility, even if a nursing facility questions whether the resident is appropriate for re-admission, the protocol that the Department mandates is that the facility readmit the resident before commencing involuntary discharge proceedings (either 30 day notice or emergency discharge based on the circumstances of the resident).
Resident discharge and re-admission practices1
Many facilities have written transfer agreements with hospitals that likewise require a nursing facility to re-admit a resident who was hospitalized for medical treatment.
It is not appropriate to refuse readmission of a resident, and such action may result in a complaint investigation, the possibility of a deficiency and possibly a Class II citation for failing to follow the involuntary discharge proceedings, as well as, civil liability regarding the resident and/or the discharging hospital.
On the other hand, a hospital does not have the right to force re-admission to a facility where the resident’s treating physician has not authorized the re-admission. In such circumstances, the involuntary discharge process is not applicable if an order to re-admission has not been received.
If you have any questions, please contact Kelly Meyers at IHCA, Ken Watkinsor Lynn Boes at the Davis Brown Law Firm, General Counsel for IHCA.
Resident discharge and re-admission practices1