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How Do You Get Someone Out of a Nursing Home?

Michael Agruss

Written and Reviewed by Michael Agruss

  • Managing Partner and Personal Injury Lawyer at Mike Agruss Law.
  • Over 20 years of experience in Personal Injury.
  • Over 8000+ consumer rights cases settled.
  • Graduated from the University of Illinois Chicago School of Law: Juris Doctor, 2004.

While most care facilities are wonderful, you may have reason to believe your loved one needs to leave. Determining how to get someone out of a nursing home involves understanding the legal, financial, and medical considerations at play. Families or individuals may decide that a change is necessary for various reasons, including dissatisfaction with the current level of care, improved health of the resident, or a desire for a change in living situation. It is essential to approach this decision with a thorough plan and awareness of the implications to ensure the health, safety, and welfare of the nursing home resident.

The process often requires careful coordination with medical professionals, the nursing home administration, and potentially, legal representatives from Mike Agruss Law. Understanding the necessary steps for a safe transfer is crucial. This might include securing a new residence or at-home care provisions, handling the logistics of the move, and managing the administrative requirements of the nursing home. Each scenario will be unique, hinging on the needs of the individual and the policies of the nursing facility.

Before taking any action, it is imperative to consult with healthcare providers to evaluate whether the nursing home resident’s health condition allows for a safe transition. In many cases, having a contingency plan is advisable to address potential challenges that could arise post-transition. Transparent communication with all parties involved will facilitate a smoother process when moving someone out of a nursing home.

Smiling Nurse Leading Patient

Understanding Nursing Home Facilities

Navigating the landscape of nursing home facilities is critical for ensuring that residents receive the requisite care. From essential services to federal regulations, understanding these fundamental aspects helps in making informed decisions.

Essential Care and Services

Nursing home facilities provide a wide range of health care services, including medical monitoring, physical therapy, and assistance with daily living activities. Skilled nursing facilities specialize in short-term rehabilitative services post-hospitalization, whereas traditional nursing facilities cater more to long-term care needs.

Medical Care: Regular assessments by licensed physicians and 24/7 nursing oversight.

Rehabilitation Services: Physical, occupational, and speech therapies.

Personal Care: Assistance with bathing, dressing, and eating.

Types of Nursing Facilities

There are primarily two types of facilities within the nursing home spectrum:

Nursing Facilities (NFs): They focus on long-term care with a non-medical emphasis, assisting residents with daily activities.

Skilled Nursing Facilities (SNFs): These are for short-term rehabilitative care following a hospital stay, providing specialized medical care.

Each facility type is designed to cater to the specific levels of care its residents require.

Federal Guidelines for Nursing Homes

In the United States, federal guidelines dictate the minimum standards for nursing homes to ensure proper care and safety. The Centers for Medicare & Medicaid Services (CMS) oversees these regulations to assure facilities meet nationwide standards for care. These guidelines cover a range of criteria, including:

  1. Resident Rights: Ensuring respect, dignity, and the right to make informed decisions
  2. Quality of Life: Providing a standard of living that enhances each resident’s quality of life
  3. Staffing: Mandating adequate staff numbers and qualifications

Legal Rights and Considerations

When seeking to move someone out of a nursing home, it is critical to understand the legal rights of the resident and the processes involved in transfers and discharges. Specific laws and regulations protect nursing home residents and dictate the conditions under which an involuntary transfer or discharge may occur.

Resident Rights

Nursing home residents have the right to participate in making their own medical decisions, including the right to refuse treatment. They retain their legal rights and civil liberties when entering a facility. It is essential that the nursing home provides a safe environment, respects the residents’ choices, and endeavors to maintain their quality of life.

Involuntary Transfer and Discharge

Nursing homes can only transfer or discharge residents for specific reasons, such as when the resident’s health has improved to the point that care is no longer necessary or the facility can no longer meet the resident’s needs. In cases where a resident has been involuntarily discharged or transferred, regulations require that they are given a 30-day notice, and they have the right to appeal the decision.

Consulting an Elder Law Attorney From Mike Agruss Law

Those facing an involuntary transfer or any issue regarding a nursing home stay could benefit from consulting an elder law attorney. A Chicago personal injury lawyer from Mike Agruss Law can offer guidance on resident rights, help contest unlawful discharges, and assist in protecting the resident’s interests throughout the transfer process.

Medical and Personal Reasons for Discharge

Discharging a resident from a nursing home is often contingent upon key medical and personal factors which may indicate that the individual could benefit from a different type of care or living arrangement.

Health Issue Resolutions

When a resident’s health improves significantly, they may no longer require the intensive services provided by the nursing home. This could be due to the resolution of specific health issues they were admitted for. For instance, if the individual has recuperated from surgery or recovered from a severe illness, and their medical care needs have decreased, this marks a viable reason for discharge.

Ability to Make Medical Decisions

Another consideration is whether residents can once again make their own medical decisions. The ability to understand and make medical considerations related to their health signifies a level of independence that might support a transition out of the facility. Especially relevant is when an individual regains mental competency which might have been previously impaired due to medical conditions such as dementia.

Financial Aspects and Insurance

When considering the transition of a loved one from a nursing home, it is crucial to understand the financial implications and how insurance factors into the equation. Deciphering the details of Medicare, Medicaid, and private pay can guide families through the financial landscape of nursing home care.

Medicare and Medicaid Coverage

Medicare typically offers coverage for short-term stays in a nursing home, such as for rehabilitation after a hospital stay. It covers certain services for up to 100 days, with the first 20 days fully paid and a co-insurance payment required from the 21st to the 100th day. However, for long-term care, Medicare’s role is limited and does not cover costs for non-skilled, daily living assistance, which constitutes the majority of nursing home care.

On the other hand, Medicaid tends to be the most common way to cover long-term nursing home care costs for those with limited income and assets. As a joint federal and state program, Medicaid can pay the bulk of these costs if the individual qualifies, subject to state-specific rules. Nursing homes that accept Medicaid are available, but it is important to verify that the chosen facility accepts Medicaid before initiating the transition.

Private Pay Considerations

In situations where an individual does not qualify for Medicaid and has exceeded Medicare’s limited coverage, private pay becomes necessary. Families must evaluate their financial resources, which may include savings, retirement funds, and the sale of personal assets. Long-term care insurance, if in place before the need for a nursing home arises, can also offset some of the costs.

Payment plans are sometimes structured on a monthly basis, and the costs vary widely depending on the location and level of care required. In the event of non-payment, a nursing home may initiate discharge procedures, but not without proper notice and planning to ensure the safety and well-being of the resident. Careful financial planning and consultation with elder law attorneys can provide pathways to protect assets while managing nursing home expenses.

Transitioning to Another Care Option

When a resident’s needs change or family members seek alternative living situations, transitioning out of a nursing home into another care setting involves careful consideration of the individual’s health requirements and personal preferences.

Moving from Nursing Home to Assisted Living

Residents may find that an assisted living facility offers a more suitable environment if their medical needs have decreased but they still require some level of support with daily activities. Arranging for a voluntary discharge typically necessitates discussions with the current facility, a thorough assessment of the prospective assisted living community, and ensuring continuity of care during the move. Key considerations include:

  • Level of personal care and medical support provided
  • Costs and payment options
  • Cultural, social, and recreational activities
  • Transportation and accessibility of the new facility

It is important that family members and the resident are in agreement with the move and understand the services offered by the assisted living facility.

Arranging for Private Care at Home

Transitioning to private care at home requires an analysis of the home environment and a plan for accommodating the healthcare needs outside of the nursing home. This often involves hiring caregivers, which might include:

  • Registered nurses
  • Home health aides
  • Personal care attendants

Families should consider the type of care needed (medical, personal, therapeutic, etc), the anticipated schedule (hours per day or live-in care), as well as the financial implications and funding sources.

It is essential to ensure the home setup is safe and accessible to support the resident’s health and mobility. Coordination with existing healthcare providers is also a must for a smooth transition.

If you have any additional questions or concerns, we encourage you to speak directly with an attorney at our law firm specializing in these situations.

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