When a Facility May Discharge a Resident

Families receiving one of these notices generally start looking for another facility. The more useful first step is to read which ground is being relied on, because several of the grounds are asserted far more often than they apply.

The permitted grounds

The resident's needs cannot be met there. Which requires the facility to show why, in terms of the resident's actual clinical needs rather than of staffing convenience.

The resident's condition has improved. So that the level of care the facility provides is no longer required, which is a clinical judgment that can be tested.

Safety or health of others. Where the resident's presence endangers others, which is a serious ground and one that requires documentation rather than assertion.

Non-payment after reasonable notice. Narrower than it sounds, and generally not applicable where an application for public funding is pending.

Or the facility is closing. Which is a different situation with its own requirements about relocation and notice.

What the notice must do

State the ground relied on. Specifically, since a notice that does not identify which of the permitted grounds applies gives nothing to answer.

Give the reasons. The facts said to establish the ground, rather than a restatement of the ground itself in the facility's own words.

Say where the resident is to go. A named destination, since a discharge to nowhere is not an orderly transfer.

Explain the right to object. Including how, by when and to whom, which is the information families most often find missing.

And generally be given in advance. With a defined minimum period, subject to limited exceptions for genuinely urgent health and safety situations.

The obligations that accompany a discharge

A safe and orderly transfer. Which means preparation, information passed to the receiving facility, and attention to the effect on the resident.

Preparation of the resident. Explaining what is happening in terms they can follow, which matters particularly where cognition is impaired.

Bed-hold rules for hospital stays. Where a resident is temporarily in hospital, since a facility cannot simply treat the absence as an ending.

Continuity of care. Records, medication and care plan information transferred, on the basis discussed in care planning and participation.

And no reprisal. Since a discharge that follows a complaint invites an obvious question, and retaliation is separately prohibited.

What to do on receiving one

Read the ground first. Because everything else follows from which one is asserted, and several are asserted more often than they apply.

Note the objection deadline. Which is on the notice, and which is the only thing that has to be done immediately.

Object in time. Since the resident generally stays in place while an objection is pending, as set out in appealing a discharge notice.

Contact the ombudsman the same day. Free, fast, experienced in exactly this, and able to intervene in a way families cannot.

And do not agree to move meanwhile. Because a voluntary move ends the protection that an objection would otherwise provide.

The situations that recur

Discharge during a pending funding application. Which is frequently improper, and is one of the strongest positions from which to object.

Discharge after a hospital admission. Where the facility declines to take a resident back, and the bed-hold and readmission rules in what an admission agreement asks become central.

Discharge said to follow improvement. Where coverage has ended but the resident's needs have not, which is a coverage question rather than a needs one.

Discharge after a complaint. Which raises the reprisal question directly and should be said out loud to the ombudsman.

And discharge where behavior is cited. Which often reflects unmet clinical needs, and where the question is whether the facility has attempted to address them.

The instinct on receiving one of these notices is to comply, because it arrives on letterhead and appears to have already decided something. It has not. It is a proposal on a stated ground, and the ground can be tested.

The most important thing to do on the first day is to object within the period stated, because the resident generally remains in place while an objection is pending. Everything else can follow.

The second is to call the ombudsman, who deals with these notices constantly, can speak to a facility with an authority a family does not have, and costs nothing.

Reading which ground is asserted shapes the whole response. Non-payment during a pending funding application, and improvement that is really the end of a coverage period, are the two most commonly misused, and both have clear answers.

What a family should not do is start moving a relative voluntarily. A move agreed to is a move that cannot be objected to, and the protection that the process offers disappears with it.

And where the notice follows a complaint about care, that sequence should be stated plainly to the ombudsman and the regulator. Retaliation is prohibited, and a facility that has responded to a complaint this way has a considerably larger problem than the original concern.

The wider point is that these notices are proposals within a regulated process, not decisions already taken. Facilities are entitled to make them and residents are entitled to test them, and the process assumes that both will happen. A family that treats the notice as final has removed themselves from a procedure that was built with them in it.

None of that means every notice is improper. Facilities do sometimes encounter residents whose needs genuinely exceed what they can provide, and a transfer in that situation is the right outcome for everybody. What the process asks is that the reason be stated, evidenced and open to challenge, which is a modest requirement and one that a well-run facility meets without difficulty. The notices that cause real damage are the ones nobody tested, issued on a ground that would not have survived a question.