Resident rights: transfers, discharges, and how to fight one

If you or a family member lives in a nursing home that accepts Medicare or Medicaid, federal law protects your right to stay there. These protections come from the Nursing Home Reform Act and its rules at 42 CFR Part 483, Subpart B. Under those rules, a facility may only make a resident leave for a short list of specific reasons, and it must follow a strict process before doing so.

Two words matter here. A transfer means moving a resident out of the facility to another place, such as a hospital or a different nursing home. A discharge means ending the resident's stay entirely. When the resident does not agree to the move, it is called an involuntary transfer or discharge, and that is what this guide covers.

Here is the key point: a nursing home cannot make you leave because staff find you "difficult," because your family asks a lot of questions, or because you switch from paying privately to paying through Medicaid. Improper discharge is one of the most common complaints that state Long-Term Care Ombudsman programs receive every year, so if this is happening to you, you are not alone and you have real options.

Under 42 CFR 483.15(c), a facility must let a resident stay and may not transfer or discharge the resident unless at least one of these six things is true:

1. Your welfare requires it. The move is necessary for your own welfare, and your needs cannot be met in the facility.
2. Your health has improved. You have gotten well enough that you no longer need the services the facility provides.
3. Safety is endangered. The safety of other people in the facility is endangered because of your clinical or behavioral status.
4. Health of others is endangered. The health of other people in the facility would otherwise be at risk.
5. Nonpayment. You have failed to pay (or to have Medicare or Medicaid pay) after the facility gave you reasonable and appropriate notice. Important: if you have applied for Medicaid and the application is still being processed, that counts as arranging payment. "Medicaid pending" is not nonpayment.
6. The facility closes. The facility stops operating.

That is the entire list. The facility must document the reason in your medical record. For the first two reasons, your own physician must be the one who documents the need. If the reason you are given does not fit one of these six, the discharge is not lawful, and you can challenge it.

Before an involuntary transfer or discharge, the facility must give written notice to you and, if known, to a family member or your legal representative. The notice must be in a language and manner you understand.

Timing. In general, the notice must come at least 30 days before the move. Shorter notice is allowed only in limited situations, such as when someone's health or safety is in immediate danger, when your health has improved enough to allow a quicker move, when your urgent medical needs require it, or when you have lived in the facility for fewer than 30 days.

Contents. The written notice must include all of the following:

• The specific reason for the transfer or discharge
• The date it will take effect
• The exact location you are being sent to
• A statement of your right to appeal to the state, and how to do it, including the deadline and where to send the appeal request
• The name, address, and phone number of the state Long-Term Care Ombudsman
• Contact information for the protection and advocacy agency, if the resident has an intellectual or developmental disability or a mental disorder

The facility must also send a copy of the notice to the Ombudsman's office. A verbal warning, a note on a whiteboard, or a phone call to a family member does not meet these requirements. If the notice is missing required information, that by itself can be grounds to win an appeal.

Every resident has the right to appeal an involuntary transfer or discharge to the state. The notice you receive must tell you how. The appeal goes to a state hearing office, not to the nursing home, and a hearing officer who does not work for the facility decides the case.

Practical steps:

1. Act fast. File the appeal as soon as you can, and before the discharge date on the notice. In many states, filing before the discharge date means the facility generally cannot move you while the appeal is pending, except in emergency situations. Deadlines vary by state, so read the notice carefully.
2. Keep everything. Save the notice, envelopes, and any letters or messages from the facility.
3. Get help. Call the state Long-Term Care Ombudsman listed on the notice. Ombudsman services are free, and advocating in discharge cases is a core part of their job. A legal aid attorney can also represent you at the hearing, often at no cost.
4. Do not move out voluntarily unless you want to. Leaving on your own can weaken your appeal.

This guide explains your rights; it is not legal advice. If you are facing a discharge date, contact the Ombudsman or a legal aid office right away rather than trying to handle a hearing alone.

A common improper practice works like this: a resident goes to the hospital for a few days, and when they are ready to come back, the nursing home says the bed is gone or refuses to readmit them. Advocates call this hospital dumping. Federal rules address it directly.

• Bed-hold notice. Before, and again at the time of, a hospital transfer or therapeutic leave, the facility must give you written information about its bed-hold policy and about any state Medicaid bed-hold coverage, which varies by state.
• Right to return. If you are eligible for Medicaid and your hospital stay lasts longer than the bed-hold period, the facility must readmit you to the first available bed in a semi-private room, as long as you still need its services and remain eligible for payment.
• A refusal to readmit is a discharge. If the facility will not take you back, that counts as an involuntary discharge. You are entitled to the same written notice and the same appeal rights described above, and you can appeal while you are still in the hospital.

If a facility tells a hospital discharge planner that it will not take a resident back, the family should ask for that refusal in writing and call the Ombudsman the same day.

State inspectors cite nursing homes for violating these rules, and those citations appear in the official inspection records that this site translates into plain language. Discharge-related citations fall in the F-622 through F-625 family:

When you look up a facility on this site, citations in this family are a signal worth taking seriously, especially repeat citations across multiple inspections. They do not prove a facility would mishandle your situation, but they show how it has handled residents' departure rights in the past.

You do not have to fight a discharge alone. Free and low-cost help exists in every state:

• Long-Term Care Ombudsman. Every state has an Ombudsman program, funded under the Older Americans Act, that advocates for residents at no charge. Their contact information must appear on your discharge notice, and you can also find your local program through the Eldercare Locator.
• Legal aid. Legal aid organizations and some state bar programs handle nursing home discharge appeals for free for residents who qualify.
• The state survey agency. If you believe the facility broke the rules, you can file a formal complaint with the state agency that inspects nursing homes. Our guide on how to file a complaint walks through the process step by step.
• Understand your payment rights. Many discharge disputes start with confusion about coverage. Our guide to Medicare vs. Medicaid in nursing homes explains who pays for what and how switching payment sources works.

This site translates official government records and explains your rights in plain language. We do not recommend facilities, and nothing here is legal advice. For a decision about your specific situation, talk to the Ombudsman or an attorney.