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Concerns Remain About Safeguards To Protect Residents During Facility-Initiated Discharges From Nursing Homes

Issued on  | Posted on  | Report number: OEI-01-18-00251

Why OIG Did This Review

  • Facility-initiated discharges that do not follow Federal regulations can be unsafe and traumatic, leading to resident harm.
  • CMS and State Long-Term Care Ombudsmen have raised concerns about the extent to which nursing homes follow Federal requirements for these discharges.
  • This review provides insights into a sample of facility-initiated discharges from nursing homes and the extent to which these discharges followed Federal requirements.

What OIG Found

In most (107 out of 126) of the facility-initiated discharge cases in our review, nursing homes discharged residents for allowable reasons; however, our review raises concerns about nursing homes’ understanding of and compliance with notice and documentation requirements for facility-initiated discharges.

  • Nursing homes sometimes fell short in providing required documentation, such as documentation that the receiving facility could provide services that meet residents’ needs.
  • Nursing homes often failed to notify residents of their discharges and frequently omitted required information in notices, which may have compromised residents’ rights and abilities to plan for safe transitions.
  • Even when nursing homes provided the resident with a facility-initiated discharge notice, only about half sent a copy of the notice to the Ombudsman, as required, potentially impeding the Ombudsman’s ability to effectively advocate for residents.

We also found that nursing homes struggled to identify facility-initiated discharges, which may present CMS and State survey agencies with challenges in overseeing these discharges during the survey process.

What OIG Recommends

  1. CMS provide a standard notice template to help nursing homes provide complete and accurate information to residents facing discharge and Ombudsmen.
  2. CMS require nursing homes to systematically document facility-initiated discharges in information available to CMS and States to enhance oversight.

CMS did not explicitly state its concurrence or nonconcurrence for the two recommendations.

Centers for Medicare and Medicaid Services
Nursing Homes, Nursing Facilities, and Assisted Living Facilities
Medicare A