Nursing Home Residents With Endangering Behaviors and Mental Health Disorders May Be Vulnerable to Facility-Initiated Discharges

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, including the reasons cited for discharges, shared characteristics among discharged residents, and the locations to which residents were discharged.

What OIG Found

Nursing homes discharged 72 of the 126 residents in our review because of behaviors that endangered them or others in a facility. In most cases, the residents exhibited aggressive or violent behaviors.

Prior to discharging these residents, nursing homes most commonly tried changing medications and counseling.

Residents discharged due to behaviors shared some characteristics such as a mental health disorder and admission for long-term versus short-term care.

Nursing homes also initiated discharges for residents who failed to pay for a stay (33 of 126) or residents whose health improved and no longer needed facility services (13 of 126).

Lastly, most residents in our review were discharged to acute-care hospitals, and 10 residents were discharged to an unknown location, a nonspecific location, or a hotel.

What OIG Concludes

Our findings highlight the challenges that nursing homes face in caring for residents with mental health disorders as well as raise questions about nursing homes’ admissions of and capacities to care for these residents. More research is needed into how to provide safe and effective long-term care for residents with mental health disorders and behaviors, especially as the demand for such care grows. To that end, the new Center for Excellence for Behavioral Health in Nursing Facilities, established by the Substance Abuse and Mental Health Services Administration in partnership with CMS, holds promise.