When a care home says your parent has to leave

The six reasons, and no others

A facility must permit each resident to remain, and may not transfer or discharge them unless one of six things is true.^{Source 1}

1. The move is necessary for the resident's welfare and their needs cannot be met in the facility.
2. The resident's health has improved enough that they no longer need the services the facility provides.
3. The safety of others in the facility is endangered by the resident's clinical or behavioral status.
4. The health of others in the facility would otherwise be endangered.
5. The resident has failed, after reasonable and appropriate notice, to pay for the stay.
6. The facility ceases to operate.^{Source 1}

"Difficult family", "we can no longer manage", "a better fit elsewhere" and "we need the bed" are not among them. Neither is switching from private pay to Medicaid: for a resident who becomes Medicaid-eligible after admission, the facility may charge only allowable charges under Medicaid.^{Source 1}

The non-payment ground is narrower than it is usually presented. It applies where the resident has not submitted the paperwork for third-party payment, or where the payer — including Medicare or Medicaid — has denied the claim and the resident refuses to pay. A disputed bill in progress is not the same thing as a refusal.^{Source 1}

The notice, and what it must say

The move must be preceded by written notice to the resident and their representative, in a language and manner they understand, at least 30 days before the transfer or discharge. A copy must go to the Office of the State Long-Term Care Ombudsman.^{Source 2}

• The reason for the transfer or discharge.
• The effective date.
• The location the resident is being moved to.
• A statement of appeal rights — including the name, postal and email address and telephone number of the body that receives appeals, how to obtain the appeal form, and how to get help completing and submitting it.
• The name, postal and email address and telephone number of the State Long-Term Care Ombudsman.^{Source 2}

A phone call asking you to collect your mother by the weekend satisfies none of this. Shorter notice is permitted only in narrow cases — danger to others, an urgent medical need, or the resident's health improving enough to allow a quicker move — and even then it must be as soon as practicable and in writing.^{Source 2}

The appeal, which stops the clock

This is the provision that changes outcomes: the facility may not transfer or discharge the resident while the appeal is pending. The only exception is where keeping them would endanger the health or safety of the resident or others — and the facility must document that danger.^{Source 1}

1. Ask for the notice in writing if you have only been told verbally. Everything else depends on it existing.
2. Call the State Long-Term Care Ombudsman. They should already have a copy of the notice, the service is free, and this is precisely what they are for. If they have not received a copy, that is itself a failure worth reporting.
3. File the appeal within the deadline stated on the notice. Filing is what freezes the move — an intention to appeal does not.
4. Keep the notice, the envelope and a note of every conversation with dates and names. Appeals turn on what was said and when.

The hospital stay, which is how most beds are actually lost

More placements end here than end with a discharge notice. The resident goes into hospital, the home fills the bed, and the family is told there is nothing to be done.^{Source 3}

• Before the transfer, the home must give written information about the state bed-hold policy, the reserve-bed payment policy under the state plan, and the home's own bed-hold policy.
• At the time of the transfer, it must give a second written notice specifying how long the bed will be held.
• If the hospital stay outlasts the bed-hold, the resident still has a right to return — to their previous room if it is available, or immediately upon the first availability of a bed in a semi-private room — where they still need the facility's services and remain eligible for Medicare or Medicaid coverage of them.^{Source 3}

And if the home decides the resident cannot come back at all, that is a discharge. The six reasons, the written notice, the ombudsman copy and the appeal rights all apply to it — a refusal to readmit is not a separate category with fewer protections.^{Source 3}

What they have to tell you, and when

Families usually find out late — a fall on Tuesday mentioned on Friday, a medication changed and noticed at the next visit. The rule is not that. On an accident causing injury with the potential to need a doctor, a significant deterioration, a significant change of treatment, or a decision to transfer or discharge, the home must immediately inform the resident, consult their physician, and notify the resident's representative.^{Source 4}

A change of room or roommate is a lesser duty but still a duty: prompt notice to the resident and the representative. And the home is separately required to keep the representative's postal address, email and phone number on file and up to date — so a home explaining that it had no way to reach you has failed a second requirement while failing the first.^{Source 4}

Ask, in writing, to be recorded as the resident representative and give all three contact routes. It is a two-minute request that converts most of this page from something you have to chase into something that arrives.

Complaining, in a way that produces a document

A grievance is not a conversation with the ward manager. It is a defined process with a defined output, and using the word deliberately changes what you are entitled to. A resident may raise one about care given and care not given, about staff behavior and about other residents, orally or in writing, anonymously, and without discrimination or reprisal.^{Source 5}

What it produces is the point. You are entitled to a written decision, and the regulation prescribes its contents: the date the grievance was received, a summary of it, the steps taken to investigate, the findings, whether it was confirmed or not confirmed, any corrective action taken or to be taken, and the date the decision was issued. A home must also give you the name and contact details of its grievance official, a reasonable expected timeframe, and the contact details of the outside bodies you can complain to instead.^{Source 5}

The home may not discourage you from going outside it. The rule bars a facility from prohibiting or in any way discouraging communication with surveyors, health department staff, the Long-Term Care Ombudsman or the protection and advocacy agency — expressly including matters that are subject to an arbitration agreement. Signing one at admission did not close that door.^{Source 6}

In practice the useful sequence is: raise it as a grievance in writing, ask for the written decision by name, and copy the ombudsman at the same time. The ombudsman is free, independent of the home, and is the body most likely to get a straight answer quickly.