The following information is based on federal regulations that apply to all nursing homes receiving Medicare or Medicaid funding. This is for informational purposes only and should not be taken as legal advice. If you feel your rights or the rights of your loved one in long-term care have been violated seek professional legal advice on how to proceed.

While federal regulations are public domain, this comprehensive interpretation, organization, and family-friendly presentation is © 2025 NursingHomeFamilyCouncil.com. All rights reserved. Distribution and linking permitted with attribution intact.

Your Loved One’s Rights in Long-Term Care

Admission, Transfer & Discharge Rights

Moving into, within, or out of a nursing home can be stressful and confusing. Federal law protects your loved one during these transitions. This guide explains when facilities can and cannot move residents, what notice they must give, and how you can appeal their decisions.

Admission Rights & Equal Treatment

Family reviewing admission paperwork with nursing home staff

Who Cannot Be Denied Admission

Nursing homes cannot refuse to admit your loved one based on:

  • How their care is paid for – Medicare, Medicaid, private pay, or insurance
  • Race, color, religion, or national origin
  • Age, gender, or sexual orientation
  • Disability or medical condition – unless they cannot provide the needed care
  • Previous complaints against nursing homes

Valid Reasons for Admission Denial

Facilities can only refuse admission if:

  • No beds available in the appropriate care level
  • Cannot provide needed care safely and effectively
  • Admission would endanger other residents’ health or safety

What You Should Receive

Before or during admission, you must get:

  • Written copy of all residents’ rights
  • Clear explanation of services included in daily rate
  • List of additional charges and what they cover
  • Contact information for state ombudsman and inspection agency
  • Advance directive information and forms if wanted

Important: If admission is denied, ask for the reason in writing. If you believe the denial was discriminatory, contact your state health department immediately.

Federal Authority: 42 CFR §483.15(b) – Admission Rights
→ Violation Remedies if admission rights are being violated

When Your Loved One Can Be Moved or Discharged

Family meeting with nursing home administrator about transfer

Legal Reasons for Transfer or Discharge

Your loved one can only be transferred or discharged for these reasons:

  • Medical needs cannot be met at the facility
  • Health or safety of other residents is endangered
  • Non-payment after reasonable notice and opportunity to pay
  • Facility stops operating
  • Your loved one’s needs improve and they no longer need nursing home care
  • Your loved one chooses to leave

Invalid Reasons – Facility CANNOT Discharge For:

  • Convenience – “easier” residents to care for
  • Filing complaints or exercising rights
  • Medicaid application pending or approved
  • Family disagreements with staff
  • Behavioral issues related to their medical condition (unless safety risk)
  • Staff shortages or facility financial problems

Required Notice

The facility must give 30 days written notice before transfer or discharge, except:

  • Medical emergency – immediate transfer needed
  • Safety emergency – immediate danger to others
  • Your loved one requests immediate discharge

Even in emergencies, written notice must be given as soon as reasonably possible.

What the Notice Must Include

  • Specific reason for transfer or discharge
  • Effective date of the action
  • Location where your loved one will be moved (if known)
  • Right to appeal and how to request a hearing
  • Contact information for state ombudsman
  • Medicaid information if payment is the issue

Federal Authority: 42 CFR §483.15(c) – Transfer and Discharge Rights
→ Violation Remedies if transfer/discharge rights are being violated

How to Fight Unfair Transfers or Discharges

Family with legal documents appealing nursing home decision

Your Right to Appeal

If you disagree with a transfer or discharge decision, you can:

  • Request a hearing with your state
  • Stay the discharge – your loved one can usually remain during the appeal
  • Get free help from the state ombudsman
  • Request legal aid if you qualify

How Appeals Work

  1. File immediately – appeals must be filed quickly (usually within 10 days)
  2. Request stay – ask that your loved one remain while appeal is pending
  3. Gather evidence – medical records, care plan, incident reports
  4. Get support – ombudsman can help navigate the process
  5. Attend hearing – present your case to an independent reviewer

Preparation Requirements

Before any transfer or discharge, the facility must:

  • Develop discharge plan with your loved one and family
  • Ensure safe placement – appropriate care available at new location
  • Provide information about care options
  • Give sufficient preparation time – 30 days unless emergency

Remember: Most discharge appeals are successful when the facility didn’t follow proper procedures or doesn’t have valid medical reasons.

Federal Authority: 42 CFR §483.15(c)(4) – Appeal Rights
→ Violation Remedies if appeal rights are being violated

Hospital Transfers & Return Rights

Elderly person returning from hospital to nursing home

When Your Loved One Goes to the Hospital

If your loved one is hospitalized, they have the right to:

  • Keep their room for a certain number of days (varies by state)
  • Return to the same room when medically ready
  • Written notice of bed hold policies before hospitalization
  • Readmission to the first available bed if bed hold expires

Bed Hold Policies

The facility must tell you:

  • How many days they will hold the bed
  • Whether you pay for bed hold days
  • What happens if the hold period expires
  • Your right to return to the first available bed

Medicaid Coverage

If your loved one has Medicaid:

  • Bed hold period is set by your state (usually 10-15 days)
  • No payment required during bed hold
  • Readmission guaranteed to first available bed if hold expires
  • Same room preference when possible

Important: Get bed hold policies in writing before any hospital transfer. Ask specifically about Medicaid rules in your state.

Federal Authority: 42 CFR §483.15(e) – Bed Hold Policy
→ Violation Remedies if bed hold rights are being violated

Emergency Preparedness & Your Safety

Nursing home emergency evacuation plan meeting

What Facilities Must Have

Every nursing home must maintain:

  • Emergency plan for natural disasters, power outages, and other emergencies
  • Evacuation procedures – how to safely move residents if needed
  • Communication system – how to contact families during emergencies
  • Staff training – regular emergency drills and preparation
  • Supply management – food, water, medications for several days

Your Family’s Role

You have the right to:

  • Know the emergency plan – ask for a copy
  • Update contact information – ensure they can reach you quickly
  • Discuss special needs – medical equipment, medications, mobility issues
  • Emergency contacts – provide multiple people they can call

During Emergencies

The facility must:

  • Notify families as soon as safely possible
  • Track all residents – know location of everyone at all times
  • Maintain medical care – continue medications and treatments
  • Coordinate with authorities – work with emergency responders
  • Document everything – keep records of actions taken

Questions to Ask

  • What types of emergencies is the facility prepared for?
  • How will you contact me during an emergency?
  • Where would residents be moved if evacuation is needed?
  • How do you handle residents with special medical needs?
  • When was your last emergency drill?

Take emergency preparedness seriously – natural disasters and power outages can happen anywhere. Make sure the facility has solid plans to keep your loved one safe.

Federal Authority: 42 CFR §483.73 – Emergency Preparedness
→ Violation Remedies if emergency preparedness standards are being violated

Warning Signs & When to Take Action

Family advocating for nursing home resident rights

Red Flags for Improper Discharge

Contact authorities immediately if the facility:

  • Threatens discharge for filing complaints
  • Demands immediate payment of large sums to avoid discharge
  • Gives less than 30 days notice without valid emergency
  • Cannot explain medical reasons for discharge clearly
  • Pressures you to find placement without helping
  • Refuses to provide required written notice

Emergency Action Steps

If facing immediate discharge:

  1. Request written notice – don’t accept verbal notice
  2. Call state ombudsman immediately
  3. File appeal within required timeframe
  4. Request stay – ask to remain during appeal
  5. Document everything – save all papers, take notes
  6. Contact legal aid if available in your area

Getting Help

Contact these resources for immediate assistance:

  • State Long-Term Care Ombudsman – free advocacy and help with appeals
  • State Health Department – file complaints about violations
  • Legal Aid Organizations – free legal help for qualifying families
  • Area Agency on Aging – local resources and support

Don’t wait if you’re facing discharge – many rights have short deadlines. Act quickly and get help from experts who know the system.

Connect with other families who have successfully fought unfair discharges: Join our community to share strategies and get support.

Federal Authority: Multiple sections of 42 CFR §483.15
→ Violation Remedies for comprehensive guidance on violations