Dumped: When nursing homes abandon patients to the hospital

Margie is an 86-year-old nursing home resident who has developed a bladder infection. As is the case with many elderly women, she also is confused as a result. On her way out the door to a hospital, she struggles and yells that “they better not tell anyone else” about why she is going to the hospital. When her elderly, out-of-state family members call to check on Margie, they are told that the Health Insurance Portability and Accountability Act (HIPAA) prevents staff from saying anything.

Five days later, when Margie’s fever is down and she is lucid and ready for discharge, she calls the nursing home—and is told she can’t come back. She calls her family in a panic, only to learn that they had no idea where she was. Margie wasn’t poor, at least not until about 2 years in the nursing home, which consumed all of her savings, including the money she realized in selling her home. Everything was gone except Social Security and a tiny pension (not enough to even begin to cover the nursing home charges).

Once Margie was hospitalized, the nursing home cleared out her room, packed her belongings, and refused to take her back, all without any advance warning. This process is as illegal as it is reprehensible. And, by the way, HIPAA was never intended to keep family members of confused patients in the dark.

An illegal practice

Unfortunately, some nursing homes regularly evict residents illegally. No illegal eviction method is more frustrating than the hospital dump. In such a scenario, a nursing home has a resident transferred to a hospital for some acute care need. Then when the time has come for the resident to be discharged, the nursing home refuses re-admittance, often claiming, “the bed is already filled.”

When a hospital discharges a patient, and the nursing home won’t take him or her back, it’s called “hospital dumping.” The dumping of mostly low-income nursing-home patients (or those who have become low-income because the nursing home has already taken all the money they have) is a growing problem, one involving a complicated interaction among nursing homes that complain of low Medicaid payments, hospitals put on the spot to find another facility to take the person, and frail elders and their families.

Here are the facts: When a nursing home resident is transferred to a general acute care hospital, federal and state rules require the bed be held for up to 7 days. If the hospitalization exceeds 7 days, the facility must nonetheless provide the resident with the first available bed in the nursing home after he or she is cleared for return.

The purpose of the legally mandated bed-hold is obvious: Residents who need to go to the hospital for acute care should not have to worry about losing their placement in their nursing home as a result. Federal law requires skilled-nursing facilities to give residents 30-days notice if they want a resident to leave.

Nursing-home administrators have various reasons for hospital dumping: perhaps the residents require more care or have behavioral issues, such as emotional agitation or abusive outbursts. One thing is sure, the residents either don’t have any money—or they have run out of the money they had.

Whatever the reason, the nursing home just leaves the resident in the hospital. According to law, if a nursing home can’t meet a resident’s medical needs, the nursing home staff should call the state department of health and senior services. But it’s quicker and cheaper (for the nursing home) to simply dump the patient on the hospital.

Nursing facilities have even told a hospital that a patient could not return because his or her cost of care was higher than the state Medicaid rate. And the nursing homes complain that they have too many of these types of residents already—if they keep every difficult low-income case, they will go broke.

Resolutions and solutions

Helping a dumped patient usually starts when a hospital social worker asks the nursing-home administrator for confirmation that a patient was given due notice; it is surprising just how many nursing home administrators are not aware that a patient must receive 30 days notice before being evicted. Patients who are wards of the state are among the prime candidates for getting dumped, primarily because these elders typically have no family members and often have legal guardians appointed by the state, usually attorneys. When residents go to a hospital, their guardians should be notified but rarely are.

Rules being broken without consequence

Nursing home abuse lawyers say that facilities around the country are breaking the rules when it comes to evicting nursing home residents. Those rules, as defined by the Code of Federal Regulations (CFR) 42 CFR 483, require that facilities must permit residents to remain unless:

  1. The transfer or discharge is necessary for the resident’s welfare and the resident’s needs cannot be met in the facility;
  2. The transfer or discharge is appropriate because the resident’s health has improved sufficiently so the resident no longer needs the services provided by the facility;
  3. The safety of individuals in the facility is endangered;
  4. The health of individuals in the facility would otherwise be endangered;
  5. The resident has failed, after reasonable and appropriate notice, to pay for (or to have paid under Medicare or Medicaid) a stay at the facility. For a resident who becomes eligible for Medicaid after admission to a facility, the facility may charge a resident only allowable charges under Medicaid; or
  6. The facility ceases to operate.

When one of the above occurs, federal law also requires everything to be documented to avoid foul play. Unfortunately, many facilities simply don’t follow those rules and transfer or discharge patients they just don’t want to care for anymore. There have been numerous reports of nursing home facilities falsely accusing residents of violence, forging documentation in order to get rid of unwanted patients or, believe it or not, dumping patients into a hospital emergency department and then refusing to take them back. Unfortunately, many patients, or their families, don’t know that filing a lawsuit is an option. Not surprisingly, the patients generally are not informed of their right to the 30-day eviction notice.

Nursing home residents who are transferred, dumped, or evicted from long-term care facilities are victims of nursing home abuse. These issues, which are far more common than most people think, are especially troubling because nursing home and assisted living facility residents and their families often simply don’t know they have rights and can fight back. Nurses, as patient advocates, ought to know this—and all discharge planners need to be aware of both the practice and the patient’s rights. Ultimately, the responsibility resides with the state, and until the state has been informed and other arrangements made, the patient must not, ever, just be dumped—by nursing home or hospital.

Leah Curtin is Executive Editor, Professional Outreach for American Nurse Today and a consultant with CGFNS International in Philadelphia, Pennsylvania.

11 COMMENTS

  1. They can do even worse things. The facility my mother’s been in for the past two months has made it clear since the beginning they were not happy to have her there. She’s competent mentally, but she has spine problems that have left her wheelchair bound (on bad days, bedbound), so she’s a bit more work than a typical nursing home patient. When they try to get her to do things that are contrary to what HER doctors and specialists have her doing at home – she’s got GREAT ones that have kept her very healthy! – she refuses to “play ball” and let them do whatever they want to her. If her meds don’t come within a reasonable time of when they’re supposed to, she calls and asks for them, which is an “inconvenience” to them. Everytime she had so much as a hangnail they tried to send her to the hospital, which she exercised her legal right to refuse to do, since it was not a medical emergency warranting 911 emergency transport. Have tried repeatedly to find another facility to take her, but the referral they send from this facility makes her VERY unattractive to other facilities. A few weeks ago, they tried to send her involuntarily to the local hospital for a psych hold, claiming that because she refuses some care she’s a danger to herself and others in the facility. Local hospital sent her right back, and called me to ask why she had even been sent there! The psych nurse that evaluated her told me yes, she’s opinionated and using her legal rights, but that doesn’t make her mentally ill. Yesterday, they got a police officer to come in and force her against her will to be taken to a hospital over an hour away, in a very unsafe neighborhood, which has a reputation for being a dumping grounds for patients the care facilities do not want. She was admitted to the medical/psych ward, and their psychiatrist, whose online ratings are beyond bad, decided this morning that she’s making “poor decisions” and is no longer competent to make her own decisions. I’m her health care POA, and of course the NH did not send those papers with her to the hospital. Conveniently. Been trying to fax them to the hospital all morning with no luck, was just told, well, bring them up here. I’m disabled, we got 6″ of snow last night, and I can’t even get to my van. They are talking about pulling out her insulin pump, her catheter, and her PICC line and forcing her to take psych meds we ALL (even the ambulance crew who took her because the cop forced them to) know she does not need. She’s had almost none of her meds for the past day and a half, the food they brought her (no choice) was inedible, and she’s in tremendous pain from the spine problems that’s chronic. They don’t check her blood sugar regularly, she has NO call light – they only check on her every 4 hours to make sure she’s still alive – and are using skin cleansing wipes on her that she is allergic to even after I asked them repeatedly by phone not to. I was told she’s only allowed one phone call a day but could have visitors and they could bring food. I can’t get there, and have no other family in the area. Ombudsman is no help, the facility is stonewalling her – they didn’t even give Mom the copy of the forms as required by law about the transfer – and she just told me, well, they’re supposed to send me the forms today. Asked for referral for Legal Aid lawyer (ombudsman works with legal aid), and she said, well that takes time and no guarantee that any of the lawyers can help her. Don’t know what to do and any suggestions would be welcome. We’re in IL (Chicago area actually), if that makes any difference. TIA

  2. My mother entered into an assisted living facility on February 25th. February 26th we were called in the middle of the night saying that my mother was wandering. She was taken to the hospital and found she had an undetected UTI. She was in rehab for a month. The assisted living facility took her back. This happened in the year she was there. The assisted living facility kept taking her back. Her estate is now drained and she is on temporary medicaid. She had to go to the hospital again for a UTI and was in rehab. The assisted living facility is now refusing to take her back saying they can no longer meet her needs. I think it may be the other way around. She can no longer meet their needs as her estate is now drained! Our family has been through quite an ordeal and a lot of hardship with this happened. My mother had tragedy’s in her life beyond anyone’s belief. Now in her final days she has to go trough this. And her family has to suffer as well.

  3. Just recently Kindred Hospital of SF Bay Area dumped my niece by not giving her advanced notice of an appointment made for her to go to Kaiser, her health plan hospital to receive a minor procedure again and refusing to accept her back one day later when the patient care coordinators of Kaiser contacted kindred to arrange the patient’s return. Kindred failed to give my niece a 30 days notice as well. Now my niece is stranded at Kaiser while they work tirelessly to find her a bed in a subacute facility. My niece never had time to mentally, emotionally or psychologically or spiritually prepare for being transported for another procedure with a 1 hr. notice that transport will be there for her within the hour from informing her. My niece has a muscle disease and is on a tracheotomy as well as she has a feeding tube. My niece needs to be in a subacute close in distance to her children and aunt who gives her the socioemotional and pschoemotional support as well as some informal type care on a daily basis. They are looking for any place to now take her which might even be long distance where family cannot physically advocate and see how she is really doing as they were accustomed up until now. If anyone can help her enforce that Kindred accept her back just until family and Kaiser can find her a suitable subacute within the local geographical area near family who can participate in her healing process which is very crucial to the patient. Please reach out by text to (510) 707-0575. Thank you.

  4. Please help. A nursing home where my father was placed in Puerto Rico just contacted the family which live in the United States are accusing us ob abandoning our father there. We seeked help at this nursing home because he was defiant and he was injured when he tried to escape the nursing home. Please advise me.

  5. This was just attempted last night by a faith-based care centre in western Canada. The hospital emergency room was full of elderly women on stretchers, two days before the 15th day of the month on the billing cycle. The care centre would not explain the circumstances to the family, but they’d already called the government official to make arrangements for reassigning her room before the ambulance left the building. The ER doctor saw through this tactic, and returned her without admission to the hospital. I overheard the care centre nurse arguing on the phone, but it was an argument lost. A person simply is not having a “heart attack” when their blood oxygen level is 98 percent and their skin has a healthy glow. What kind of nurse doesn’t know this? ER doctors can and do stop this nonsense, thank goodness.

  6. I’m afraid that this is happening with my brother right now. He was transferred to the hospital last Friday, 12 21-18. Now he is stuck there until at least Wednesday, the day after Christmas! They are saying that the social worker has to re-apply for him to go back to the nursing home. If they refuse him, what should my first step be? Thank you.

  7. This sucks for the hospital too. Especially so if it’s a patient who doesn’t have any legitimate acute care needs (I.E. Granny was being combative today, so we call 911 and say she ‘had a fall’ or has ‘generalized weakness’ and dump her on the hospital. Hopefully, I can punch out before she gets back”).

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