Involuntary nursing home discharges and transfers are a legitimate problem in the United States. According to the States’ Long-Term Care Ombudsman Programs (LTCOP), one of their top 5 complaints is inadequate discharge planning or improper evictions from nursing home facilities. In fact, annually there are approximately 14,000 complaints of this sort that the LTCOP attempts to resolve. The reasons for involuntary nursing home discharges and transfers vary but may be a result of residents requiring a higher level of care than the nursing home feels equipped to handle, and more commonly, may be due to the end of Medicare coverage.

Nursing home discharges and evictions can of course be a hugely stressful time for residents and their families. It’s important that residents and their families are aware of the resident’s legally protected rights and the steps that they can take to ensure the best-informed choices for their long-term care.

“What is a legitimate and legal nursing home discharge? As a family member, how can you protect your loved one throughout a nursing home’s eviction process? What are the resident’s rights?”

As part of VOYCE’s Community Education Series, Chien Y. Hung, Program Director of VOYCE presented a webinar on these important topics.

What You Need to Know About Leaving a Nursing Home BEFORE You Move In

Discharges – The Bottom Line

The bottom line is that we all have good intentions, we want to protect residents and ensure their wellbeing. If a long-term care facility intends to discharge a resident for a particular reason, there are guidelines that must be followed. It’s important that these guidelines are followed and that staff, residents, and their families have a good understanding of how the discharges should be delivered.

Long term-care facilities have a legal obligation to follow the guidelines prescribed by the Missouri Department of Health and Senior Services. These guidelines must be followed as set out in the Licensure Regulations Manual – ‘19 CSR 30-82-50 Transfer and Discharge Procedures’.

There are countless reasons why a nursing home may legitimately need to (or unfairly want to) discharge a senior but they must always follow the guidelines and adhere to the regulations.

Leaving a facility – Voluntary and Involuntary Leaving

There are two different kinds of leaving a facility – voluntary and involuntary.

Voluntary discharge is when a resident decides to discharge themselves. While no discharge letter is used, the facility still needs to complete adequate discharge planning. Depending on the policies of the facility, the resident may also need to notify the facility in advance.

Involuntary leaving of a facility is a common occurrence and can be a confusing and upsetting time for residents and their families. It is important that residents and their families are aware of the resident’s rights in order to ensure that everything happens legally. Facilities have a responsibility to ensure that they operate within the confines of the regulations and to offer a discharge letter to the resident.

Emergency Discharges

An emergency discharge is usually carried out for one of the following reasons:

  • The safety of individuals in the facility is endangered
  • The health of individuals in the facility is endangered
  • The resident’s health has improved sufficiently so the resident no longer needs the services provided by the facility
  • An immediate transfer or discharge is required by the resident’s urgent medical needs
  • The resident has not resided in the facility for thirty (30 days)
  • An emergency discharge is resulted from an argument, drastic incident, and this kind of discharge needs to be issued ASAP

Proper Discharge Letter

A written discharge notice must be provided to the resident in a ‘language and manner’ understood by the resident and representative(S) and must include:

  • The reason for the transfer/discharge
  • The proposed effective date
  • The location to which the resident will be transferred or discharged
  • Information on the resident’s appeal rights
  • Contact info for the long-term care ombudsman program and (if applicable) the agencies responsible for advocacy on behalf of persons with intellectual and developmental disabilities, or persons with mental disorders

Where to turn for help?

Our ombudsmen are available to advocate for any concerns you or your loved one have about your experience with long-term care.

If you feel like your resident rights are not being upheld, we are here.

 Contact our Ombudsmen today!


  1. 1
    D Normand on March 23, 2022

    My dad lived in a Assist Living apartment and when to the hospital for treatment, and had to go for rehap and now, the assist living apartment facilities will not let him come back because they say he is a fall risk. They are forcing my mon and dad to look for other assist living facilities.
    They want to say together. They are married for 70 years. Dad can be discharged but no place to go. My mon found a new place and could not give 30 day notice and now Riverview wants an extra months rent paid.
    Mom does not have money to pay for two places. The skilled nursing home and two apartment rent . Plus, the moving fee to move them to the new location with in 7 days.

    1. 2
      lsykes on April 20, 2022

      Please call our office to talk to an ombudsman if you still need assistance with this issue:

  2. 3
    Brenda on April 19, 2022

    First, contact VoYce St. Louis right away. Ask a resident advocate to go with you and meet with the administrator.
    Second, the administrator can and should override the cost of the room. Since THEY are telling the family your father cannot stay, then you shouldn’t be held financially.
    Third, if that doesn’t work, do your homework and find someone on the board who you could speak to. There are many ways to get this fee settled.
    Everyone is a fall risk. That is why there are walkers and wheelchairs. To not let him return is so unreasonable. You may need to ask for this in writing.
    Good Luck.
    Obviously, I have been in your shoes.

  3. 4
    NEWELL A. HOLMAN on November 16, 2022


    1. 5
      lsykes on November 17, 2022

      Thank you for reaching out, Newell. I would advise talking to the hospital social worker about any of the questions you have in relation to the hospital stay. As for her return to her long-term care community, you can reach out to one of our ombudsmen to discuss the details of your particular situation.

  4. 6
    Crystal on December 6, 2022

    I have a resident that lives in a Assisted Living facility on a Medicaid Waiver in Indiana who refuses to pay his portion for his rent. What am I allowed to do, or can do, to discharge him from the Assisted Living facility? He is telling other residents that he refuses to pay and we are not allowed to do anything about it. I don’t want the other residents to start refusing to pay their pvt. portion.
    What are Indiana guidelines for Medicaid recipients living in a Medicaid Waiver Assisted Living if they refuse to pay? I am in need of guidance.
    Thank you!

    1. 7
      Marjorie Moore on December 7, 2022

      VOYCE’s ombudsmen are certified in the State of Missouri and cannot speak directly to your issue because of the differences in state laws. We recommend you contact your local ombudsman for assistance, you can find them at

  5. 8
    Kelly Magreevy on February 15, 2024

    My dad was living at an independent living facility. He got sick sent to the hospital and now he is in a skilled nursing facility. He can no longer care for himself. He won’t be able to go back to independent living. Not sure what to do now. I have so much going on in my life and not close to him. He has a pension that could pay for a board and care place. Can I hire a conservator to take care of everything include moving him out etc and just let him/her handle his money too?! I just don’t have the energy or time to move him from one place to the other AND I don’t want to be financially responsible for him anymore. I signed for him to get him into independent living. I just want to give notice there have someone else move out!

    1. 9
      Marjorie Moore on February 29, 2024

      You may look into securing a geriatric care manager in his area. See our webinar on this topic:

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