Preventing Unsafe Discharges from Skilled Nursing Facilities

When an older adult is in a skilled nursing facility (SNF), families expect compassionate care and a safe, well-planned discharge. Unfortunately, across the United States, premature or unsafe discharges still happen, often due to insurance deadlines, staffing issues, or facility pressures.

That’s where Haven Health Care Advocates steps in. Whether you need help with elder care in Tampa, FL, assistance navigating health insurance appeals, or guidance from a geriatric care manager in Tampa, Haven Health Care Advocates supports families through every step of the discharge and appeal process.

Here Are Some Unsafe Discharge Red Flags

Red Flag	Why It's a Risk
Discharge planned without family involvement	Communication gaps lead to unaddressed safety needs.
No home-health or therapy arranged	Patients lose essential follow-up care needed for recovery.
Missing equipment (walker, oxygen, shower chair)	Increases immediate fall and injury risks at home.
Sudden Medicare or insurance denial	Patients may be forced to leave before they are ready.
New confusion or medical decline ignored	Unsafe for cognitively impaired patients to transition home.

Table of Contents

Why Unsafe or Premature Discharges Happen in U.S. SNFs

Unsafe or premature discharges happen for many reasons:

1. Insurers ending skilled-care coverage before the resident is clinically ready

2. Administrative pressure to free up beds

3. Poor discharge planning or missing documentation

4. Facility-initiated discharges that do not meet regulatory requirements

These sources reinforce the importance of independent advocacy to prevent unsafe transitions.

• CANHR – Challenging Hospital Discharge Decisions

• Disability Law Center – Involuntary Discharge from Nursing Homes

• Center for Medicare Advocacy – Skilled Nursing Facility Discharge Rights

• GNA Now – How Healthcare Advocates Can Prevent Unsafe Discharges

What Rights Do Residents Have, and Why You Need an Advocate

According to the Center for Medicare Advocacy, residents and families have several rights when SNFs attempt to discharge them:

• The right to written notice of “non-coverage” (if Medicare ends coverage) typically given at least 2 days before termination of Part A benefits.

• The right to appeal coverage decisions via expedited or standard appeal processes and to continue services during the appeal review.

• Under the Nursing Home Reform Act, even if Medicare ends coverage, a resident cannot be discharged unless the facility meets lawful discharge criteria (as above).

• If a facility attempts a discharge without meeting these requirements or fails to give proper notice or documentation the discharge may be unlawful or unsafe.

Because of the complexity coverage rules, legal rights, facility compliance having a professional advocate, care manager, or legal support can dramatically improve a resident’s protection and outcomes.

How Advocates Protect Patients

Advocate Action	How It Protects the Patient
Attends and supervises care conferences	Ensures decisions are based on medical readiness, not facility pressure.
Manages and files insurance appeals	Helps secure more covered days when medically necessary.
Coordinates post-discharge services	Ensures nurses, therapists, and caregivers are ready *before* discharge.
Performs home safety checks	Prevents falls and complications during the first 72 hours home.
Keeps families updated and empowered	Reduces confusion and helps families make informed decisions.

How Haven Health Care Advocates Protect Seniors

Advocates and care managers from Haven Health Care Advocates:

• Review Medicare and insurance notices for accuracy

• File expedited Medicare appeals to prevent abrupt discharge

• Confirm physician documentation and compliance with federal law

• Attend care conferences and challenge unsafe plans

• Coordinate home care, therapy, and medical equipment for safe transitions

When Families Should Contact Haven Health Care Advocates

Families should contact Haven Health Care Advocates if:

• They receive a Medicare Non-Coverage notice

• The SNF attempts premature discharge

• No safe discharge plan is provided

• They feel pressured to sign discharge papers

• A loved one is medically unready to return home

Haven Health Care Advocates ensures the discharge is safe, legal, and properly coordinated or appeals the decision if needed.

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In Conclusion

Unsafe or premature SNF discharges can be stressful and dangerous for families, but Haven Health Care Advocates provides professional guidance to protect residents’ health, safety, and rights.

If you need help with elder care in Tampa, FL, Medicare or health insurance appeals, or support from a geriatric care manager in Tampa, Haven Health Care Advocates ensures every transition is safe, lawful, and well-coordinated.

Frequently Asked Questions

• Can a nursing home discharge a patient with nowhere to go?

  Generally, no.
  Under federal law (the Nursing Home Reform Act), a nursing home cannot discharge a resident unless a safe and appropriate discharge plan exists. The facility must ensure:

  • The resident has a safe place to go

  • Necessary care, services, and equipment are arranged

  • Advance notice and documentation are provided

  A discharge to “nowhere,” homelessness, or an unsafe environment is typically considered an illegal or unsafe discharge.
  Residents and families can appeal these discharges, and advocates can intervene to protect the resident.

• What is an unsafe discharge from a hospital?

  An unsafe discharge happens when a patient is sent home or transferred before they are medically, physically, or cognitively ready, or without adequate support. Examples include:

  • No caregiver or home-health services arranged

  • No medication instructions or follow-up appointments

  • Discharge despite confusion, weakness, or new symptoms

  • Patient doesn’t understand how to care for themselves

  • No medical equipment provided

  Unsafe discharges increase the risk of falls, complications, and rehospitalization.

• What is an unsafe discharge from rehab?

  An unsafe rehab discharge occurs when a skilled nursing or rehabilitation center releases a patient:

  • Before they’ve met key mobility or therapy goals

  • Without confirming the patient can perform daily activities safely

  • Because insurance ends coverage, not because the patient is ready

  • Without arranging therapy, nursing, or caregiver help at home

  Medicare often covers additional days if the rehab stay is still medically necessary, and families can appeal a premature termination.

• What are SNF discharge requirements?

  Federal law states a Skilled Nursing Facility (SNF) can only discharge a resident for six lawful reasons:

  1. The resident’s health has improved and they no longer need SNF care

  2. The resident’s needs cannot be met at the facility

  3. The resident is a danger to the health or safety of others

  4. The resident fails to pay after reasonable notice

  5. The facility is closing

  6. The resident voluntarily chooses to leave

  Additionally, the SNF must provide:

  • A minimum 30-day written notice (except in emergencies)

  • A safe and appropriate discharge plan

  • Written documentation from the physician validating the discharge

  • Appeal rights

• What is a Medicare discharge from a skilled nursing facility?

  A Medicare discharge typically means Medicare Part A coverage for skilled care is ending, not necessarily that the patient must leave the facility immediately.

  Key points:

  • You have a right to receive a Notice of Medicare Non-Coverage (NOMNC)

  • You may request a fast-track appeal through the Quality Improvement Organization (QIO)

  • During an expedited appeal, you usually remain in the facility

  • Even if Medicare stops paying, the facility must still follow all legal discharge rules

  Medicare termination ≠ immediate eviction.

• What is voluntary discharge from a nursing home?

  A voluntary discharge is when a resident chooses to leave a SNF or nursing home on their own.
  However, the facility must:

  • Explain risks of leaving

  • Offer a safe discharge plan

  • Provide prescriptions, follow-up instructions, and documentation

  • Not pressure or coerce the resident

  Residents can leave voluntarily, but the facility must still take reasonable steps to ensure safety.

• What is an unsafe discharge from a hospital in California?

  California has additional protections under the California Health & Safety Code and state regulations. An unsafe discharge in CA includes:

  • Releasing a patient to the streets, shelters, or cars without planning

  • Discharging without informed consent if the patient lacks capacity

  • Failure to involve family/advocates

  • No care coordination, medications, or follow-up

  • Violating patient rights outlined in California’s discharge laws

  California is one of the strictest states regarding patient dumping and unlawful discharges.

• Can a family refuse hospital discharge?

  Yes, families can challenge or delay a hospital discharge if they believe it is unsafe.
  Families can:

  • Request a meeting with the medical team

  • Ask for a second opinion

  • Speak with a case manager or social worker

  • File a Hospital Discharge Appeal (Medicare beneficiaries file through QIO)

  • Request a reassessment of the discharge plan

  While you cannot technically force a hospital to keep the patient indefinitely, you can trigger a formal review and delay the discharge until safety concerns are addressed.