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“Involuntary Discharge” from the nursing homes has become a way for the homes to get rid of chronic patients to make room for acute ones: survivors of COVID-19 who can be “rehabilitated.”

2020-06-23

photo by belajati raihan fahrizi courtesy of pixabay.com

Before the pandemic, nursing homes would discharge patients without their consent on a regular basis.  Since the pandemic began, the involuntary discharge problem has become a crisis.  Nursing homes can take patients who have been discharged from the hospital after a severe bout of COVID-19 and promise to rehabilitate them, getting paid extra Medicare dollars for their care.  Usually Medicaid pays for long term patients, but Medicare pays much more for short term nursing home stays.

From a New York Times article of June 21, 2020:

They [nursing homes] are kicking out old and disabled residents — among the people most susceptible to the coronavirus — and shunting them into homeless shelters, rundown motels and other unsafe facilities, according to 22 watchdogs in 16 states, as well as dozens of elder-care lawyers, social workers and former nursing home executives.

Many of the evictions, known as involuntary discharges, appear to violate federal rules that require nursing homes to place residents in safe locations and to provide them with at least 30 days’ notice before forcing them to leave.

While the popular conception of nursing homes is of places where elderly people live, much of their business is caring for patients of all ages and income levels who are recovering from surgery or acute illnesses like strokes. Medicare often pays for short-term rehabilitation stints; Medicaid covers longer-term stays for poor people.

Nursing homes have long had a financial incentive to evict Medicaid patients in favor of those who pay through private insurance or Medicare, which reimburses nursing homes at a much higher rate than Medicaid. More than 10,000 residents and their families complained to watchdogs about being discharged in 2018, the most recent year for which data are available.

The pandemic has intensified the situation.

Last fall, the Centers for Medicare and Medicaid changed the formula for reimbursing nursing homes, making it more profitable to take in sicker patients for a short period of time. Covid-19 patients can bring in at least $600 more a day in Medicare dollars than people with relatively mild health issues, according to nursing home executives and state officials.

 

From a website by people’s law, frequently asked questions regarding “involuntary discharges”

Can a nursing home transfer or discharge me?

Nursing homes can only discharge or transfer residents for very limited reasons. If you do not agree to leave, it is called an involuntary transfer or discharge. Federal and state laws have strict rules about involuntary transfers and discharges. In most cases, there are only five reasons a nursing home can involuntarily transfer or discharge you:

  1. A transfer or discharge is necessary for your welfare and your needs cannot be met by the nursing home. Your doctor must write in your medical chart why the discharge or transfer is necessary.
  2. The transfer or discharge is appropriate because your health has improved sufficiently so that you no longer need the services provided by the facility. Your doctor must write in your medical chart why the discharge or transfer is appropriate.
  3. You are endangering the health or safety of an individual in the nursing home. A doctor must write in your medical chart why the discharge or transfer is necessary.
  4. You have failed to pay or have others pay the nursing home for your stay. The facility must have given you reasonable and appropriate notice of the amount you owe.
  5. The facility has stopped operating or, if you are a Medicare or Medicaid recipient, the facility has been decertified or withdrawn from the program.

Do I receive advance notice of a discharge or transfer?

The nursing home must give you a written notice at least 30 days before the proposed transfer or discharge date. A continuing care retirement community must provide 60 days notice. The notice must also be sent to the local Long Term Care Ombudsman, the Department of Health, and any of your relatives who have acted as your representative.

From “aging care”, a website that seeks to legally represent patients who have been “involuntarily discharged”:

Hospital “Dumping”

One tactic that facilities use to achieve an involuntary discharge in a roundabout way is “dumping.” This occurs when a nursing home transfers a patient to a hospital and then refuses to readmit them. In some states, there is a policy in place that requires a facility to hold the resident’s bed for a certain number of days while they are hospitalized. Medicaid will pay for all or part of this bed-hold period, depending on the state, but if a resident is paying privately, they may be responsible for these fees. Regardless of the strategy used to discharge a resident, the facility must still provide a comprehensive care plan for the patient and ensure that they have a safe place to go.

From an NBC news article posted November 19, 2019:

Nationally, long-term care ombudsmen, who advocate for elderly and disabled residents of nursing homes and assisted living facilities, received 10,610 complaints about discharges and transfers in 2017, up from 9,192 in 2015. The ombudsmen, whose work is federally mandated and state-funded, receive more complaints about discharges and transfers than any other grievance.

Advocates, experts and the federal government say that nursing homes tend to evict low-income, longer-term residents who receive Medicaid, to make room for shorter-term rehabilitation patients who are covered by Medicare. Medicare reimburses nursing homes at a higher rate than Medicaid, so it’s more lucrative for facilities to house Medicare patients who stay for short stints before recovering and moving elsewhere.

My conclusions: The result of the pandemic has been this: weak, debilitated patients who have barely survived a run-in with COVID-19 are a lucrative business for nursing homes.  They respond by kicking out vulnerable long-term elderly or disabled patients to make room for better paying post-COVID recovery patients.  The vulnerable patients are easy prey for the virus.  The end result is that nearly half of the deaths due to COVID-19 have occurred in nursing homes and another large percentage are elderly, vulnerable people who are not yet in homes– if they survive, they will be sent there to be rehabilitated.

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