CMS Mulls Ways to Address Improper Skilled Nursing Discharges

The Centers for Medicare and Medicaid Services (CMS) has announced a new initiative aimed at blunting the growing trend of improper discharges at skilled nursing facilities (SNFs).

Across the country, the illegal “dumping,” or eviction, of SNF residents has become a widespread issue—so much so that it’s now one of the most frequent complaints made to states’ long-term care ombudsman programs, CMS said in a Dec. 22 memo addressed to state survey agency directors.

Commonly reported reasons for SNF-initiated discharges include payment concerns; behavioral, mental, and emotional problems; or resident distress. However, residents don’t always agree with SNFs’ reasoning—and sometimes, those improper discharges make headlines, as was the case when a California SNF’s eviction of an 83-year-old resident prompted a lawsuit last March.


“Discharges which violate federal regulations are of great concern because in some cases they can be unsafe and/or traumatic for residents and their families,” David R. Wright, director of CMS’ Survey and Certification Group, wrote in the memo. “These discharges may result in residents being uprooted from familiar settings; termination of relationships with staff and other residents; and residents may even be relocated long distances away, resulting in fewer visits from family and friends and isolation of the resident.”

CMS said it’s considering a variety of solutions to the ongoing problem, including surveyor and provider training, intake and triage training, and civil money penalty (CMP)-funded projects that may help prevent improper discharges.

The government agency is also encouraging states to consider CMP reinvestment proposals that would fund ways to prevent improper SNF discharges. Some examples included:


— Educational programs designed to inform residents and their families of their rights;

— Creating teams of health professionals to provide support to SNFs and reduce risk of harm to self or others when a resident is exhibiting expressions or indications of distress;

— Projects designed to educate staffers on best practices for engaging residents and families to reduce distress;

— Formation and support of groups focusing on nursing home issues like resident placement or transitional care, as well as dementia or other memory-related issues

Furthermore, CMS said its regional offices will review deficiencies caused by SNF-initiatied discharges.

Mixed feelings

Some SNF resident advocates are happy CMS acknowledged there’s an issue with nursing home discharges, but said there are many more steps to resolving it.

“We’re very pleased that CMS is formally discussing that there is an actual problem with nursing home discharges,” Tony Chicotel, staff attorney for the California Advocates for Nursing Home Reform (CANHR), told Skilled Nursing News. “So if the first step to solutions is admitting there is a problem, we’ve taken that step to some degree.”

Thus far, private litigation brought by residents and advocacy groups is the only enforcement option making a difference, he said. At the heart of the issue is enforcement, a puzzle piece that so far hasn’t fallen into place.

“The action part of the memo is feeble and not likely to change anything,” Chicotel added. “We need enforcement and a resetting of incentives.”

Written by Tim Regan

Companies featured in this article: