In November 2021, the Office of Inspector General (OIG) submitted a report that includes recommendations for facility-initiated discharges in nursing homes. Facility-initiated discharges are legal when the discharges comply with Centers for Medicare & Medicaid Services (CMS) regulations.
The OIG review consisted of surveying the State Ombudsmen in the 50 states and the District of Columbia. They also analyzed CMS administrative data in order to conclude how many nursing homes had received a deficiency related to a facility-initiated discharge. Additionally, the OIG interviewed officials in the Administration for Community Living (ACL), CMS, and all 10 CMS Regional Offices (ROs) about efforts to reduce inappropriate facility-initiated discharges. They also interviewed five State Ombudsmen about the effect of COVID-19 on these discharges.
Findings included that neither ACL nor CMS collects data on the number of facility-initiated discharges that have occurred. Additionally, many State Ombudsmen do not count or track facility-initiated discharge notices received from facilities. Therefore, the OIG was not able to determine exactly how many facility-initiated discharges have occurred.
Other challenges that the OIG faced when trying to determine the number included the pandemic, and that Ombudsmen, CMS, and state agencies have different perspectives on regulations and enforcement of facility-initiated discharges. Furthermore, following the CMS initiative to review and enforce actions in cases of noncompliance with facility-initiated discharge requirements, State agencies cited more nursing homes for non-compliance with discharge notice requirements. The trends and outcomes of the CMS initiative have not been determined at this time.
As a result of the study, the OIG has provided the following recommendations:
- CMS: Provide training for nursing homes on Federal requirements for facility-initiated discharge notices. Assess the effectiveness of enforcement of inappropriate facility-initiated discharges. Implement deferred initiatives to address inappropriate facility-initiated discharges.
- ACL: Assist State Ombudsman programs in establishing a data-collection system for facility-initiated discharge notices. Establish guidance for analysis and reporting of data collected by State Ombudsman programs from facility-initiated discharge notices.
- ACL and CMS: Coordinate to strengthen safeguards to protect nursing home residents from inappropriate facility-initiated discharges. Ensure that all State Ombudsmen, State agencies, and CMS ROs have an ongoing venue to share information about facility-initiated discharges and potentially other systemic problems in nursing homes.
CMS and ACL agree with the majority of the OIG’s recommendations and have provided comments for all of OIG’s recommendations.
The OIG’s full report can be accessed at Facility-Initiated Discharges in Nursing Homes Require Further Attention (hhs.gov).
Issue:
Facility-Initiated Discharges are permitted when federal regulations are followed. The regulations for discharging residents without their consent must include one of the specific reasons for why the resident is being discharged by the facility without the resident’s consent and providing adequate notice to the resident regarding the discharge. All members of the healthcare team must be aware of the requirements for a facility-initiated discharge. When this action does not follow the federal regulations that are enforced by CMS, it can result in deficiencies and fines to the facility.
Discussion Points:
- Review your policy and procedures on facility-initiated discharges. Update as needed.
- Train all staff on your policy and procedure for a facility-initiated discharge. Document that these trainings occurred and file the signed document in each employee’s individual education file.
- Audit all facility-initiated discharges to ensure that the facility’s policy and procedure is current and that it was followed.
