Nursing Home Permitted To Discharge Aggressive Resident

OCTOBER 13, 1997 VOLUME 5, NUMBER 15

Charles Robbins, suffering from multiple sclerosis, was admitted to Heritage Estates nursing home in the late 1970s. For seventeen years, his care was paid for by Medicaid.

In 1994, Robbins became more of a management problem for Heritage Estates. He verbally abused other residents of the facility, and occasionally was physically aggressive.

When Robbins assaulted another patient, he was referred to the psychiatric ward of a local hospital for evaluation. While he was there, Heritage Estates notified him he would be discharged from the nursing home in thirty days.

A social worker from Heritage Estates met with Robbins and explained the notice and his transfer options. He was also told that he had a right to appeal the decision.

Robbins appealed the transfer order, and a hearing was held before an administrative law judge. Heritage persuaded the judge that Robbins’ violent behavior and hostile actions justified his discharge. Robbins appealed again, this time to District Court, and the decision was sustained. Finally, Robbins appealed to the Court of Appeals.

Robbins’ discharge from Heritage Estates was upheld. The opinion of the Court of Appeals relied heavily on the testimony of Heritage Estates staff members that Robbins had “recent and recurring episodes of pushing tray tables and carts into other residents, intimidating them and even striking an elderly female resident with his fist. Given this behavior, Robbins cannot escape the department’s legal conclusion … that his aggressive acts were ‘unduly disturbing to other residents.'” Robbins v. Department of Inspections and Appeals, July 23, 1997.

Robbins’ appeal was based on federal law, which provides protections for nursing home patients in a number of different ways. The Nursing Home Reform Act of 1987 limits the ability of nursing homes to discharge patients. In fact, involuntary discharge is only permitted in six circumstances:

  1. Where discharge is necessary to meet the resident’s welfare, and the welfare of the resident can not be protected by the facility.
  2. Where the resident’s health has improved to the point that nursing home placement is no longer necessary.
  3. Where the safety of other individuals in the nursing home is endangered.
  4. Where the health of other individuals in the nursing home is threatened.
  5. When the resident has failed, after reasonable notice, to pay for the stay at the facility.
  6. When the facility closes down altogether.

In addition to that basic protection, the Nursing Home Reform Act also requires that discharge for either of the first two reasons (welfare of the patient or lack of need for nursing home placement) must be established by the resident’s own physician, and that the fourth basis (endangering the health of other residents) must be established by a physician though not necessarily the patient’s attending physician.

In most cases, he resident is entitled to thirty days’ notice of the facility’s intention to discharge, though the time can be shortened if necessary for safety reasons. Even when the facility successfully moves to evict a resident, the nursing home’s responsibility does not end; arrangements must be made for a safe and orderly discharge in every case.

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