ASSISTED LIVING AND SKILLED NURSING: TRANSFERRING RESIDENTS TO OTHER SETTINGS

There seems to be ongoing confusion surrounding the intricacies of involuntarily discharging a resident. Clarity was attempted through this article, with cited rules and step-by-step instructions provided.  

Perhaps even more confusing is the process of transferring a resident to another care setting. Because RCW 70.129.110 combines the two (very distinct) topics, it’s no wonder misunderstandings prevail. This article aims to delineate the differences between discharging a resident and transferring one.  

A resident discharge is best defined as movement from a licensed or certified care setting to another setting where care may or may not be provided. This might include a resident permanently moving home or to another long term care facility. This topic has been thoroughly described in a previous article. 

A resident transfer, on the other hand, involves the temporary movement of a resident from a licensed or certified care setting to another licensed or certified care setting. This movement is short term and typically for medical or mental health treatment or rehabilitation, with an expected eventual return to the original facility.

RCW 70.129.110 highlights the five reasons a resident may be transferred or discharged:

1. Necessary for the resident’s welfare and the resident’s needs cannot be met in the facility
2. The safety of individuals in the facility is endangered
3. The health of individuals in the facility would otherwise be endangered
4. The resident has failed to make the required payment for his/her stay
5. The facility ceases to operate

Most often this section is viewed through the lens of a permanent discharge; if at all possible, the resident receives a formal 30-day notice to move from the facility. Transfers are a bit different, as they typically are more urgent in nature and, therefore, there might not be time to wait. RCW 70.129.110 (4)(b)(i – iii) states that notice may be made as soon as practicable before transfer or discharge when the health and/or safety of individuals in the facility are endangered or when an immediate transfer or discharge is required by the resident’s urgent medical needs.

Most often we view these transfers as urgent medical conditions warranting hospitalization, such as a stroke or broken hip. Other reasons for transferring a resident out of the facility for a time might include the need for geropsychiatric hospitalization or inpatient drug rehabilitation services.

Regardless of the reason for the transfer, the law is clear: reasonable accommodations should be attempted (if possible) prior to the transfer, and a written notice must be given.

Just like a formal discharge notice, the transfer notice must address specific topics:

1. The reason for the transfer
2. The effective date of the transfer
3. The location to which the resident has been transferred
4. The name, address, and telephone number of the state long-term care ombuds
5. For residents with developmental disabilities and/or mental illness, the mailing address and telephone number for Disability Rights Washington

If the written notice is not given to the resident before s/he is transferred, the facility must deliver it to the resident as soon as practicable. That might mean delivering the document to the hospital or other care setting. You will also need to notify other pertinent parties, including the resident’s family/surrogate decision maker, primary care provider, and DSHS case manager (if the resident’s stay is paid for partially or fully by Medicaid).

Since the facility is required to provide bed hold information, this is a good time to also include a letter notifying the resident/responsible party of how long the resident’s bed will be held, and steps to take should the resident need additional time beyond the facility’s standard bed hold expectations. For assisted living facilities with Medicaid contracts, WAC 388-105-0045 must be followed regarding holding a resident’s bed/room.

Finally, the facility is still required to provide sufficient preparation and orientation to residents to ensure safe and orderly transfer from the facility. That might include identifying the resident’s preferred hospital during the admission process and taking note of that preference; it may also include ensuring the resident has items s/he needs once s/he gets to the next destination, such as clothing and personal devices like dentures and hearing aids.

If, after the resident has been transferred to another care setting, it is determined that the resident’s condition will not allow him/her to return to your care setting, you are required to issue a permanent discharge notice, following all the steps outlined in RCW 70.129.110.

For questions about resident transfers from assisted living facilities, contact Vicki McNealley via email or call 1-800-562-6170 extension 107. For questions about resident transfers from skilled nursing facilities, contact Elena Madrid via email or call 1-800-562-6170 extension 105.