Issuing a discharge notice to a resident and his/her surrogate decision maker is never an easy task. Not only is it emotionally difficult for all involved parties, but it can also be time consuming to fulfill all requirements outlined in RCW 70.129.110. If not done carefully and thoroughly, issuing a discharge notice can quickly elevate from a mundane task on your to-do list to a contentious, relationship-ruining event.

By carefully following the expectations as outlined in the Resident Rights law, and infusing a sense of caring concern, the steps towards successfully moving a resident to a more appropriate living environment can be smooth and (almost) painless.

Before reviewing the contents of a complete discharge notice, there are a few primary issues to keep in the forefront:

  • Reasonable accommodations must be attempted before a discharge notice is offered. Reasonable accommodation does not include the imposition of a financial burden on the facility, nor does it require you to change the philosophy of services you offer. It does, however, require you to get creative, possibly bend your policies a bit, all while focusing on ways to keep the resident where s/he is now.
  • The resident remains the central focus of all we do. Discharge notices, then, are focused on the resident’s safety, and the resident’s well-being. By remaining focused on the resident (and not on staff safety, for example), any argument of unfairness or uncaring are better refuted.
  • The formal discharge letter should never be a surprise. A smooth discharge starts on the day the resident moves in; reviewing the disclosure form, admission agreement, and necessary policies offers opportunity whereby you can clearly explain when a person’s residency must end. Consistent communication along the way lends to honesty, upfront expectations, reasonable accommodation ideas, and ultimately a team effort to find a well-suited living arrangement should the time come.
  • The written notice of discharge should be provided to the resident in person and read to him/her so that s/he can ask questions, even if the resident has dementia or other cognitive issues. The notice should also be mailed, certified with return receipt, to the legal responsible party. By doing both actions, you make sure the resident and surrogate decision maker are aware of the next steps necessary to move the resident elsewhere and you fulfill the expectations of the law.

Before issuing the notice of discharge, it’s important to meet with the resident and family and let them know of the need to move their loved one; make this a discussion and brainstorming session if possible, and a connection whereby the family and resident can form a support network with you while choosing another living arrangement. Advise the family and resident that a written notice is forthcoming and will likely appear harsh or otherwise formal but is required by law. Alternately, you might consider presenting this letter during the meeting so that you may better explain and answer any questions right away.

In looking at RCW 70.129.110, one can create a kind, but firm written notice that not only meets the expectations of the law, but also directs the reader in next action steps to accomplish a successful move-out.

Let’s break the notice down, topic by topic.

SALUTATIONS. The law states that the “resident and representative” must be notified. This means the resident will receive a written notice of discharge, as will his/her legal representative. In addition, you must notify any interested family member.

REASON FOR LETTER. This is your opportunity to engage in kindness here. “It is with sadness that I write this letter to inform you of the need to move from…” or something similar.

REASON FOR MOVE-OUT. You’ll need to be specific. The reason should be significant enough that it stands firmly outside of your disclosure form and/or admission agreement. There are only five reasons you can legally discharge a resident; your notice needs to include specific examples on one or more of the following:

  • Discharge is necessary for the resident’s welfare; the resident’s needs cannot be met in the facility;
  • The safety of individuals is endangered;
  • The health of individuals is endangered;
  • The resident has failed to make required payment;
  • The facility is closing.

REASONABLE ACCOMMODATIONS TRIED. Detail in the letter/notice all attempts to work with the resident to keep him/her safely in the facility. Outline the results of those reasonable accommodations attempts.

EFFECTIVE DATE. This must be at least 30 days from the date you deliver the written notice. Spell that out so it’s clear: “Your last day of residency here is [date]” or similar.

THE LOCATION TO WHICH THE RESIDENT WILL BE DISCHARGED. This will take some work on your part. You’ll need to find an alternate location that (a) can meet the needs of the resident, (b) has a bed available, (c) will accept the method of payment the resident uses, and (d) would potentially accept the resident. This is where relationships become paramount. Ideally you know the other facilities – skilled nursing, assisted living, and adult family homes – in and around your facility’s geographic area, and you know people there to contact. This makes finding a good location much easier and serves to benefit not only the resident and family, but you and your neighboring long term care facility, too. The discharge location must be safe!

THE NAME, ADDRESS, AND TELEPHONE NUMBER OF THE OMBUDS. This must be included in the letter. Assisted Living Facilities do not send the discharge notice to the ombuds; this is only required for skilled nursing facilities.

THE NAME, ADDRESS, AND TELEPHONE NUMBER OF DISABILITY RIGHTS WASHINGTON. This is only required if the resident has a diagnosis including a mental illness or a developmental/intellectual disability. Do not send the discharge notice to Disability Rights Washington; this is not required.

Finally, the use of a standardized discharge form is required only for skilled nursing facilities

While the use of a form, however developed, might ensure that all required areas are addressed, their use can be viewed by the recipient as cold and overly formal. For assisted living facilities, an example of a properly written discharge notice is here.

There are resources available to you when and if a resident chooses to appeal the discharge. A video, here, outlines how the facility leadership can prepare for an appeals hearing should one be scheduled. 

For more questions about assisted living facility discharge notices, email Vicki McNealley or call her at (800) 562-6170, extension 107.

There are additional requirements outlined in the CMS CFR for nursing homes/skilled nursing facilities, see §483.15 Admission Transfer and Discharge Rights. For questions about skilled nursing facility discharge notices, email Elena Madrid or call her at (800) 562-6170, extension 105.

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