Involuntary Discharge From An Assisted Living Facility

A few years ago, we wrote another article about how to open an assisted living facility. It's become quite a popular article, and we're pleased that so many people have taken the time to comment. Many of these comments are from people who are thinking about opening their own facility, or residential care home, and they are just beginning the information collecting phase of their journey.

As I read these comments, at times I can't help but to think that some of these folks are a little ignorant, or perhaps diluted about the more difficult aspects of running a facility. Several people have commented that they have a deep desire to "help the elderly" and to create a happy and healthy home for seniors...in so many words. We think this is a great attitude, but there is certainly a level of reality that you need to wrap your head around if you are planning on operating an assisted living home - especially if you plan on accepting residents who have Alzheimer's, dementia, or any other mental illness.

I also receive e-mails every day from families asking for our help in finding an assisted living situation for their loved ones - usually mom or dad - and often times, these e-mails are very desperate sounding - like they have exhausted all of their resources - since mom or dad has issues that are difficult to deal with - and make it difficult to place him or her.

One such e-mail went like this:

"My father-in-law is almost 90, and he has suffered mini-strokes and has severe dementia. He tends to become aggressive and unruly and yes...he is a difficult person to be around. It seems to be getting worse. He spent time at another facility, where they involuntarily discharged him without much notice. We desperately need to find a suitable assisted living facility, but one that can handle such a person with advanced dementia - and one that won't discharge him after he has moved in. Can you help?"

E-mails like this always make me think of several things.

1) If you are planning on starting an assisted living facility, you need to be prepared for residents like this - difficult, unreasonable, and sometimes physically aggressive residents. These type of residents can require enormous resources - in terms of attention, safety monitoring, and patience. Also, a resident may move in and be relatively easy to deal with, and then deteriorate over time as their condition worsens.

2) As a family, if you are trying to place a loved one that has dementia or Alzheimer's, you need to prepare yourselves for the possibility of discharge...perhaps involuntary, if mom or dad becomes too difficult do care for.

3) Do most facilities have a policy regarding involuntary discharge, and if so, is it in writing, and a part of the resident agreement/contract?

4) How much notice is a facility required to give - either according to their contract, or if there are any applicable state or local laws that may apply? We recommend checking with the local area agency on aging, or health services department wherever the facility in question is located.

5) Is the facility required to list reasons for the discharge, or is it at will?

The whole subject of involuntary discharge can be looked upon from several points of view - mainly, from the family point of view, and the facility point of view.

Taking the facility's side - we understand and support the fact that if a resident becomes aggressive to the point of being dangerous to him or herself, and the other residents of the facility - and if the facility has exhausted all means to care for the resident in a safe and dignified manner - then discharge may be the necessary outcome.

From the family point of view, we also think that there needs to be a very specific policy in writing that the facility presents to the family upon move-in stating in very specific terms what their discharge policy is, how much notice will be given, how much financial liability will result (deposits, rent, etc), and what, if any reasons will be provided.

We also think it is appropriate for a family to ask how many discharges the facility has had in the past, or how many it averages per year (for larger facilities)

Lastly, will the resident have any rights to appeal the discharge? Ask the facility.

There are, of course, many reasons that a facility may elect to discharge a resident, and so far we have only covered mental health issues as reasons. Naturally, there are a number of other reasons that a facility may elect to discharge a resident, such as running out of funds/not paying rent, violating rules, such as smoking in non-smoking areas with repeated warnings (which can be serious if it is done around residents with respiratory issues), wandering, etc.

The best course of action from any point of view is to ask the right questions, and to get it in writing.

We found a decent example of an explanation of involuntary discharge on the Administrative Rules .pdf on the Department of Public Health & Human Services for Montana site here:
http://www.dphhs.mt.gov/qad/statutesrules/subchapter28.pdf

Most assisted living facilities **should** have something similar on file, or as a part of any resident or lease agreement. If they do not, ask if they would sign one that you provide. If they refuse, then perhaps the facility is not the best fit for mom or dad.

- Assisted Living Directory