Involuntary Discharge From An Assisted Living Residence/Facility

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.

“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.

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

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Responses to this article:

Kim Wrote:

I’m facing the same situation mother has advanced dementia & my father has had 3 strokes a seizure and other Heath conditions, yes Iam fighting for both of my parents 84 and 80 years of age. My problem getting behind in rent and not having any resources to help out. I am so afraid they will be discharged at any day & I don’t have a place for them to go. What do I do? Kim

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15 January 2014 at 3.42 pm

Saba Wrote:

I really can’t tell you how unsettling and unhealthy it is for a senior, especially one with memory issues or Alzheimer’s, to be shuffled around from facility to facility. I have seen it first hand, so this is an important issue to me, and should be to anyone involved with senior care.

10 January 2013 at 11.43 pm

Mavis Wrote:

A lot of assisted living homes (especially smaller ones) seem to go out of business at a pretty good percentage/rate. This would mean a ‘discharge’ for all residents, so it might be wise to choose a home that has been in service for a while.

3 November 2011 at 12.55 pm

Henry Wrote:

Basically, is discharge another word for “eviction” – I don’t remember most apartments having it in the lease, but it is implied if you break the rules?

13 July 2010 at 10.50 am

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