People can be discharged from nursing homes for many reasons. Discharges may be a positive outcome and at an individual’s choice. In other cases, discharges may be at the direction of the facility and against the will of the resident. There are strict rules about when involuntary facility-initiated discharges (FIDs) are allowed. FIDs may be unsafe and traumatic for the residents involved and may result in higher costs of care, raising concerns to the public and to Medicare and Medicaid programs. Prior to the COVID-19 pandemic, media news and Ombudsman programs reported that FIDs were becoming the leading cause of complaints for nursing home residents. This study identifies resident characteristics related to increased risk of live discharges and how these relationships vary across time, states, and facility types. It also presents findings on the relationship between live discharges of residents with risk factors and post-discharge outcomes. We primarily studied nursing facility residents as there were no identifiable risk factors among skilled nursing facility residents.
This research was conducted under contract #HSP233201600021I between HHS/ASPE’s Office of Behavioral Health, Disability, and Aging Policy (BHDAP) and Research Triangle Institute. Please also visit the ASPE Long-Term Services & Supports/Long-Term Care page for additional research in this area.