Notifying the Washington State LTC Ombuds of Facility-Initiated Discharges and Transfers
June 25, 2018 | Resources
- Discharges and Transfers for Nursing Homes
Q1: When a facility initiates a discharge or transfer of a resident, who must the facility notify in
writing?
A1: Pursuant to 42 CFR 483.15(c)(3), nursing facilities that initiate a discharge or transfer of a
resident must provide a copy of the discharge or transfer notice to all of the following:
The resident;
The resident’s representative(s), and The State LTC Ombuds.
Q2: How should a copy of the notice be sent to the State LTC Ombuds?
A2: Send a copy of each notice by email to LTCOP@mschelps.org, or by fax to
(253) 815-8173. For your convenience, postcards with contact information for the State LTC
Ombuds are enclosed and are available at www.waombudsman.org. Notices by post mail will
not be accepted.
Q3: After receiving notice of a facility-initiated discharge or transfer, what will the State Ombuds
do?
A3: The State Office will record the receipt of the notice and forward it to the appropriate
Regional LTC Ombudsman Office. However, facilities should not expect that providing notice to
the State LTC Ombuds will result in Ombuds advocacy on behalf of the Resident. Residents and
others who want assistance from a LTC Ombuds (in discharges and any other areas) should
continue to use the regular channels to contact their local Ombuds office. See
www.waombudsman.org for contact information for a local LTC Ombudsman Program.
Q4: What is a “facility-initiated” discharge or transfer?
A4: The Centers for Medicare and Medicaid Services designates a facility-initiated transfer or
discharge as “a transfer or discharge which the resident objects to, did not originate through a
resident’s verbal or written request, and/or is not in alignment with the resident’s stated goals
for care and preferences.” (Memo, 2/1/2018, ALTSA: NH #2018-001 S&C 18-08-NH: an initiative to
address facility-initiated Discharges that violate federal regulations)
Q5: What information must be included in the notice of facility-initiated discharge or transfer?
A5: The notice requirements for transfer/discharge of a resident from a nursing facility must
contain:
The reason for transfer or discharge;
The effective date of transfer or discharge;
The location to which the resident will be transferred or discharged;
A statement of the resident’s appeal rights, including contact information for the appeal
agency, information on how to obtain an appeal form, and assistance in completing the
form and submit the appeal hearing request;
Contact information for the Washington State Long-Term Care Ombudsman Program; and
Contact Information for Disability Rights Washington 315 5th Avenue South, Suite 850,
Seattle, WA 98104, Voice 206.324.1521 or 1.800.562.2702, Fax 206.957.0729, Email
Info@dr-wa.org.
Q6: Is it adequate notice to send a copy of the DSHS Form #10-237?
A6: Yes, it must be an exact copy of the written notice provided to the resident and the resident
representative(s). However, please note that providing a copy of DSHS Form # 10-237 to the
State LTC Ombuds fulfills only the requirement to notify the State Ombuds of a facility-initiated
discharge or transfer. Receipt of such a form by the State Ombuds does not constitute waiver
of any resident rights, nor does it constitute an admission by the State Ombuds that the notice
meets other legal notice requirements.
Q7: As an alternative to DSHS form # 10-237, is it enough to send the State LTC Ombuds a copy of a
notice drafted by the nursing facility?
A7: Yes, as long as it is an exact copy of the notice provided to the resident and the resident’s
representative(s). However, please note that providing a copy of the notice to the State LTC
Ombuds fulfills only the requirement to notify the State Ombuds of a facility-initiated discharge
or transfer. Receipt of such notice by the State Ombuds does not constitute waiver of any
resident rights, nor does it constitute an admission by the State Ombuds that the notice meets
other legal notice requirements.
Q8: Is it enough to send the State LTC Ombuds a list of discharges and transfers?
A8: No. Nursing facilities that initiate a discharge or transfer of a resident must provide the
State LTC Ombuds an exact copy of each discharge or transfer notice that is sent to each
resident and resident representative(s). *If the resident is transferred under “emergency”
circumstances to an acute care setting (Emergency Department or Hospital) the facility must
notify the State LTCOP as soon as practicable. SEE Q12 Below.
Q9: Is it enough to give a copy of the notice to my local ombudsman?
A9: No. The notice must be promptly sent to the State LTC Ombuds.
Q10: What if the information in the notice changes prior to effecting the transfer or discharge?
A10: The facility must send an updated notice to each recipient (the resident, the resident
representative(s), and the State LTC Ombuds) as soon as practicable once the updated
information becomes available.
Q11: What if the resident is a Medicaid and Medicaid-Pending beneficiary?
A11: If the resident is receiving Medicaid, you must contact the local HCS office.
Q12: Is notice to the State Ombuds still required when a facility initiates a discharge or transfer of a
resident who has already left the facility (for example, the resident is in the hospital or out on
therapeutic leave)?
A12: In such situations, the facility is still required to send a written discharge notice to each
recipient (the resident, the resident representative(s), and the State LTC Ombuds).
UPDATE *If the resident is transferred to a hospital for an emergency, copies of notices for
emergency transfers must also still be sent to the ombudsman, but they may be sent when
practicable, such as in a list of residents on a monthly basis. (Example of list form is enclosed)
Q13: What other legal requirements apply to notices of transfer and discharge?
A13: Facilities must continue to fulfill all other legal obligations related to discharge and
transfer, including but not limited to attempting to avoid the discharge or transfer using
reasonable accommodations, informing residents of their right to appeal, and providing
sufficient preparation and orientation to the resident to ensure safe and orderly transfer or
discharge. For additional guidance, please contact Residential Care Services at the Department
of Social and Health Services, your member association office, or your legal counsel.