A Section Q referral brings in a local agency that looks at what your parent would need to live outside the nursing home: services, housing and programs that may help pay. If you're working out how to get a parent out of a nursing home, that referral is where it starts, and you ask for it inside the building. Staff ask your parent whether they want to talk to someone about returning to the community, a "yes" sets the referral in motion, and talking to someone doesn't guarantee a move.

In This Guide

How to Get a Parent Out of a Nursing Home: The Short Answer

Maybe your mom asks every Sunday when she can go home, and you leave each visit carrying the question with you. That's a heavy thing to hold, especially if you helped make the decision that got her there. There's already a formal route for that question, and it starts with the nursing home's own staff.

The Centers for Medicare & Medicaid Services (CMS) publishes a handout for residents titled "Your Right to Get Information about Returning to the Community". It tells residents that the staff at their nursing home will ask about their care and whether they want to talk to someone about the possibility of returning to the community, and to say "yes" if they do. A "yes" means staff call a local agency for community living, which CMS calls a Local Contact Agency.

Inside the building, this step has a name. The Administration for Community Living (ACL) ties the local contact agency referral to CMS guidance for Section Q of the Minimum Data Set (MDS), which is why this guide calls it a Section Q referral. So the plain-English ask to the social worker is: "Please make a Section Q referral to the local contact agency."

Be clear-eyed about what this route is. What CMS's handout describes is a right to be asked and to get information and a referral, rather than a right to leave on a set date. In CMS's own words: "Talking to someone doesn't guarantee that you'll be able to move back to your community due to the care and services you need." If the nursing home is the one pushing for a discharge your parent doesn't want, that's a different set of rules; our guide to nursing home residents' rights explains where to start.

What Happens After Your Parent Says Yes, Step by Step

It helps to know the sequence before you sit down with the social worker, so you can tell where things stand and what to ask next. Here is the route as CMS's handout, the federal discharge planning rule and CMS's guidance to nursing home inspectors describe it.,

1
Step 1

Staff ask your parent

CMS's handout says staff will ask the resident about their care and whether they want to talk to someone about returning to the community. The nursing home records that your parent was asked.,

2
Step 2

Your parent says yes, and staff make the referral

CMS's guidance to inspectors says the nursing home staff is responsible for making referrals to the local contact agency "if appropriate, under the process that the State has established." The nursing home records any referral it makes.

3
Step 3

The local contact agency calls or visits

According to CMS, the agency talks with your parent about the services and support they need and looks into housing options or home modification services, plus programs that may help pay, like Medicare, Medicaid, or any other insurance your parent has.

4
Step 4

The plan gets updated

The nursing home updates your parent's care plan and discharge plan, as appropriate, based on what comes back from the referral. CMS's guidance adds that for a resident who wants to go home, "the nursing home must determine if appropriate and adequate supports are in place, including capacity and capability of the resident's caregivers at home."

5
Step 5

The plan to leave, if your parent wants one

If the services and support your parent needs are available, CMS says the resident decides whether to start a plan to leave (more on where family's role stops). CMS's guidance says the post-discharge plan of care is developed with the care team and your parent, plus your parent's representative with your parent's consent, and a representative of the local contact agency can join at your parent's request.,

6
Step 6

Or a written "not feasible."

If the nursing home concludes a return to the community isn't feasible, it records who made that determination and why. If that's the answer you get, ask who made the determination and why, and bring in the ombudsman if your parent disagrees.

Who's Who in a Return-Home Referral

Part of what makes this hard is the cast of agencies with similar names. Here's who does what.

  • Local contact agency: CMS's guidance defines it as each state's designated community contact agencies that can give people information about community living options and available supports and services. The guidance says the local contact agency may be an Aging and Disability Resource Center (ADRC), an Area Agency on Aging, a Center for Independent Living, or another state-designated body, so which office plays this role is set by each state. ACL records that, under CMS guidance for MDS Section Q, many Medicaid agencies designated ADRCs to serve as the local contact agency.
  • Aging and Disability Resource Center: according to ACL, an ADRC is a single point of entry into the long-term services and supports system for older adults, people with disabilities, caregivers, veterans and families. It serves people of all income levels and isn't a bricks-and-mortar office; some states call theirs an "access point" or a "no wrong door" system. Our guide to AAAs, ADRCs and the Eldercare Locator sorts out which door to knock on.
  • Social worker or discharge planner: CMS's handout points residents to the nursing home's social worker or discharge planner as someone who can help. That makes them a good first person to ask for the referral.
  • Long-Term Care Ombudsman: the federally mandated advocate for nursing home residents, and the place to turn if the referral stalls.

What the Nursing Home Must Document

Under 42 CFR 483.21, the federal discharge planning rule for nursing homes, a nursing home's discharge planning process must:

  • Involve the resident and the resident representative in developing the discharge plan, and tell both of them the final plan.
  • Document that the resident has been asked about their interest in receiving information about returning to the community.
  • If the resident is interested, document any referrals made to local contact agencies or other appropriate entities.
  • Update the resident's comprehensive care plan and discharge plan, as appropriate, based on what those referrals bring back.
  • If discharge to the community is determined not to be feasible, document who made that determination and why.

Use this list in a care-plan meeting. You don't need to be confrontational to ask, "Has Mom been asked about returning to the community? Was a referral made? What came back?" Your parent also has the right under federal resident-rights rules to take part in care planning, to name the people they want included, to request meetings and to see the care plan.

Your Role as Family, and Where It Stops

You may be the one doing the driving, the phone calls and the worrying. It's natural to feel that should give you a say. The federal framework does give family a real place at the table, but it's a seat beside your parent, not in front of them.

Here's what the sources say about family. Under 42 CFR 483.21, the nursing home involves the resident and the resident representative in developing the discharge plan. CMS's guidance adds that family members, significant others or the resident's representative should be involved in deciding whether adequate supports are in place for a return home "with the resident's permission, unless the resident is unable to participate in the discharge planning process." If your parent can't communicate a preference or take part in discharge planning, CMS's guidance says the information should come from the resident's representative.

The decision itself sits with your parent. Federal resident-rights rules give every nursing home resident a right to self-determination, including the right to choose their health care and providers of health care services, consistent with their assessments and plan of care, and the right to be told the options and choose the one they prefer, including refusing treatment. CMS's handout puts it simply: if the services and support are available, the resident decides whether to start a plan to leave.

That cuts both ways, and it can hurt. If your dad wants to go home and you don't think home is safe, he still gets to ask. If you want him home and he says no, the federal guidance frames your involvement as taking part with his permission. What a power of attorney or guardianship would change is a separate legal question this guide doesn't cover; our guide to guardianship vs. power of attorney is the place to start, and an elder law attorney in your state can tell you how it applies to your family.

If Your Parent Said No, or Was Asked Long Ago

A "no" at admission isn't the end of the road. CMS's handout says the resident can change their mind about leaving at any time, and that nursing home staff will ask again later whether the resident wants to talk to someone, because needs may change over time.

This matters if your parent has been in the nursing home for a long time. CMS's guidance to inspectors says that for residents who have been in the facility for a longer time, it is still important to inquire, as appropriate, whether the resident would like to talk with local contact agency experts about returning to the community, because new or improved community resources and supports may have become available since the resident was first admitted. So if your parent's health has improved, or you've moved closer, or a family member can now help at home, that's a reason to raise the question again rather than assume the answer is still the same.

How to Pay for Care When a Parent Leaves a Nursing Home

This is the part that keeps a lot of families up at night. Home can be where your parent wants to be and still be hard to pay for, and that's not a failure on your part. The local contact agency's job includes looking into programs that may help pay, so you don't have to have this figured out before you ask.

Program What it can help with The limit to know
Medicare skilled nursing facility benefit Short-term skilled care after a qualifying hospital stay Up to 100 days per benefit period; it doesn't pay for long-term custodial care
Medicaid home and community-based services Care at home or in the community, where your state offers it Optional for states; waivers can cap enrollment, so waiting lists exist,
Money Follows the Person Moving from a nursing home or other inpatient facility into the community Runs state by state; requires a 60-consecutive-day Medicaid-paid stay first,

Medicare covers a short stay, not the long haul

Medicare's skilled nursing facility benefit covers care only on a short-term, post-acute basis, and it doesn't pay for long-term custodial care. Medicare's skilled nursing facility benefit covers up to 100 days per benefit period, and after day 100 Medicare pays nothing. Medicare.gov points people who need long-term care toward Medicaid, if they meet their state's eligibility rules.

Medicaid home care depends on your state

Under federal Medicaid rules, nursing facility services (for people 21 and over) are a mandatory benefit in every state, while home and community-based services are optional. Waivers let a state offer home care only to specific groups and cap enrollment, which is why waiting lists exist and why what's available at home varies by state. For Section 1915(c) home and community-based services waivers, federal rules add a level-of-care gate: the services go to people the state determines would otherwise need the level of care provided in a hospital, a nursing facility or an intermediate care facility for individuals with intellectual disabilities. When a state caps its waiver and keeps a waiting list, qualified applicants can be placed on it. If that's where your parent lands, the move home can take longer than anyone wants, and that isn't something your family did wrong. Ask the local contact agency how your state's waiting list works and which other programs may help pay in the meantime. Our Medicaid HCBS waivers by state guide lists what your state offers.

Money Follows the Person, and its limits

Money Follows the Person (MFP) is a federal Medicaid demonstration under which CMS awards funding to states to move Medicaid participants from institutional settings like nursing facilities into community-based settings. Money Follows the Person is state by state, not a benefit available everywhere: CMS says 45 states, the District of Columbia and two territories have been awarded MFP funding since the program began.

To qualify for a state's MFP program, your parent must have lived in an inpatient facility, such as a hospital or nursing facility, for at least 60 consecutive days immediately before starting, with Medicaid paying for that inpatient care. MFP also requires that your parent would continue to need that inpatient level of care but for home and community-based services, and that your parent move into a qualified residence. Days spent in short-term rehab now count toward MFP's 60-consecutive-day minimum stay. Under MFP, a qualified residence is any one of three types: a home owned or leased by your parent or a family member; an apartment with an individual lease, lockable access and its own living, sleeping, bathing and cooking areas; or a community residence where no more than 4 unrelated people live. If Medicaid hasn't been paying for your parent's stay, or the stay is shorter than 60 days in a row, MFP may not fit right now. That's a rule about payment and timing, not a verdict on your family, and the local contact agency also looks into other programs that may help pay.,

MFP's funding is time-limited. Congress set aside $450 million a year for Money Follows the Person for fiscal years 2024 through 2027, and ACL describes MFP as extended through September 30, 2027. Meeting the rules doesn't mean a funded spot is waiting, so ask the local contact agency whether your state is running MFP now and what the process looks like. Our guide to how to pay for in-home care covers the other ways families cover care at home.

What to Do if the Referral Stalls

It's discouraging to ask and then hear nothing. You and your parent have places to turn.

Start with the Long-Term Care Ombudsman Program. Every state, plus the District of Columbia, Puerto Rico and Guam, has a State Long-Term Care Ombudsman office. Its services are free and confidential, and anyone can contact it with concerns, but it represents the resident: when a family member files a complaint, the program works out, as far as it can, what the resident wants and follows that. CMS's guidance specifically names the ombudsman as available to assist with transitions from the nursing home. Our long-term care ombudsman guide explains what to expect when you call.

If you want to reach the local ADRC or Area Agency on Aging yourself, the Eldercare Locator, a free public service of ACL, connects families to local services. You can call or text 1-800-677-1116 (Monday through Friday, 8 a.m. to 9 p.m. ET) or search at eldercare.acl.gov. ACL notes that contact information for many ADRCs can be found through the Eldercare Locator.

If your parent came to the nursing home straight from a hospital and you're still in the early weeks, our guide to hospital discharge planning covers the hospital side of the same kind of planning.

Frequently Asked Questions

Can the nursing home stop my parent from leaving?

CMS's handout describes a right to be asked and referred, rather than a right to leave on a set date. It says that if the services and support a resident needs are available, the resident decides whether to start a plan to leave the nursing home, and that talking to someone doesn't guarantee a move back to the community. Under 42 CFR 483.21, the nursing home must involve the resident in developing the discharge plan, and if it decides a return to the community isn't feasible, it must document who made that determination and why, so ask to see that record. This guide doesn't cover leaving without a discharge plan. If staff are instead pressuring your parent to agree to leave, see our guide to pressured and unsafe nursing home discharges. If your parent and the nursing home disagree, the Long-Term Care Ombudsman is a free advocate who works at your parent's direction.

Does the nursing home have to refer my parent to the local contact agency?

Not automatically in every case. The federal rule requires the nursing home to document that your parent was asked about returning to the community and to document any referrals it makes. CMS's guidance says staff are responsible for making referrals to the local contact agency "if appropriate, under the process that the State has established," and that a referral may be appropriate for many residents who could move to a community setting of their choice.,

Can I ask for the referral on my parent's behalf?

Yes, you can raise it. One way to put it to the social worker or discharge planner: "Has Mom been asked about returning to the community? She keeps telling me she wants to go home. Can you make a Section Q referral?" Staff will still put the question to your parent, because CMS's handout tells the resident to say "yes" if they want to talk to someone. If your parent can't tell staff what they want or can't take part in discharge planning, CMS's guidance looks to your parent's representative for that answer, so make sure staff know who that is.

Is this only for people on Medicaid?

CMS's handout doesn't describe the conversation as Medicaid-only: it says the local contact agency looks into programs that may help pay, like Medicare, Medicaid or any other insurance your parent has, and ACL says ADRCs serve people of all income levels., Money Follows the Person is the piece that does require Medicaid: your parent's qualifying stay must be one where Medicaid paid for the inpatient care.

Learn More

Care TypesNursing Home Residents' Rights: What Federal Law GuaranteesMedicare and Medicaid nursing homes owe residents federal rights: dignity, visitors, records in 24 hours, no abuse or convenience restraints. How to use them. Care TypesThe Long-Term Care OmbudsmanEvery state has a free, confidential long-term care ombudsman for nursing home and assisted living residents. What they do, whose side they're on, how to call. Care TypesNursing Home vs. Home CareNursing home vs. home care: 2026 national costs, what each provides, what Medicare and Medicaid pay in each setting, and the signs that tell you which one fits. CaregiverAAA vs. ADRC vs. Eldercare Locator: Which Door Do I Use?Eldercare Locator, Area Agency on Aging, or ADRC? Learn what each federal front door to elder care does and which one to call first for your aging parent. MedicaidMedicaid HCBS Waivers by StateMedicaid HCBS waivers pay for care at home instead of a nursing facility. How 1915(c) waivers work, who qualifies, why waitlists happen, and your state's guide. FinancialHow to Pay for In-Home CareHow to pay for in-home care in 2026: what it costs and how Medicare, Medicaid HCBS waivers, VA benefits, and long-term care insurance each help cover it.

Find personalized help working out whether your parent can come home from a nursing home at brevy.com.

The information on Brevy.com is for educational purposes only and is not a substitute for professional legal, financial, or medical advice. Rules vary by state and program and change frequently. Always verify with the relevant agency or a qualified professional. Brevy is not a law firm, financial advisor, or healthcare provider.

Still have questions?

Brevy answers from this guide and every other guide here, and can check what you qualify for.

BC

Brevy Care Team

Expert eldercare guidance from Brevy's team of healthcare professionals and researchers.