Can a Nursing Home Kick You Out? Discharge Rights and Appeals (2026)

A nursing home can discharge a resident only for one of six federal reasons, with written notice, and filing an appeal normally stops the move while the appeal is pending.1 So can a nursing home kick you out, or kick out your mom or dad? Not just because it wants to. If the call came this week, take a breath: you have more say than the facility may have suggested, and the first call, to the long-term care ombudsman, is free.2

In This Guide

• Can a Nursing Home Kick You Out? Who Is Protected
• When Can a Nursing Home Kick Out a Resident? The Six Legal Reasons
• Which Notice Do You Have?
• What a Nursing Home Discharge Notice Must Say, and When
• How to Appeal a Nursing Home Discharge, Step by Step
• Appeal Deadlines Are Set by Your State
• When the Nursing Home Won't Take Your Parent Back After a Hospital Stay
• When Medicare Ends or Medicaid Is Still Pending
• When You're Pressured to Agree to a Move or Sign Out
• If You Win the Appeal but the Home Won't Take Her Back
• Frequently Asked Questions
• Learn More

Can a Nursing Home Kick You Out? Who Is Protected

The federal transfer and discharge protections in 42 CFR 483.15 apply to facilities that participate as a Medicare skilled nursing facility or a Medicaid nursing facility.4

Inside a participating facility, the protections don't depend on who pays. Federal rules require the facility to keep identical transfer and discharge policies for all residents regardless of payment source, and the Centers for Medicare & Medicaid Services (CMS) tells inspectors that a facility's bed-hold and return policies apply to every resident, however the bill is paid.4 A parent paying privately in a certified home has the same protections as a parent on Medicaid.

Assisted living is different: these federal rules cover Medicare and Medicaid nursing facilities,4 while each state licenses and regulates assisted living, so check state rules.5 The District of Columbia's discharge statute, for example, covers assisted living residences as well as nursing homes.6

For the rest of the federal protections, see nursing home residents' rights.

When Can a Nursing Home Kick Out a Resident? The Six Legal Reasons

Being told your parent's behaviors mean she has to leave can feel like a verdict. It isn't one yet. Federal rules say the facility must permit each resident to remain and may transfer or discharge a resident only for one of these six reasons:1

1. The move is necessary for the resident's welfare and the resident's needs cannot be met in the facility.
2. The resident's health has improved enough that the resident no longer needs the facility's services.
3. The safety of individuals in the facility is endangered because of the resident's clinical or behavioral status.
4. The health of individuals in the facility would otherwise be endangered.
5. The resident has failed, after reasonable and appropriate notice, to pay for the stay (or to have it paid by Medicare or Medicaid).
6. The facility is closing.

The record has to back up the reason. When the facility says it can't meet your parent's needs, the record must show the specific needs it can't meet, what the facility tried, and what service the receiving facility offers to meet them.1 The resident's own physician must document the "needs can't be met" and "health has improved" grounds, and a physician must document the two endangerment grounds.1

So ask which ground the facility is using, ask to see the documentation, and ask what it tried first.

Which Notice Do You Have?

Three very different messages can sound like an eviction.

The end of Medicare coverage is not, by itself, one of the six grounds for discharge.1

What a Nursing Home Discharge Notice Must Say, and When

Before a transfer or discharge, the facility must notify the resident and the resident's representative in writing, in a language and manner they understand, and must send a copy of the notice to the Office of the State Long-Term Care Ombudsman.1 The written notice must come at least 30 days before the move.1

The rules allow notice "as soon as practicable" instead in five situations:1

• the safety of individuals in the facility would be endangered;
• the health of individuals in the facility would be endangered;
• the resident's health has improved enough to allow a faster move;
• the resident's urgent medical needs require an immediate move; or
• the resident has lived in the facility for less than 30 days.

A closing facility follows its own advance-notice rule, with a relocation plan.1

Under federal rules, a discharge notice must include:

• the reason for the transfer or discharge, its effective date, and the location your parent is being sent to;1
• a statement of appeal rights, with the name, mailing and email address, and phone number of the entity that takes appeals, plus how to get an appeal form and help filling it out;1
• the name, mailing and email address, and phone number of the Office of the State Long-Term Care Ombudsman.7

Note the date you received it. If anything is missing, tell the ombudsman.1

Where your parent is going matters too. CMS's 2025 surveyor guidance says discharge planning must identify a destination that meets the resident's health and safety needs, and tells inspectors to check whether the facility considered the caregiver's availability and capability to give the care needed.1 Your parent and you, as representative, have a right to be involved in developing the discharge plan.8 If the plan says "home with daughter" and nobody asked you, say so.

How to Appeal a Nursing Home Discharge, Step by Step

If your parent appeals, federal rules say the facility "may not transfer or discharge the resident while the appeal is pending," unless failing to move her would endanger the health or safety of the resident or others in the facility, and the facility must document that danger.1

Worried that speaking up will make things worse for your parent? That's a fair fear. Federal rules give residents the right to voice grievances without discrimination or reprisal,10 and states must prohibit retaliation against anyone who files a complaint with or cooperates with the ombudsman.11 Our long-term care ombudsman guide covers what the ombudsman can do. An appeal is your parent's best tool, but it isn't a guaranteed win.

Appeal Deadlines Are Set by Your State

Don't assume you have 30 days to appeal. The federal rules set the 30-day notice and the stay during an appeal, but the hearing runs through your state, and these examples show how much deadlines differ:

• Connecticut. Notice must come at least 30 and no more than 60 days before the move. A resident may appeal up to 60 calendar days after the facility issues the notice, but must appeal within 20 days of receiving it to stay the move, absent good cause.1 For a facility's failure to readmit, the resident has 20 days from receipt of the notice to request a hearing.12 (Connecticut appeals)
• District of Columbia. The facility must give at least 21 calendar days' notice before a discharge or transfer, unless a narrow exception applies or the resident and representative agree to shorter notice, and that agreement counts only if knowingly and voluntarily given at the time the move is proposed. The resident has 7 days from receiving the notice to request a hearing.6 (DC appeals)
• Massachusetts. A resident has 30 days after receiving a notice of intent to discharge or transfer, but only 14 days after notice of an emergency discharge or of a discharge following the facility's failure to readmit after a hospitalization.12 (Massachusetts appeals)
• North Dakota. The discharge is delayed if the hearing request is filed before the discharge's effective date.13 (North Dakota appeals)
• Montana. When a resident contests a nursing facility discharge, the state health department is not a party to the hearing; it provides the forum.12 (Montana appeals)
• Tennessee. Hearing rights attach to a nursing facility transfer or discharge, but our sources don't state that deadline, so don't assume Tennessee's general Medicaid appeal windows apply.12 (Tennessee appeals)
• Florida. State resident-rights law separately requires at least 30 days' advance notice of an involuntary transfer or discharge, except in an emergency a licensed professional on the home's staff determines, or where federal Medicare or Medicaid rules conflict.14 (Florida appeals)

Whatever your state, follow the appeal instructions on the notice and confirm the deadline with the ombudsman the same day. Our guide to Medicaid fair hearings explains the hearing system.

When the Nursing Home Won't Take Your Parent Back After a Hospital Stay

Mom is ready to leave the hospital, and the discharge planner says the nursing home has no bed for her. That isn't final.

A Refusal to Readmit Is a Discharge

Under federal rules, if a nursing home decides that a resident it transferred with an expectation of return cannot come back, the facility must follow the full discharge requirements, including notice and appeal rights.1 CMS guidance adds that the record should show the facility's efforts, including working with the hospital to confirm her needs fit its scope of care.1

The Bed-Hold Notices

Before a hospital transfer, the facility must give written information about the state's bed-hold period (if any), the state's reserve-bed payment policy (if any), the facility's own bed-hold policy and its policy on letting residents return; at the time of the transfer it must give a second written notice stating how long the bed hold lasts.1 Both notices are required whether or not the state plan has a bed-hold period.1 Bed-hold lengths and payment differ by state, so read the notice your parent got.

The Right to Return After the Bed Hold Ends

If the hospital stay runs past the bed-hold period, a resident who still needs the facility's services and is eligible for Medicare skilled nursing or Medicaid nursing facility services must be returned to her previous room if it's available, or to the first available bed in a semi-private room.1

You Can Appeal From the Hospital

CMS's current guidance to inspectors states this rule two ways.1

• In one passage, if the resident or representative appeals the discharge while in the hospital, the facility must allow the resident to return pending the appeal, unless there is evidence that the facility cannot meet the resident's needs or that her return would pose a danger to the health or safety of the resident or others in the facility.
• In its section on not permitting residents to return, the guidance states the exception more narrowly: the facility must let the resident return to her room or an available bed during the appeal unless there is documented evidence that the return would endanger the health or safety of the resident or others.

Either way, the guidance says the facility's decision not to let her return while the appeal is pending must not be based on her condition when she was first sent to the hospital.1

Ask the hospital's discharge planner to hold off on placing your parent elsewhere while you request the written notice and call the ombudsman. Our guide to hospital discharge planning covers the hospital side of the move.

When Medicare Ends or Medicaid Is Still Pending

Medicare ending is not an eviction. Medicare Part A covers skilled nursing facility care only on a short-term basis: up to 100 days per benefit period, with a daily coinsurance of $217 for days 21 through 100 in 2026, and nothing after day 100. Medicare doesn't pay for long-term custodial care.15 When skilled coverage ends, the provider must deliver a NOMNC at least two calendar days before Medicare-covered services end.1 If you think coverage is ending too soon, you can ask for a fast appeal by following the notice's instructions no later than noon the day before the termination date listed on it.16 Our Medicare fast appeal guide walks through it.

CMS's guidance says that when Medicare coverage may be ending and the resident still needs long-term care, the facility should offer the ability to remain, including paying privately or getting help applying for Medicaid.1 The same guidance warns that if Medicaid is denied, the resident would owe for the days after Medicare stopped paying, and that if no Medicaid bed opens, or the home takes only Medicare, getting Medicaid to pay would mean moving to a home with a Medicaid bed.1 See why Medicare doesn't pay for long-term care and skilled nursing facility costs.

Nonpayment is narrower than families are told. The federal nonpayment ground applies only if the resident doesn't submit the paperwork for third-party payment, or after the third party, including Medicare or Medicaid, denies the claim and the resident refuses to pay.1 CMS's current surveyor guidance adds two protections:

• A resident can't be discharged for nonpayment while a determination on her Medicaid eligibility is pending.1
• Switching from the private-pay rate to the Medicaid rate is not nonpayment.1

And once a resident becomes eligible for Medicaid after admission, the facility may charge only Medicaid-allowable amounts.1 The facility is also responsible for telling the resident about a change in payment status.1

One gap to know about: neither the regulation nor this guidance addresses a Medicaid denial that's under appeal, and by the regulation's own words nonpayment can apply after Medicaid denies the claim and the resident refuses to pay.1 If your parent's Medicaid was denied and the facility is moving toward a nonpayment discharge, call the ombudsman and a legal aid office right away. If you haven't applied yet, our guide to nursing home Medicaid by state is the place to start.

When You're Pressured to Agree to a Move or Sign Out

Sometimes there's no notice, just a hint your parent would be happier elsewhere, or papers to sign out against medical advice (AMA). If that's happened, you're not imagining the pressure.

Federal rules give residents the right to exercise their rights free of interference, coercion or reprisal from the facility.10 CMS's guidance tells inspectors that sign-outs and AMA departures should be thoroughly investigated to find out whether the resident or representative was forced, pressured or intimidated into leaving, and that such a departure calls for a further look at whether the facility met the discharge requirements, including the notice.10 The guidance is also blunt that when a facility offers to discharge a resident to a place that doesn't meet her health or safety needs and the resident agrees, that is noncompliance by the facility.10

Call the ombudsman before anyone signs anything.

A move your parent genuinely wants is a different path. CMS guidance describes state-designated local contact agencies that help nursing home residents who want to return to the community,17 and our guide to getting a parent out of a nursing home walks through that chosen move.

If You Win the Appeal but the Home Won't Take Her Back

A hearing win has not always meant getting back in.

What the Rules Promise

When a hearing decision favors the resident, federal Medicaid rules require the state agency to promptly make corrective payments and, "if appropriate," provide for admission or readmission to a facility.9 CMS's 2025 surveyor guidance says the resident or representative can report the discharge to the State Survey Agency as a complaint based on the favorable ruling. The agency can't cite the facility based only on the ruling, but it must triage the complaint and survey the facility within its complaint timelines.9

What the Inspection Can Do

If the survey finds noncompliance and your parent's health or safety is threatened where she is now, the guidance says the facility's plan of correction should either readmit her until a safe and compliant discharge can be done, or coordinate a transfer to another setting where she'll be safe. It also says violations of the discharge rules would generally be cited at the Harm or Immediate Jeopardy severity level.9 When a complaint involves immediate jeopardy that may be ongoing, the State Survey Agency must start an on-site investigation within three business days of receiving it.18

The ombudsman advocates for your parent; the State Survey Agency assesses and triages complaints and must investigate the most serious ones on site, and with your parent's consent the ombudsman can refer a complaint to it.19 A certified nursing home must post contact details for the State Survey Agency and the ombudsman program.7

What Courts Have Said

Two cases show where litigation stands:

• In Anderson v. Ghaly (2019), three California residents had each won an appeal of a refusal to readmit, and none had been readmitted. The Ninth Circuit held that the right to an appeal includes the state's implementation of the decision, but found their complaint didn't plausibly allege a violation; it vacated the dismissal and remanded so the residents could replead. It was not a win on the merits.20
• In Health and Hospital Corporation of Marion County v. Talevski (2023), the Supreme Court held 7-2 that residents can sue under 42 U.S.C. 1983 to enforce the federal predischarge-notice provisions. Section 1983 reaches only those acting under color of state law, and the home in that case was government-owned.21

If your parent won and is still locked out, keep the ombudsman involved, file the survey-agency complaint, and ask a legal aid office or an elder law attorney whether a court route fits her facts.

Learn More

Find personalized help fighting a nursing home discharge 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.