Nursing Home Refuses to Readmit After Hospital Stay? What to Do (2026)

If a nursing home refuses to readmit your parent after a hospital stay, federal rules treat that refusal as a discharge, with written notice and appeal rights.1 So if the hospital discharge planner just told you the home "has no bed for her," that phone call is not the last word. You may be standing in a hospital hallway right now, tired and scared about where Mom sleeps next week. The steps below are the ones that matter in the next day or two, starting with the paperwork the nursing home should already have given you.

In This Guide

• What No Bed for Her Means Under Federal Rules
• Find the Two Bed-Hold Notices
• When the Bed Hold Runs Out
• What the Nursing Home Has to Show to Refuse Readmission
• The Written Discharge Notice to Ask For
• How to Appeal a Refusal to Readmit From the Hospital
• Your State Sets the Appeal Deadline
• What the Hospital Discharge Planner Can Do
• How the Long-Term Care Ombudsman Can Help
• If She Wins the Appeal and Still Isn't Taken Back
• What to Ask for Today
• Frequently Asked Questions

What No Bed for Her Means Under Federal Rules

It's natural to hear "there's no bed" as a fact about the building, like a hotel that's full. Under federal law it's something else: a decision about your parent, and decisions like that come with rules.

Under 42 CFR 483.15, if a nursing home determines that a resident it transferred with an expectation of return cannot come back, the facility must meet the same requirements that apply to a discharge.1 Whether you call it a refusal to readmit or hospital dumping, the rule is the same. Guidance from the Centers for Medicare & Medicaid Services (CMS) to nursing home inspectors adds that an emergency trip to the hospital is a transfer, not a discharge, because the resident's return is generally expected, and that residents sent emergently to a hospital must be permitted to return.1

A discharge is allowed only on a short list of federal grounds.1 Our guide to nursing home discharge rights walks through each ground and the full appeal process. This page stays on the hospital side.

The federal discharge and readmission protections cover nursing homes that take part in Medicare as a skilled nursing facility or in Medicaid as a nursing facility. Inside such a home, CMS guidance says the facility's bed-hold and return policies apply to all residents, regardless of payment source.5 If your parent lives in a state veterans home or a VA community living center, see our guide to state veterans home discharge rights.

Find the Two Bed-Hold Notices

Before you call anyone, look through the papers that came with Mom to the hospital, or the folder from her nursing home. Federal rules require two separate written bed-hold notices, and they tell you what the home promised.1

1. Before the transfer. The nursing home must give the resident or representative written information on the state's bed-hold period (if any), the state plan's payment policy for holding a bed (if any), the facility's own bed-hold policy, and its written policy on letting residents return.1
2. At the time of the transfer. The nursing home must give the resident and representative a second written notice stating how long the bed-hold lasts.1

Federal law requires both notices whether or not the state plan has a bed-hold period at all.1 The notices are where you'll find your parent's actual numbers. Didn't get either one? Write that down. CMS tells inspectors looking into a refused return to check whether the bed-hold notice and the discharge notice were given.1

When the Bed Hold Runs Out

This is the moment a family may be told it's over. The right to return doesn't end with the bed hold, though it comes with two conditions.1

Under 42 CFR 483.15(e), a nursing home's written return policy must provide that a resident whose hospital stay runs past the state's bed-hold period goes back to her previous room if it's available, or to the first available bed in a semi-private room, if she both still requires the facility's services and is eligible for Medicare skilled nursing facility or Medicaid nursing facility services.1 The Social Security Act sets the same first-available-semi-private-bed floor for Medicaid-eligible residents.1

Two details often get lost at the hospital desk:

• An unpaid Medicaid balance doesn't block the return. CMS guidance says Medicaid-eligible residents must be permitted to return to the first available bed even if they have outstanding Medicaid balances.1
• Medicare's skilled nursing benefit is short-term. Medicare Part A covers skilled nursing facility care only on a short-term, post-acute basis, generally after an inpatient hospital stay of at least three consecutive days, for up to 100 days per benefit period, and it doesn't pay for long-term custodial care.6 Our 3-day rule guide explains the qualifying stay and its exceptions.

What the Nursing Home Has to Show to Refuse Readmission

If the nursing home's position is "she can't come back," the federal guidance puts the burden of explanation on the home, and it looks at your parent as she is now.

CMS guidance says that when a facility discharges a resident while she is in the hospital after an emergency transfer, it must have evidence that her status at the time she seeks to return, not at the time she was transferred, meets one of the discharge grounds.1 The same guidance points out that the facility was able to care for the resident before the hospitalization, so the documentation must clearly show why it can no longer do so.1

According to that CMS guidance, a nursing home that won't permit a resident to return should have a medical record showing it made efforts to:1

• determine whether she still needs its services and is eligible for Medicare skilled nursing or Medicaid nursing facility services;
• get an accurate picture of her condition, through calls between hospital and nursing home staff or visits to the hospital;
• find out from the hospital which treatments, medications and services she'll need on return;
• work with the hospital before discharge so her needs fit the home's scope of care, for example by trying to reduce a psychotropic medication or switching IV medications to oral ones.

Be honest with yourself about the hard cases, too. The guidance gives the example of a resident who now needs ventilator care or dialysis that the nursing home can't provide, in which case the home may not be able to meet her needs.1

How Inspectors Test "No Bed" and "Can't Meet Her Needs"

CMS tells state inspectors how to check these two explanations, which helps you ask the right questions.1

• "No bed." Inspectors review the home's admissions starting from when the resident was ready to return, to see whether her bed was held under the bed-hold policy, whether a bed was available when she sought to return, and if not, whether she was offered the first available semi-private bed.1
• "Can't meet her needs." Inspectors look into why the needs can't be met and review admissions to see whether residents with similar care needs were admitted or allowed to stay, which the guidance says could indicate the home can meet her needs and is out of compliance.1

Write down the date the hospital told you she was ready to go back. That date is where an inspector's review of admissions starts.

The Written Discharge Notice to Ask For

A phone call relayed through a discharge planner is not a discharge notice. Ask the nursing home, in writing, for the notice federal rules require.

Before a transfer or discharge, the facility must notify the resident and representative in writing, in a language and manner they understand, and send a copy to the Office of the State Long-Term Care Ombudsman.1 The written notice must include:

• the reason for the discharge, its effective date, and the location the resident is being discharged to;1
• a statement of her appeal rights, with the name, mailing and email address and phone number of the entity that takes appeals, and how to get an appeal form and help filing it;1
• the mailing and email address and phone number of the State Long-Term Care Ombudsman.7

A nursing home's written discharge notice is generally due at least 30 days before the resident is moved, but it can come "as soon as practicable" in five situations, including when a resident's urgent medical needs require an immediate move or when she has lived in the facility less than 30 days.1 Look closely at the location line. CMS guidance says discharge planning must identify a destination that meets the resident's health and safety needs.1

How to Appeal a Refusal to Readmit From the Hospital

You don't have to wait until Mom is out of the hospital bed to fight this.

The state Medicaid agency must grant a hearing to any resident who believes a nursing facility has wrongly decided she must be transferred or discharged.8 Under 42 CFR 483.15(c)(1)(ii), once a resident appeals, the facility may not discharge her while the appeal is pending unless not doing so would endanger the health or safety of the resident or others, and the facility must document that danger.1

For your family, that means appealing from the hospital should get Mom back into the home while the appeal runs, and the home can keep her out only if it can point to real evidence. CMS's current inspector guidance says so for a resident who appeals from the hospital, though it words the exception two ways (Appendix PP, tag F627, reissued in Transmittal 232, effective April 25, 2025).1

• Where it talks about appeals from the hospital. If the resident or her representative appeals the discharge while she is in the hospital, the facility must allow her to return pending the appeal, unless there is evidence that the facility cannot meet her needs or that her return would pose a danger to the health or safety of the resident or others in the facility.1
• Where it talks about a home refusing her return. If the resident chooses to appeal, the facility must allow her to return to her room or an available bed during the appeal unless there is documented evidence that her return would endanger the health or safety of the resident or others.1

The hospital-appeal passage adds that a facility's decision not to let the resident return while her appeal is pending must not be based on her condition when she was originally sent to the hospital.1 If the home points to her needs rather than to a documented danger, ask it to show you that evidence in writing.

Your State Sets the Appeal Deadline

The clock for asking for a hearing comes from your state, and for a failure to readmit it can be short. Three examples show how much it varies:

• Connecticut. For a nursing facility's failure to readmit, the resident has 20 days from receiving the facility's notice to request a hearing.3 See our Connecticut appeals guide.
• Massachusetts. The hearing request is due 14 days after written notice of a discharge that results from a nursing facility's failure to readmit after a hospitalization, or 30 days after a facility fails to readmit and gives no notice.3 See our Massachusetts appeals guide.
• District of Columbia. A facility that is a District Medicaid provider may not discharge a resident because of a temporary hospitalization if payment for the bed continues to be made available, and a resident has 7 days from receiving a discharge notice to request a hearing.2

For other states, see the state deadlines section of our discharge rights guide, follow the instructions on the notice, and confirm the deadline with the ombudsman the same day.

What the Hospital Discharge Planner Can Do

The discharge planner is often the person delivering the bad news, so it can feel like they're on the nursing home's side. They work for the hospital, and the hospital has its own federal duties to your family.

Medicare's hospital rules at 42 CFR 482.43 require a discharge planning process that includes the patient and her caregivers as active partners, and the hospital must provide a discharge planning evaluation on request of the patient, her representative or her physician, and discuss the results with them.9 The hospital must also tell the patient or representative about their freedom to choose among participating Medicare providers, and it must not specify or otherwise limit the qualified providers available to her.9

In practice, tell the planner you're appealing the nursing home's refusal, ask them to hold off on placing your parent somewhere else while you get the written notice, and ask for a discharge planning evaluation if one hasn't been done. Our hospital discharge planning guide covers the hospital side in more depth.

The hard part is timing: the hospital may be ready to discharge her before the hearing is decided. Once you've appealed, CMS guidance says the nursing home must let her return while the appeal is pending, unless there is evidence it can't meet her needs or that her return would endanger her or others in the facility.1 So ask the planner to send her back to the home and to get any refusal in writing. If someone suggests a temporary bed elsewhere, ask the ombudsman how that could affect her appeal before you agree.

One route sounds similar but answers a different question. A Medicare fast appeal asks an independent reviewer, the Beneficiary and Family Centered Care Quality Improvement Organization (BFCC-QIO), whether her covered hospital services are ending too soon.10 If you ask no later than the day she's scheduled for discharge, Medicare says she can stay in the hospital while the reviewer decides and won't have to pay for the stay, apart from any coinsurance or deductibles, until noon of the day after the decision.10 That buys time on the hospital side only. The nursing home's refusal still goes to the state fair hearing.8 Our Medicare fast appeal guide explains that process.

How the Long-Term Care Ombudsman Can Help

The Long-Term Care Ombudsman Program has an office in every state, its services are free and confidential, and it represents the resident and follows her direction, so expect the ombudsman to ask what your parent wants.4

The federal Administration for Community Living (ACL) uses an involuntary discharge as its own example. When a resident gets a discharge notice with a right to a hearing, ACL says an ombudsman representative could make sure she understands the notice and how to request a hearing, refer her to a non-profit legal services program to file the request, testify at the hearing, go with her for support, or serve as her spokesperson.11 Notice the word "could." ACL also says the program isn't required to provide legal services, though federal rules do require it to help residents seek legal remedies. So if the home is digging in, ask the ombudsman for a referral to legal aid.11

To find your state's office, ACL points to the state directory run by the National Consumer Voice for Quality Long-Term Care.4 Our long-term care ombudsman guide explains what else the program does.

If She Wins the Appeal and Still Isn't Taken Back

Winning the hearing should be the end of it, and sometimes it isn't. Few things are more exhausting than winning and still watching Mom wait in a hospital bed, so lean on the ombudsman here.

Under 42 CFR 431.246, when a hearing decision favors the resident, the state Medicaid agency must, "if appropriate," provide for her admission or readmission to a facility.8 CMS guidance adds that the resident or her representative may report the discharge to the State Survey Agency as a complaint based on the favorable ruling. The agency can't cite the home based only on the ruling, but it must triage the complaint and survey the home within its complaint timelines.8 If an inspection finds noncompliance and her health or safety is threatened where she is now, CMS guidance says the home's plan of correction should either readmit her until a safe, compliant discharge can be done, or arrange a transfer to a setting where she'll be safe.8

The home has to post the State Survey Agency's addresses and phone number,7 and 1-800-MEDICARE (1-800-633-4227) can give you its contact information too.12 If the agency determines a complaint involves immediate jeopardy that may be present and ongoing, it must start an on-site investigation within three business days of receiving it.13

Courts are a lawyer's question, not a family's first step. Federal courts have held that residents can sue over a state's failure to provide a fair appeals process, which includes carrying out the decision (Anderson v. Ghaly, Ninth Circuit, 2019),14 and can sue under 42 U.S.C. 1983 to enforce the Federal Nursing Home Reform Act's predischarge-notice rules against those acting under state authority, such as the government-owned home in Talevski (Supreme Court, 2023). Ask a lawyer whether either fits your parent's case.15

What to Ask for Today

You don't have to do all of this alone, and you don't have to do it perfectly. Work down the list:

Learn More

Find personalized help reading a bed-hold or discharge notice 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.