Nursing Home Regulatory Review – F623 Providing Notice Before Discharge or Transfer

Over the last few months there have been a few instances of providers failing to provide a written notice of transfer or discharge to the resident or their family, particularly when the resident is being transferred to an acute care hospital.  

F623 includes several elements that must be completed when the nursing home initiates a transfer or discharge (note this includes emergency transfers to the acute care hospital).

Before the transfer or discharge, the nursing home must:

• Notify the resident and their representative(s) of the transfer or discharge and the reasons for the move in writing and in a language and manner they understand.  A copy of this notice must be sent to the State Long-Term Care Ombudsman. (Note, DIA and the LTC Ombudsman have previously indicated that a list of residents at established time frames are sufficient (i.e. monthly).
• Record the reasons for the transfer or discharge in the resident’s medical record.
• Include elements outlined below in the notice.

 Timing of the notice:

• Generally, the notice must be made by the nursing home at least 30 days before the resident is transferred or discharged.
• Notice must be made as soon as practicable before transfer or discharge when:
  • The safety of individuals in the nursing home would be endangered.
  • The health of individuals in the nursing home would be endangered.
  • The resident’s health improves sufficiently to allow a more immediate transfer or discharge.
  • An immediate transfer or discharge is required by the resident’s urgent medical needs.
  • A resident has not resided in the nursing home for 30 days.

 Contents of the notice:

• The reason for transfer or discharge.
• The effective date of the transfer or discharge.
• The location to which the resident is transferred or discharged.
• A statement of the resident’s appeal rights, including the name, address (mailing and email), and telephone number of the entity which receives such requests; and information on how to obtain an appeal form and assistance in completing the form and submitting the appeal hearing request.
• The name, address (mailing and email) and telephone number of the Office of the State Long-Term Care Ombudsman.
• For nursing home residents with intellectual and developmental disabilities or related disabilities, the mailing and email address and telephone number of the agency responsible for the protection and advocacy of individuals with developmental disabilities established under Part C of the Developmental Disabilities Assistance and Bill of Rights Act of 2000.
• For nursing home residents with a mental disorder or related disabilities, the mailing and email address and telephone number of the agency responsible for the protection and advocacy of individuals with a mental disorder established under the Protection and Advocacy for Mentally Ill Individuals Act.

Changes to the notice. If the information in the notice changes prior to effecting the transfer or discharge, the nursing home must update the recipients of the notice as soon as practicable once the updated information becomes available.

Notice in advance of nursing home closure. In the case of nursing home closure, the individual who is the administrator of the nursing home must provide written notification prior to the impending closure to the State Survey Agency, the Office of the State Long-Term care Ombudsman, residents of the nursing home, and the resident representatives, as well as the plan for the transfer and adequate relocation of the residents.

In order to ensure that each resident and their representative receives all required information, it is likely the best practice to develop a template form that contains all of the required information that has a few areas for handwritten information such as the resident name, the date of the notice, the date of the transfer or discharge, and the location.

Note the requirement that if the transfer or discharge location is changed at any point, the notice must be updated. The interpretative guidance also includes information that if the location changes at any point, a new 30-day period begins and the resident’s appeal rights start over. When the interpretative guidance was revised in 2022, I asked DIA about the interpretation such as if the resident transfers from one acute care hospital to another does this require a new notice. DIA believed at that time the interpretative guidance was more relevant to instances where the resident may be transferring or discharging to another location (such as discharging to nursing home A) and during the process, nursing home A decides they’re unable to care for the resident and the nursing home that is transferring now secures a location in nursing home B. The notice would be updated to include the discharging location to nursing home B and a new appeal period would begin.