Right to Refuse a Transfer to Another Room

The next regulation in the resident rights regulation is F560 and allows the residents to refuse certain transfers within the nursing home. There are three indications for a room change in which the resident can refuse:

1. To relocate from a distinct SNF area of the building to a non-SNF area.
2. To relocate from a distinct NF area of the building to a SNF distinct area.
3. For the convenience of staff.

The regulation also indicates that if a resident refuses to transfer to a different distinct area of the building, that it does not affect their eligibility or entitlement to Medicare or Medicaid benefits. However, the interpretative guidance outlines the financial responsibility of the benefits if the residents decline the move.

First, we need to define distinct areas within the nursing home setting as most nursing home providers who accept Medicare and Medicaid services are known as dually certified. According to Appendix PP in the State Operations Manual (SOM) a distinct unit is part of a larger complex, it is physically distinguishable from the larger building and may be comprised of one or more buildings, or parts of buildings (such as wings or floors). A distinct part must include all beds within the designated area and cannot consist of a random collection of individual rooms or beds that are scattered throughout.

If the resident refuses to transfer to the other area of the building because they now qualify or are eligible for Medicare or Medicaid services, the staff are responsible for notifying the resident or the representative of the resident’s eligibility and what the financial responsibility may be. If the resident is unable to pay for those services, the staff may issue a notice of discharge and assist with a safe discharge or transfer.

In addition, the residents are allowed to refuse transfers that are solely for the convenience of staff. When considering this specific requirement, remember back to the pandemic as this specific requirement was included in the 1135 waivers and no longer allowed for the residents to refuse to transfer to another area of the building. In these situations, residents are being asked to move to possibly cohort individuals based on the type of care they need. As an example, the A hall has residents who only require the assistance of one staff member, therefore when Joe began needing two staff, the nursing home asked him to move to a different room. This type of move would be solely for the convenience of staff as the area that Joe currently resides in does not have a specific license which only allows for assistance of one staff member.