Basic Care and Assisted Living Discharge Rights in North Dakota

The basic care facility just told your parent they have to leave. Maybe it's because Medicaid is slow to process. Maybe it's a behavioral complaint. Maybe the facility claims they can no longer meet your parent's care needs. Whatever the reason, they cannot simply put your parent out without following strict legal procedures.

North Dakota law protects residents of basic care facilities, assisted living facilities, and skilled nursing homes from involuntary transfers — and your parent has specific rights to fight back.

The 30-Day Notice Requirement

Under N.D.C.C. Chapter 50-10.2, facilities cannot transfer or discharge a resident without providing a minimum 30-day written advance notice. This notice must include:

• The specific reason for the transfer or discharge
• The effective date of the transfer
• The proposed new location
• Contact information for the State Long-Term Care Ombudsman (1-855-462-5465)
• A statement of the resident's right to appeal

Verbal notifications don't count. An administrator saying "your mother needs to leave by Friday" has zero legal force without proper written notice.

Legally Permitted Reasons for Transfer

A facility can only initiate an involuntary transfer or discharge under these specific circumstances:

Medical necessity: The resident's condition has changed so that the facility can no longer meet their clinical needs (e.g., a basic care resident now requires 24-hour skilled nursing).

Resident safety or the safety of others: The resident's behavior poses a documented and ongoing threat — not a single incident, but a pattern that the facility has attempted to address through care plan modifications.

Nonpayment of fees: The resident has not paid after reasonable opportunity and notice. However, if the nonpayment is because Medicaid is pending, many facilities are required to accept Medicaid-pending residents and cannot discharge solely because the application hasn't been processed.

The facility is closing: The entire facility is ceasing operations.

Basic Care Facility vs. Skilled Nursing Facility

North Dakota licenses these as distinct facility types with different rules:

Basic Care Facilities (NDCC Chapter 23-09.3) provide room, board, supervision, and personal care — but not 24-hour skilled nursing. They're funded primarily through the Basic Care Assistance Program (BCAP) for eligible residents and private pay.

Skilled Nursing Facilities (NDCC Chapter 23-16) provide round-the-clock medical care, rehabilitation, and clinical supervision. Funded through Medicare and Medicaid.

Assisted Living Facilities (NDCC Chapter 50-32) are primarily private-pay housing. Medicaid Waiver services can pay for personal care inside an ALF, but Medicaid never covers room and board.

Transfer rights apply to all three — the 30-day notice and appeal process protects residents regardless of facility type.

How to Fight an Involuntary Transfer

Step 1: Contact the Ombudsman immediately. Call 1-855-462-5465 or email [email protected]. The Ombudsman will investigate the facility's stated reasons and determine whether they've met legal requirements. File using state form SFN 1829.

Step 2: Request a fair hearing. If your parent is on Medicaid, they have the right to a state fair hearing to contest the transfer. Filing for a hearing may delay the transfer while it's pending.

Step 3: Review the care plan. If the facility claims they "can't meet" your parent's needs, demand to see the care plan and documentation of what they've tried. Facilities must demonstrate that they've made reasonable efforts to address the issue before resorting to transfer.

Step 4: Check for retaliatory motive. If the transfer notice came shortly after a complaint, a request for accommodation, or a dispute with staff, it may constitute retaliation — which is illegal under federal nursing home resident rights.

The Hospital-to-Facility Transition

During a hospital discharge to a basic care or skilled nursing facility, families should understand:

• The receiving facility's admission agreement should not contain waiver-of-rights clauses for discharge protections
• Medicaid-pending status is not a legal basis for refusing admission or initiating early discharge at Medicare/Medicaid-certified facilities
• Short-term rehab patients have the same transfer rights as long-term residents — a facility cannot force a rehab patient into long-term status or discharge them without proper notice simply because Medicare rehab coverage ends

When the Facility Is Right

Sometimes a transfer is appropriate — if your parent's medical needs genuinely exceed what a basic care facility can provide, a higher level of care may be safer. In those cases, work with the discharge planner and Ombudsman to ensure the transfer is to an appropriate facility, not just the first available bed.

The Complete Resident Rights Toolkit

The North Dakota Hospital-to-Home Guide includes a facility admission agreement review checklist, involuntary transfer appeal templates, and the Ombudsman complaint filing guide — so your family knows their rights before signing any facility paperwork.

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