Nursing Home Discharge Rights Maryland: How to Fight an Involuntary Transfer

The nursing home administrator says your parent has to leave. Maybe they claim the facility can no longer meet their needs, or they're pressuring you about unpaid bills. Before you start packing, understand that Maryland and federal law severely restrict when and how a nursing home can discharge a resident — and your parent has the right to appeal and stay during the review.

The Four Legal Grounds for Involuntary Discharge

Under 42 CFR § 483.15 and Maryland regulations, a skilled nursing facility can only initiate an involuntary discharge for these specific reasons:

1. The resident's welfare requires it — their clinical needs have changed and the facility genuinely cannot provide the level of care required
2. The resident has recovered — they no longer need skilled nursing services
3. Safety of others — the resident's behavior actively endangers the health or safety of other residents
4. Non-payment — the resident has failed to pay (or have Medicaid pay) after receiving reasonable written notice

No other reason is legally sufficient. A facility cannot discharge a resident because they're "difficult," because they filed a complaint, or because their Medicaid reimbursement rate is lower than the private-pay rate.

The 30-Day Written Notice Requirement

Before executing an involuntary transfer, the nursing home must provide written notice at least 30 days in advance to:

• The resident
• Their next of kin or legal representative
• The Long-Term Care Ombudsman
• The Maryland Department of Health

The only exception is an emergency transfer — when the resident poses an immediate danger to themselves or others, or has been in the facility fewer than 30 days.

The written notice must include the reason for discharge, the planned discharge date, the destination, and — critically — the resident's right to appeal.

How to Appeal

The resident or their representative can request mediation and a formal hearing before an Administrative Law Judge at the Office of Administrative Hearings within 30 days of receiving the discharge notice.

If the appeal is filed within the 30-day window, the nursing home cannot execute the transfer until a final administrative decision is issued. This is the strongest protection available — filing the appeal effectively freezes the discharge.

The Safe-Destination Mandate

Regardless of the reason for discharge, the facility must send the resident to a safe and secure setting that is:

• Licensed and capable of meeting the resident's documented medical and functional needs
• Verified by the facility as appropriate for the resident's level of care

At discharge, the facility must provide:

• A comprehensive medical assessment
• A post-discharge plan of care
• Written clinical confirmation that the transfer won't cause medical harm
• A complete medication list
• A physical three-day supply of all current medications

Where to Get Help

Long-Term Care Ombudsman: Independent advocates who investigate complaints and can attend discharge planning meetings. They serve as your parent's representative during the appeal process.

OHCQ complaints: File with the Office of Health Care Quality:

• Online: OHCQ Complaint Form
• Phone: 410-402-8108
• Nursing home complaints: [email protected]
• Complaints against administrators: [email protected]

Maryland Legal Aid: Provides free legal representation for nursing home residents facing involuntary discharge in qualifying cases.

The Maryland Hospital Discharge Guide includes an Eviction Protection Worksheet with template appeal language and step-by-step instructions for the Office of Administrative Hearings process.

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