Nursing Home Eviction Rights Washington: SNF Discharge Protections and How to Fight Back

The Six Legal Grounds for Discharge

Under federal Medicare Conditions of Participation (42 CFR § 483.15) and Washington State regulations, a nursing home can only involuntarily discharge or transfer a resident for six specific reasons:

1. The transfer is necessary for the resident's welfare and the facility cannot meet the resident's needs.
2. The resident's health has improved sufficiently that nursing facility services are no longer needed.
3. The safety of other residents is endangered.
4. The health of other residents is endangered.
5. The resident has failed to pay after reasonable and appropriate notice, and the facility has pursued all available means to collect.
6. The facility is closing.

That is the complete list. A nursing home cannot discharge a resident because they have converted from private pay to Medicaid, because they are "difficult," because a family member complained, or because the facility wants to free the bed for a higher-paying patient. Each of these situations occurs regularly in Washington, and each is illegal if it does not fall within the six enumerated categories.

The 30-Day Written Notice Requirement

Before any involuntary discharge, the nursing home must provide a written notice at least 30 days in advance. This notice must include:

• The specific reason for the discharge (citing one of the six legal grounds)
• The effective date of the transfer
• The location the resident will be transferred to
• The resident's right to appeal through a state hearing
• Contact information for the Long-Term Care Ombudsman Program
• Contact information for the state's Protection and Advocacy agency (Disability Rights Washington)

If the facility claims an immediate threat to health or safety, it may provide notice as soon as practicable rather than 30 days in advance — but it must still provide written documentation of the emergency and the resident retains appeal rights.

How to Appeal

When you receive a discharge notice, request a hearing immediately with the DSHS Office of Administrative Hearings (OAH). Washington allows an appeal request up to 90 days after you receive the notice, but to suspend the transfer or discharge, OAH must receive the request on or before the date set in the notice or before the actual transfer or discharge.

If OAH receives the appeal by the applicable date, it triggers a critical protection: the resident has the right to remain in the facility during the appeal process. The nursing home cannot force the transfer while the hearing is pending. This "stay-put" right is one of the most powerful tools families have, and facilities often fail to mention it in their discharge paperwork.

At the hearing, the burden of proof falls on the facility. The nursing home must demonstrate — with clinical documentation, incident reports, or financial records — that its reason for discharge meets one of the six legal standards. General assertions like "we can no longer meet their needs" are insufficient without specific clinical evidence.

Common Illegal Eviction Patterns

Medicaid conversion pressure. A resident admitted as private pay depletes their savings and applies for Medicaid. The facility suddenly discovers that the resident's "needs have changed" or that it "cannot provide appropriate care." If the facility is Medicaid-certified and the resident's care needs have not genuinely changed, this is an illegal discharge.

Post-hospitalization refusal to readmit. A Medicaid resident is hospitalized and the facility claims the bed is no longer available. If the hospitalization exceeds 24 hours and DSHS pays the bed hold while there is a high likelihood of return, Washington's bed-hold rules (WAC 388-105-0045) require the facility to hold the bed for up to 20 days. After 20 days, the resident has the right to return to the first available appropriate bed.

Behavioral incidents without documentation. Facilities sometimes cite a single behavioral episode — an outburst, wandering, a conflict with staff — as grounds for immediate discharge under the "safety of other residents" provision. The facility must show a pattern of behavior that poses an ongoing risk, that it has attempted interventions, and that the behavior cannot be managed with available resources.

The Ombudsman's Role

The Long-Term Care Ombudsman Program is the resident's independent advocate. Contact them immediately at the first sign of involuntary discharge pressure — before formal notice arrives if possible.

The ombudsman will:

• Review the discharge notice for legal compliance
• Investigate whether the stated reason is genuine
• Attempt to resolve the situation informally with the facility
• Accompany the resident or family to the administrative hearing if needed
• File formal complaints with DSHS Residential Care Services if the facility violated regulations

File a complaint through the Washington Ombudsman portal (waombudsman.org) or call the statewide helpline. The service is free and confidential.

Protections Specific to Adult Family Homes and Assisted Living

Washington's smaller care settings — adult family homes (up to 6 residents) and assisted living facilities — have their own discharge rules under WAC 388-76 and RCW 18.20. These facilities must provide a written residency agreement that spells out the grounds for discharge, and they cannot evict a resident without following the procedures outlined in that agreement.

For adult family homes, DSHS Residential Care Services can impose daily civil fines of up to $3,000 for regulatory violations, including improper discharges. If a facility threatens an illegal eviction, report it directly to RCS — the regulatory consequences for the home are severe enough that a credible complaint often resolves the situation without a hearing.

For families coordinating discharge planning and long-term care placement simultaneously, the Hospital-to-Home Washington guide includes a SNF contract audit checklist that flags problematic discharge clauses before you sign an admission agreement.

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