Unsafe Discharge of an Elderly Parent in New Hampshire

What Counts as an Unsafe Discharge

A discharge becomes unsafe when the destination environment cannot support the patient's actual functional needs. In practice, that looks like sending a parent with severe mobility limitations to a home with steep stairs and no ground-floor bathroom. It looks like discharging someone with advanced dementia to a home where no one is available to provide 24/7 supervision. It means releasing a patient who needs wound care or IV antibiotics when no home health agency has confirmed they can staff the case.

New Hampshire law under RSA 151:21 requires hospitals to provide appropriate discharge planning that accounts for the patient's clinical condition and home environment. Federal Conditions of Participation reinforce this — the hospital must assess post-acute needs and coordinate services before the patient leaves.

The gap between what the law requires and what actually happens at the bedside is where families get hurt. Case managers are under administrative pressure to move patients out quickly because DRG reimbursement structures reward shorter stays. The case manager may acknowledge your concerns verbally while still scheduling the discharge for the next morning.

How to Formally Object

Verbal objections evaporate. Written objections create a record. Here's how to make your objection stick:

Put it in writing to the case manager and hospital administration. State the specific reasons the discharge is unsafe. Be concrete: "My mother cannot walk without a two-person assist, and the home has 14 stairs to the only bathroom with no option for a first-floor setup." That specificity gives the discharge team a concrete limitation to address in the discharge plan.

Request that your objection be placed in the patient's electronic health record. This creates a contemporaneous clinical record and gives you a way to verify that your concerns were received.

Invoke the CARE Act (SB 187) by asking whether you are recorded as the designated caregiver and whether the hospital has provided instruction on the after-care tasks described in the discharge plan. The instruction must include a live demonstration and an opportunity for questions. The CARE Act itself does not delay discharge, so document any gap promptly.

Contact Acentra Health at 1-888-319-8452 to file a formal discharge appeal. You must call before your parent leaves the hospital and before midnight on the scheduled discharge date. Filing the appeal legally stays the discharge — the hospital cannot remove your parent or charge them for continued care while the independent medical review is pending.

When the Hospital Won't Listen

If the case manager and attending physician dismiss your concerns, escalate to the hospital's patient advocate or patient-relations department. If the hospital does not have a separately designated advocate, ask the patient-relations office who handles patient complaints.

You can also contact the New Hampshire Long-Term Care Ombudsman at (603) 271-4375 if the discharge involves a transfer to a skilled nursing facility or residential care setting. The Ombudsman serves as an independent advocate for residents' rights and can intervene in discharge disputes involving post-acute facilities.

For situations involving potential neglect or abuse — including repeated pressure to accept a clearly dangerous discharge plan — the state's Adult Protective Services can be reached through the DHHS Bureau of Adult and Aging Services.

Protecting Your Parent Going Forward

The strongest position you can be in during a discharge dispute is prepared before the crisis hits. Knowing the specific deadlines, having the right phone numbers ready, and understanding what documentation the hospital is required to provide changes the dynamic entirely. The New Hampshire Hospital Discharge Guide provides structured worksheets for documenting unsafe conditions and pre-formatted language for filing formal objections.

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