Public Benefits are Key!: Long-Term Care – March 29th, 2023

The Right to Long-Term Care for Adults at Risk of Homelessness

For this special training, we were joined by Meredith Grigg and Ashley Greenberg from Northwest Justice Project!

Northwest Justice Project is Washington’s largest civil legal aid provider for low-income people. They support people involved in matters such as family safety and security plans, protection of income, education rights, access to benefits, housing stability, employment issues and have served veterans, farm workers, victims of crime, survivors of domestic violence, Western State Hospital patients, and lots of others!

Meredith and Ashley are keen advocates for the long-term care rights of people in variety of circumstances, having worked with entities like Seattle Children’s, Harborview Medical Center, and Aging and Disability Services, where they have come across clients unfairly discharged from a long-term care facility.

Who is this Training for?

This training is for any client advocate or service provider who has a client who is medically vulnerable or disabled and is at risk or currently experiencing homelessness. You may have learned that your client was in a facility, and then discharged from the facility without their consent to a hospital or a shelter, without the option to return or to appeal the decision.

This training aims to deliver resources and best practices to providers who care about the well-being of their clients and want to see them regain access to a long-term care facility.

What is Long-Term Care?

Long-Term Care facilities are spaces for medically vulnerable or disabled adults to receive specialized care outside of one’s home in their community.

Types of Long-Term Care facilities include:

  • Nursing Homes
  • Assisted Living Facilities
  • Enhanced Service Facilities
  • Veterans Homes
  • Adult Family Homes

Out-of-pockets costs of living in a long-term care facility can vary, but generally works out to $6,500-$9,500 per month in a nursing home and $3,500-$7,000 per month in other facilities.

For the vast number of people who cannot afford these out-of-pocket costs, Long-Term Care Medicaid can cover expenses if the care is considered medically necessary and a person does not have excessive income or resources. Long-Term Care Medicaid is distinct from Classic Medicaid or Apple Health, but is still granted by DSHS, whereas an application will often be presented by a case manager at a long-term care facility.

What is an Unfair Discharge?

It is important to note that anyone who has qualifying medical conditions has the right to long-term care. It has come to the attention of many of our care advocates that a significant number of our clients may be entitled to long-term care placement, but have been discharged against the client’s best wishes in an illegal process – the impact of which for many medically vulnerable clients has been homelessness, transfer trauma, and severe negative health impacts.

A long-term care facility is legally required to do everything they can to prevent unfair discharge and to ensure the health and safety of their residents. Officially, facilities must provide reasonable accommodations to preserve a community that serves all residents and providers, and to do planning around discharge if necessary.

Long-term care facilities are legally barred from discharging anyone for reasons outside of the following:

  1. When a resident’s health declines and the facility believes they can’t provide adequate care
  2. When a resident’s health improves and a client may not need a facility’s level of care
  3. When a resident presents health or safety risk to their community
  4. When a resident cannot pay for their stay in the facility
  5. When the facility is slated to close

Additionally, facilities are required to follow a specific process when discharging. They must:

  • Give 30 days’ notice
  • Provide that notice in writing in a language the resident understands
  • Give copies of the notice to resident, their family, and DSHS if the resident is on Medicaid
  • List the reason of discharge from the mandated list of 5 reasons
  • Record the location the resident is discharging to, to avoid inappropriate placement
  • Inform the resident that they have the right to an administrative appeal

In practice, however, some facilities have been known to discharge a resident without taking preventative steps, without appropriate notice, without informing the resident of their rights, and in way that can cause homelessness and trauma.

According to Meredith and Ashley, unfair discharges can be due to conflicts between administrators and residents, citing ‘challenging personalities’ and disproportionately affects BIPOC people and people with disabilities.

Scenarios of an unfair discharge may include:

  • A facility sending a resident to an emergency room, regardless of a resident’s need for care, and then barring them from returning
  • A resident exiting the facility for planned medical care and then being barred from returning
  • A facility claiming that a resident’s needs exceed their ability to serve the client, regardless of any change in a resident’s health or needs, and discharging and barring them from returning
  • A facility will discharge due to the resident’s nonpayment in cases where a resident pays out of pocket, without waiting for a client to be granted Long-Term Care Medicaid coverage.

It’s important to note that these are just a few scenarios our advocates from Northwest Justice Project have heard of. These instances and likely others are illegal and deeply mis-serve vulnerable clients. Thankfully, there are resources to redress such injustices and restore access to care!

What can a Client Advocate Do?

There are several tools a client advocate or service provider can take.

Before a resident is unfairly discharged, there are several best practices one can take if they suspect conflict might happen. To prevent discharge, NWJ recommends:

  • Getting in touch with the client’s facility to understand details of conflict
  • Document everything while the client is still at facility, and continue if discharge happens
  • Attempt to identify the barriers and work out a solution with the facility, if they are amenable. Examples include establishing more appropriate supplemental care or attempting a move within the facility to avoid conflicts with specific people.
  • File an appeal with state administrative office or partner Long-Term Care Ombuds Office before discharge (see contact info below)
  • Contact alternate facilities if discharge might be possible

We know that many providers may work with clients who have already been unfairly discharged. In that case, the best option is to appeal the discharge.  Appeals can be based on violation of notice requirements, mishandled care, lack of discharge planning, not providing reasonable accommodations, or other reasons. There are multiple levels of appeals a person may take.

  1. WA Office of Administrative Hearings (OAH) – must be filed within 90 days of discharge
  2. Health are Authority Board of Appeals – must be filed within 21 calendar days from OAH decision if decision doesn’t restore residency – for Medicaid recipients only
  3. Partner with the WA Long-term Care Ombuds Office – this can be a tool to investigate the offending facility and can deliver corrective action
  4. Legal Action – this option can be resource and time-intensive, but can be helpful if a facility refuses to comply – contact Ashley or Meredith for more information (contact info below)

The result of these options is readmission to the offending facility and should be for clients who want to return. Unfortunately, this process does not serve a client who doesn’t want to return to the facility –in this case it is recommended to seek admission to a new facility if available.

Looking for additional resources?