F0621

E

Discriminatory Discharge Practices Targeting Medicaid LTC Residents

Puyallup, Washington Survey Completed on 01-21-2026

Penalty

No penalty information released

Summary

The deficiency involves the facility’s failure to ensure residents were treated equally regarding transfer, discharge, and provision of services regardless of Medicaid payment source, and failure to ensure Medicaid residents were not being discharged because of their payor status. A Change of Ownership (CHOW) application dated 07/23/2025 indicated the new owner requested Medicaid certification and a letter to residents and families stated there would be no disruption in care. However, the new, undated admission agreement under the new facility name only offered month‑to‑month or respite/short‑term stay options, and the facility website listed skilled nursing, rehabilitation, activities, and social services but did not list LTC services. The Administrator stated facility practices had not changed but acknowledged they discharged “all kinds of residents,” started discharge planning on admission, and that acceptance and retention of LTC Medicaid residents “depended” on the resident.

Interviews and records showed a pattern of targeting Medicaid LTC residents for discharge or transfer. The DON reported that social services sought residents willing to transfer to other SNFs to increase availability to provide services to the community and that residents on the East wings, previously LTC, were being placed on skilled care. Census review showed a high proportion of Medicaid residents on the East wings, and discharge records from 01/01/2026 to 01/21/2026 showed nine residents discharged to other nursing homes, all of whom were Medicaid. An administrator and DNS from a receiving facility stated the discharging facility was referring Medicaid residents because they now only accepted Medicare residents, were making room for more skilled residents, and were trying to transition to skilled‑care‑only operations.

Multiple residents and their representatives reported being told that LTC residents, particularly Medicaid‑funded residents, could not remain. One resident’s representative stated they were told the facility was no longer doing LTC, only rehabilitation, and another emergency contact reported being told that the LTC side of the building “had to be discharged.” Several residents and POAs, all with Medicaid as primary payor source, reported being informed that the facility was becoming a short‑term/post‑acute or rehabilitation facility and that LTC residents “don’t belong,” could not stay, or would be transitioned because they were stable and did not need skilled care. A Nursing Facility Case Manager stated the new ownership wanted to run the facility like a rehabilitation place, fill beds, and discharge residents as soon as possible. Residents and representatives described fear and upset as LTC residents were approached about transfers without written notices, and staff interviews confirmed an active process of discharge planning for “everyone” and transitioning stable, non‑skilled residents out of the facility, many of whom were Medicaid LTC residents.