F0627

E

Involuntary Discharge of LTC Residents Without Proper Basis, Notice, or Resident-Centered Planning

Puyallup, Washington Survey Completed on 01-21-2026

Penalty

No penalty information released

Summary

The deficiency involves the facility’s failure to permit residents to remain in the facility and its involuntary discharge of multiple LTC residents without proper basis, documentation, or discharge planning focused on resident goals. The facility’s admission agreement allowed involuntary discharge only for specific reasons, such as unmet medical needs, improved health, endangerment, nonpayment, facility closure, or other legal grounds, and required prior consultation with the resident, representative, and attending physician except in emergencies. Surveyors found that 8 of 9 residents reviewed for nursing home transfers were involuntarily discharged or transferred without adequate documentation of the basis for transfer, without sufficient time and orientation, and without an effective discharge planning process reflected in the care plan. The report states this failure placed residents at risk of displacement, discrimination based on ability to pay, and decreased quality of life.

One resident who had a care plan goal to remain in the facility for LTC and whose state case management record documented no discharge plan was told by phone that the facility was no longer taking LTC residents and would be transferred to another SNF. The resident reported liking the facility, feeling at home, and wanting to stay near friends and church in the local area, while their representative and emergency contact stated they did not want the resident moved and were simply told the resident was moving. The roommate reported that staff came in late one afternoon and informed the resident they would be moved the next day, which surprised the resident. The facility’s written transfer notice for this resident cited improved health as the reason for transfer, and the discharge plan of care documented discharge to another SNF on the same date as the notice, while the Social Services Director could not clearly explain why the resident did not remain and only stated that this was the discharge plan they “landed on.”

Another long-term resident, who had lived in the facility for several years and enjoyed the facility’s programs, stated that moving was not their idea and that they believed they were going to a different state but were instead taken to another SNF. This resident did not pack their own belongings and reported missing items, appearing distressed and fixated on their possessions. Their representative and sister stated the resident likely would not have wanted to move, needed help with decision-making, and was shocked by the move, believing they were going elsewhere; they also reported being told the new facility was closer when it was actually farther away, and that the resident’s social supports were in the original community. The admitting facility’s administrator and DNS reported that the discharging facility’s new company was referring Medicaid residents out because they now only accepted Medicare residents and were transitioning the building to skilled care only, sending LTC residents to other facilities.

Additional residents with documented care plan goals to remain for LTC or with no documented discharge care plan were also moved. One resident, whose state case management notes showed no discharge plan and an inactive case due to staying LTC, stated they had lived in the facility for about three years and planned to stay, but were told they were being discharged because “long-term don’t belong,” and that staff chose the receiving facility, presenting it as the only option other than a city the resident did not want. Another resident admitted for nursing and rehab, who had come off skilled services, was discharged to a SNF closer to a visiting friend according to staff, but the resident and friend both stated they were told the resident had to move, were not given a choice of facility, and that the move happened quickly without time to pack belongings.

A long-term resident since 2019 with a care plan goal to stay in the facility reported not knowing they were moving until the morning of the move, receiving no written notice, and not being given a choice of discharge location, while the Social Services Director gave vague responses about offering discharge options. Another resident initially admitted for rehab and unable to return to prior living, who wanted to be with their POA in another SNF, stated they were told the facility was short term only and that they had to go to another nursing home for LTC; the POA reported being told by the facility that the building had been sold, it was now short term, and the resident had to leave that morning. A further resident with a care plan discharge goal of returning home with a roommate and then moving to an ALF or AFH was instead transferred to another SNF; this resident stated the facility was moving everybody because they were not going to have LTC residents anymore, that they were not given a choice of options, and that staff picked a facility and moved them the next day after boxing up their belongings. A nurse manager stated residents who did not want to leave were not being discharged, asserting that acceptance of another placement showed agreement, while the administrator stated no one had been discharged without agreeing and that they would not discharge people who were not agreeable, despite multiple resident and family accounts to the contrary.

The report cites related deficiencies at F621 (Equal Practices Regardless of Payment Source) and F628 (Discharge Process) and references WAC 388-97-0120(1)(2), in the context of the facility’s pattern of discharging LTC residents, many of whom were Medicaid, while transitioning to a skilled-only model without adequate documentation, notice, or individualized discharge planning aligned with resident goals and preferences.