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Ending the California Hospital Dump


Nursing homes regularly evict residents illegally. No illegal eviction method is more frustrating than the hospital dump. In such a scenario, a nursing home has a resident transferred to a hospital for some acute care need. Once the resident has been hospitalized, the nursing home clears out her room, packs her belongings, and refuses to take her back, all without any advance warning. This process is as illegal as it is reprehensible. And the time has come for it to end.

Transfers to a Hospital – The Right to a Bed-Hold

Whenever a nursing home resident is transferred to a general acute care hospital, federal and state rules require her bed be held for up to seven days. If the hospitalization exceeds seven days, the facility must nonetheless provide the resident with the first available bed in the nursing home after she is cleared for return (Medi-Cal residents or residents who did not receive bed-hold notice only).

The purpose of the legally mandated bed-hold is obvious: residents who need to go to the hospital for acute care should not have to worry about losing their placement in their nursing home as a result. At the time of hospitalization, the resident likely has built relationships with the facility staff members who know the resident and her care needs. Those relationships, as well as therapeutic progress, would likely be lost if the resident were forced to start over in a new nursing home. In addition, for better or worse, nursing homes serve as the homes of their residents. Residents spend weeks, months, and sometimes years in their nursing homes. They receive mail, visitors, and meals, hang their pictures, store their personal belongings, and live their lives. A tenant in an apartment would never dream of losing her home because she went to the hospital for a few days.

Refusals to Honor Bed-Holds: Trauma Drama

Despite legally mandated nursing home bed-holds, facilities often refuse to readmit hospitalized residents, primarily because it’s so easy. The residents who are discarded are typically disabled, unfamiliar with their bed-hold rights and in no position to take on a nursing home that has locked the door behind them. The Depart- ment of Public Health, charged with enforcing state and federal nursing home rules has been nearly non-existent in protecting the rights of residents to have their beds held. In the vast majority of cases, the facility is issued no enforcement action whatsoever.

Perhaps the main reason for hospital dumping is that it’s highly profitable for nursing homes. Residents who are refused readmission following a hospitalization are almost uniformly Medi-Cal beneficiaries. Replac- ing a “Medi-Cal resident” with a resident whose stay is covered by Medicare can garner a facility tens of thousands of dollars in additional revenue over the course of a few months.

From the dumped resident’s perspective, they are utterly abandoned, not only losing their home but also their care services and the relationships they may have devel- oped with staff members and other residents. The loss of the nursing home bed eviscerates the resident’s sense of safety, exploiting their vulnerability and powerless- ness. The loss of one’s home, without warning or legal remedy, can cause incalculable upheaval and damage. Residents who are dependent on others for most or all of their care needs are particularly vulnerable to transfer trauma that can send their health spiraling downward and occasionally cause death.

The illegal dumping of nursing home residents into hospitals is also a tremendous drain on state resources. Residents who needlessly sit in hospitals often spend weeks or even months in residential limbo, while running up an expensive bill paid for by the state.

BUDGET BUSTER: STATE COSTS IN A HOSPITAL DUMP CASE

Nursing home reimbursement rate: $150 - $200 per day Hospital Administrative Day rate: $351 per day DHCS Administrative Fair Hearing cost: $4,600

Total state costs for 30 days of wrongful refusal to readmit: $4,600 + ($175/day x 30 days) = $9,880.

Dumping on the Rise

Data obtained from the state unequivocally demonstrate that nursing home bed-hold abuse and illegal evictions are on the rise. The number of nursing home eviction appeal hearings held by the state has drastically risen over the past decade, more than tripling from 53 in 2000 to 186 in 2011. A significant number of these hearings are held when a resident has been dumped into a hospi- tal but has the wherewithal to seek an appeal.

While 95% of all residents who are dumped into hospi- tals prevail at their hearing, fewer and fewer are getting readmitted. Facilities have learned that the state will take no additional action to ensure that a resident is actually readmitted following a successful appeal. The total lack of enforcement is an invitation to recalcitrance.

AB 1752 – Taking the Profit Out of Hospital Dumping

To end the illegal refusal to readmit nursing home residents, CANHR is sponsoring AB 1752 (Yamada), the Bed-Hold Protection Act of 2012. AB 1752 relies on one simple premise: meaningfully penalize nursing homes that abandon residents in hospitals. The bill will impose stiff mandatory and daily fines on any nursing home that illegally refuses to readmit a resident follow- ing a successful state appeal. The fines will realign

the warped profit-incentive facilities have to illegally evict poor residents on Medi-Cal. Most importantly, AB 1752 sends a message to nursing homes that callously dumping residents into hospitals will no longer be toler- ated in California.

For more information about bed-hold issues or AB 1752, please contact Anthony Chicotel, CANHR Staff Attor- ney, at tony@canhr.org.

Page Last Modified: March 15, 2012