I hate to break it to you- but there will come a time when you must discharge a resident. I know as administrators and nursing leaders we believe we can save everyone, but there will be circumstances where the resident just will not be able to meet the criteria to live in an ARCP. See the regulation below for the specifics on how and why you will need to terminate the residency agreement:
- 6837. Termination of Residency Agreements
- Voluntary Termination of Residency Agreement
- The residency agreement shall specify:
- the number of days and the process for notice required for voluntary termination of the residency agreement; and
- the circumstances under which prepaid service charges and deposits are not refundable to the individual.
- Involuntary Termination of Residency Agreements
- The resident shall be allowed to continue residency in the ARCP unless one of the following occurs:
- the resident’s mental or physical condition deteriorates to a level requiring services that cannot be provided in accordance with these licensing regulations;
- the resident’s mental or physical condition deteriorates to a level requiring services that exceed those agreed upon in the residency agreement and PCSP;
- the safety of other residents or staff in the ARCP is endangered;
- the health of other residents or staff in the ARCP would otherwise be endangered;
- the resident or resident’s representative has failed to pay or has paid after timely notice in accordance with the residency agreement for a resident’s stay at the ARCP; or
- the ARCP ceases to operate.
- Involuntary Termination Process
- The resident, the resident’s representative, if applicable, and the state and local long-term care ombudsman shall be notified in writing of the intent to terminate the residency agreement.
- The notice shall be written in a language and in a manner that the resident and the resident’s representative, if applicable, understand.
- The written notice shall be given no less than 30 calendar days in advance of the proposed termination; however, the advance notice period may be shortened to 15 days for nonpayment of a bill for a stay at the ARCP.
- The written notice shall contain:
- the reason for the involuntary termination of the residency agreement;
- the right to formally appeal the involuntary termination of the residency agreement to the DAL; and
iii. contact information for the state and local long-term care ombudsman and for the DAL.
- The resident and/or the resident’s representative, if applicable, shall have the right to dispute any involuntary termination of the residency agreement in accordance with §6833.G.6-7.
- The involuntary termination of the residency agreement shall be suspended until a final determination is made by the DAL.
- If the involuntary termination of the residency agreement is upheld, the ARCP shall provide assistance in locating an appropriate residence and services.
- Emergencies. If an emergency arises whereby the resident presents a direct threat of serious harm, serious injury, or death to the resident, another resident, or staff, the ARCP shall immediately contact appropriate authorities to determine an appropriate course of action.
- The resident’s removal from the premises in response to an emergency does not constitute the termination of the residency agreement. Required notice as described above shall be provided if the ARCP wishes to terminate the residency agreement.
- The ARCP shall document the nature of the emergency and the ARCP’s response to it.
- The ARCP shall notify the resident’s representative of all emergencies immediately after notification of the appropriate authorities.
At times facilities have been known to err on the side of keeping residents who have outgrown their licensure, have behavioral issues, or even unpaid rent, in the community for longer than they should mostly due to census issues. I caution you against this and suggest the timely discharge of residents who will ultimately cause you pain down the road.