What families should know before a Virginia nursing home discharge.

1. Know that discharge is a legal process, not just a date

Federal law gives every skilled nursing facility resident specific discharge rights. In most non-emergency situations, the facility must provide written notice at least 30 days in advance, explain the reason for discharge, list the location the resident is being transferred to, and inform the resident and family of the right to appeal.

2. Understand the six lawful reasons for discharge

A nursing home can only discharge or transfer a resident for one of these reasons:

• The resident's needs cannot be met at the facility.
• The resident's health has improved and they no longer need SNF care.
• The resident's presence endangers the health of others.
• The resident's presence endangers the safety of others.
• The resident has failed to pay (after reasonable notice).
• The facility is closing.

"We just need the bed" is not a lawful reason. If a discharge notice does not clearly fit one of these categories, families have grounds to appeal.

3. Ask for a safe discharge plan in writing

A safe discharge plan is more than a piece of paper handed over at the door. Before discharge, request written information covering:

• Diagnosis summary and current condition
• Complete, reconciled medication list with doses and reasons
• New prescriptions and where they will be filled
• Diet, allergies, mobility level, and equipment needs
• Wound care, therapy, or nursing orders that continue after discharge
• Follow-up appointments with dates, addresses, and provider names
• Home health, hospice, or outpatient therapy referrals
• Warning signs that should prompt a call to the doctor or 911
• Direct contact number for questions in the first 72 hours

4. Have a "medication moment" before you leave

Medication errors are the most common cause of readmission after a nursing home stay. Before discharge, sit down with a nurse and go through every medication: what it is, what it treats, the dose, when to take it, and what was stopped or changed compared to the pre-admission list. If anything is unclear, ask for the pharmacist to be paged.

5. Confirm the receiving setting is truly ready

If discharge is to home, walk through the space with fall risks, stairs, bathroom safety, oxygen, and equipment in mind. If discharge is to assisted living or another facility, confirm in writing that the new setting has:

• The full clinical record and current medication list
• The capacity to provide the level of care being ordered
• A named contact who will meet the resident on arrival
• A plan for the first 24 hours, including medications, meals, and check-ins

6. Know how to appeal a discharge in Virginia

If a discharge feels unsafe or premature, families have the right to appeal. Options include:

• Requesting a hearing through the Virginia Department of Medical Assistance Services for Medicaid residents.
• Filing a complaint with the Virginia Department of Health Office of Licensure and Certification.
• Contacting the Virginia State Long-Term Care Ombudsman Program for advocacy support.
• For Medicare-covered stays, requesting a fast-track appeal through the Beneficiary and Family Centered Care Quality Improvement Organization (BFCC-QIO) listed on the discharge notice — often within 24 hours.

7. Plan the first 72 hours after discharge

Most readmissions happen in the first three days. Set up a simple check-in schedule for medications, meals, and any changes in condition. Confirm home health or therapy actually shows up as scheduled. Call the primary care provider within a week — earlier if anything has shifted.

8. Get a second set of eyes if you need one

Discharge planning happens fast, often across multiple people who don't always talk to each other. An independent care navigator can attend the discharge meeting, review the plan, confirm the medication list, and help you push back when something doesn't add up — before you're standing in the parking lot with a folder of paperwork.