Federal regulations at 42 C.F.R. §483.15(c), set out specific and detailed protections for nursing home residents who are faced with involuntary transfer or discharge from their facilities. One provision, 42 C.F.R. §483.15(c)(7), requires facilities to “provide and document sufficient preparation and orientation to residents to ensure safe and orderly transfer or discharge from the facility.” Despite the regulatory mandate, recent newspaper articles about Utah and Ohio document an apparent increase in discharges to homeless shelters.
For many years, advocates for residents urged the Centers for Medicare & Medicaid Services (CMS) to address inappropriate discharges of residents to homeless shelters. CMS responded in recent revisions to the State Operations Manual (SOM), CMS’s official guidance to state surveyors in how to conduct surveys and how to code the severity of deficiencies. Although SOM documents described below do not have page numbers, all changes appear in red italics and computers may identify page numbers.
Appendix PP of the SOM, Guidance for Surveyors, provides CMS’s official explanation of what the regulatory standards of care mean. A July 2025 revision added new language about unsafe discharges (at unnumbered p. 216 in the 926-page document):
[I]f the discharged resident’s health and/or safety is threatened in the setting they are currently located, the facility’s plan of correction should state that the facility will either, 1) Re-admit the resident until a safe and compliant discharge can be done, or 2) Coordinate a transfer of the resident to another setting where they will be safe. The facility should not be determined in substantial compliance until one of these two items is complete (and all other noncompliance has been corrected)...
Additionally, for situations in which residents’ discharge locations did not meet their health and/or safety needs, enforcement should be implemented immediately. For example, a discretionary denial of payment for new admissions should be imposed to go into effect within 2 or 15 days (as appropriate) and remain in effect until a return to substantial compliance as evidenced by either, 1) the resident is readmitted and not discharged unless a safe and compliant discharge is done, or 2) the facility coordinates a discharge to another setting where their needs will be met.
In a January 30, 2026 revision to the State Operations Manual, CMS added new language to the classification of immediate jeopardy, the highest level of facility noncompliance. Section 5075.1 (at unnumbered p. 121 of the 310-page document) now includes the following language:
“For nursing homes, all intakes where a resident was discharged to an unsafe setting, or in a manner that place the resident at risk for serious harm (e.g. the resident still has medical needs but they cannot be supported in the setting they were discharged to).”
Advocacy: If a nursing home proposes to discharge a resident to a homeless shelter or other unsafe location (discharges to storage units and hotels have also been reported), the resident (or advocate) should file a complaint with the state survey agency (typically, the health department), explaining why the homeless shelter cannot meet the resident’s care needs, citing CMS’s guidance in the State Operations Manual and Appendix PP, and seeking immediate relief requiring the nursing home to readmit the resident.
References:
CMS, State Operations Manual, Appendix PP – Guidance to Surveyors for Long Term Care Facilities, Rev. 232, Issued: 07-23-25)
CMS, “Revisions to the State Operations Manual (SOM) Chapters 5 and 7,” QSO-26-03-NH (Jan. 30, 2026), which includes the revisions.
Utah: Taylor Stevens, “Older adults are being discharged out of long-term care facilities – and into homelessness,” Fox13now.com (Apr. 9, 2026) (Utah ombudsman program found 57 residents were discharged to a homeless shelter or hotel since March 2024 and 34 residents were discharged to “unknown” locations)
Ohio: Jake Zuckerman, “Ohio’s nursing homes are dumping patients at homeless shelters,” The Columbus Dispatch (Apr. 17, 2026) and “Nursing homes are dumping patients at homeless shelters, federal inspectors report says,” Associated Press (Apr. 14, 2026)
Iowa: Clark Kauffman, “State: Troubled nursing home tried to evict resident to a homeless shelter,” Iowa Capital Dispatch (Apr. 20, 2026).