In Ohio, federal inspectors have documented cases in which nursing-home staff discharged medically fragile residents to homeless shelters, including situations where shelter workers said the patients needed urgent help and where investigators said they could not determine what happened after the transfers. The accounts, described in inspection findings tied to Centers for Medicare and Medicaid Services oversight, depict long-term care facilities trying to discharge people when beds are limited or coverage ends, while shelters struggle to meet the medical and medication needs involved.
One case described by CMS inspectors involved a resident identified as Resident #83 and a homeless shelter response that prompted a call to the fire department. Inspectors wrote that a woman using a walker arrived incontinent and carrying “a large bag of medications,” and that she was diabetic, managing a tibia fracture, and dealing with alcohol-related dementia. CMS also wrote that Resident #83 was scared and unclear about what was happening when staff told inspectors about the circumstances.
CMS said the facility that discharged her, Eastland Rehabilitation and Nursing Center in Columbus, did not call the county’s psychiatric bed board to find placement before sending the resident to the shelter. Inspectors said the shelter initially declined to admit her, leaving her outside in late-summer heat, before shelter staff later allowed her to sit in a lobby with water while they brought in a city rapid response team that included the fire department and a social worker.
The inspection accounts also describe obstacles to follow-up. Inspectors said neither Eastland nor CMS could locate the woman by the time the report was published, and the inspection report said “the events of what occurred at the addiction recovery center or how/why Resident #83 ended up at the homeless shelter … could not be determined” because the facility could not provide additional information about Resident #83.
Advocates and industry leaders described the practice as part of a broader problem in long-term care discharges, tied to unstable housing and pressure from insurers. Chip Wilkins, who leads the city of Dayton’s Long Term Care Ombudsman program and acts as a legal advocate for long-term care residents, said the issue is showing up more often and that even facilities closely monitored on discharges still sometimes send people to places that cannot manage their needs. Wilkins said, “Invariably, that ends up being a horrible experience for the individual because they’ll go to the shelter, and typically, within two to three days, the shelter will send them to the hospital because they can’t meet their needs.”
Wilkins said the proposed discharge location is among the first things the ombudsman’s office checks in involuntary discharges from nursing homes, calling homeless shelter discharges priority cases because they are “almost always unsafe.” He said shelters often cannot manage complex medication regimens and may not be able to support people who rely on equipment such as wheelchairs or walkers. He also said issues can trace back to insurers, including Medicare and Medicaid, that cut off residents’ benefits.
Leilani Pelletier, Ohio’s statewide ombudsman, said her office receives copies of involuntary discharges and that such shelter discharges against residents’ wishes are rare, while also citing a much larger base of routine nursing-home exits. Pelletier said nursing homes have legal obligations to ensure discharges are “safe and appropriate” and that it is not up to facilities to unilaterally decide where a person should go. She said there are cases where shelter placement could be appropriate, but questioned situations where no work or investigation is done to determine whether a homeless shelter can safely meet a resident’s needs.
Industry officials pointed to rising housing instability and broader payment pressures. Scott Wiley, CEO of the Ohio Health Care Association, said the challenges nursing facilities in Ohio are facing reflect a wider trend affecting facilities across the country, and that oversight and resources are needed to address it. Wiley said the issue has been growing as more residents face unstable housing and that it will require a collaborative approach that “a single nursing facility provider is not equipped to manage on their own.”
Some CMS inspection findings also describe discharge-rule violations and medication gaps in Ohio facilities cited for transferring people to homeless shelters. The reporting included references to federal inspectors’ descriptions of cases where providers allegedly failed to ensure patients got medications at discharge, and where they allegedly did not provide the required notice period before involuntary discharge, including one case involving a patient who told inspectors staff never told him he was being taken to a shelter.
Officials and providers also disputed details or declined to comment on specific findings. In the Eastland case, the administrator declined to return phone calls about the inspection, and facility staff declined to provide contact information for Garden Healthcare, described in CMS data as the nursing home’s corporate owner that operates multiple other facilities. In another inspection example involving a facility later sold and rebranded, a receptionist declined to provide her name and said the facility is in “substantial compliance” with the state, according to the reporting.
The federal findings were distributed through the Associated Press partnership with Signal Ohio, which reported and described the CMS inspection details. The reporting also noted that a previous version misstated the ownership structure of one facility, saying the updated ownership is Hillsboro Health and Rehab, LLC, with earlier reporting based on outdated data reflected on the CMS website as of April 13.