Ohio nursing homes have been moving some involuntarily discharged residents to homeless shelters even when inspectors and state advocates say the destinations are not equipped for nursing-home medical needs, according to federal inspection findings and interviews with ombudsman officials.
The pattern came into focus in Ohio after a shelter staff member called the fire department when a woman arrived needing assistance and carrying medications, an account that federal inspectors described as alarming. In the description tied to an Aug. 3, 2023 inspection by federal monitors for the Centers for Medicare and Medicaid Services, the woman was listed as incontinent, using a walker, diabetic, managing a tibia fracture and alcohol-related dementia, and uncertain about who had dropped her off.
Inspectors reported that the situation began after the woman was removed from Eastland Rehabilitation and Nursing Center in Columbus, where CMS tied the involuntary discharge to drinking beer at the facility-resident’s home. The federal review said staff tried to place her into rehabilitation for substance use, but that beds were not immediately available, and it documented that Eastland did not call a county psychiatric bed board to find a placement option.
Instead, inspectors said Eastland took her to the homeless shelter, where about 100 people were ahead of her on a waiting list. CMS inspectors said the shelter initially declined to admit her, leaving her outside in late-summer heat, and that staff later relented, allowing her to wait in a lobby while the shelter contacted city rapid response staff, including the fire department and a social worker.
In the inspection report, CMS officials and inspectors said they could not locate the woman by the time the report was published. The report also stated that the “events of what occurred … and how/why Resident #83 ended up at the homeless shelter … could not be determined” because the facility was unable to provide additional information about her, and it noted that Eastland’s administrator declined to return phone calls about the inspection.
In interviews, Dayton’s Long Term Care Ombudsman program leader Chip Wilkins described the broader context as one in which nursing homes are monitored on discharges, but still transfer residents to destinations that may not meet their needs. “We are starting to deal with it more and more,” Wilkins said, describing facilities trying to send residents to hospitals and not take them back, or instead dropping them off at homeless shelters. He added, “I would say certainly over the last six months there has been an uptick.”
Wilkins said ombudsmen treat homeless shelter discharge proposals as priority cases because they often present safety concerns for residents who rely on mobility aids and face complex medication schedules. He said the difficulty can play out quickly, explaining that people may arrive at shelters and then be sent to hospitals within a few days because shelters cannot manage what residents need.
Statewide ombudsman Leilani Pelletier said her office receives copies of involuntary discharge notices from Ohio nursing homes and checks the proposed discharge location. While Pelletier said discharges to shelters against residents’ wishes are rare, she also said her office estimates about 13,000 Ohioans are discharged from a nursing home each month. She emphasized that nursing facilities have legal obligations to ensure discharges are “safe and appropriate,” and she said it is not up to the facilities to unilaterally decide where people should go, adding that the real issue arises when there is little or no work or investigation into whether a shelter can safely meet the person’s needs.
CMS’s inspection record also described additional Ohio examples where inspectors said rules were violated around shelter discharge planning and timing. In one case involving Meadowbrook Manor in Trumbull County, inspectors said a patient with long-term illnesses and a history of substance use and homelessness received a 30-day discharge notice but was sent to a shelter 20 days later anyway, with inspectors also finding problems with how medications were handled upon discharge. Another CMS-cited case, at New Lebanon Rehabilitation and Healthcare Center, described an insurer termination letter and said the facility provided roughly 24 hours’ notice before discharging a woman to a homeless shelter, with the facility’s social services director saying he did not know where she went and only that a friend picked her up.
Separately, a federal inspection described a different case where a male nursing home resident was allegedly discharged to a homeless shelter without adequate notice and with information about the destination purportedly misrepresented. In that account, the facility later sold and rebranded, but CMS records reflected the prior name, and CMS inspectors reported that the patient was not identified in the investigation.
Industry representatives cited in the reporting pointed to broader pressures affecting Medicaid-covered care and nursing facilities’ discharge choices. Scott Wiley, CEO of the Ohio Health Care Association, said the challenges nursing facilities faced reflected a “broader and concerning trend” tied to more residents facing unstable housing and called for additional state oversight and resources to address homelessness-related discharge problems.