A troubling pattern is emerging across the United States: nursing homes are discharging medically fragile residents — often elderly, low-income, and heavily dependent on round-the-clock care — directly to homeless shelters. Federal inspectors have now documented multiple cases, and advocates say the problem is getting worse.

This isn’t a fringe issue. It’s a systemic failure that puts some of the most vulnerable people in our society at serious risk. And for families with loved ones in long-term care facilities, understanding this practice — and what rights residents have — could be the difference between safety and a dangerous, potentially life-threatening discharge.

What Federal Inspectors Found

The Centers for Medicare and Medicaid Services (CMS), which funds the majority of nursing home care in the United States, has cited at least seven nursing facilities in recent years for improperly discharging residents to homeless shelters.

One case stands out for its severity. According to inspection records from Eastland Rehabilitation and Nursing Center in Columbus, Ohio, a woman with alcohol-related dementia, a tibia fracture, and diabetes was transported to a homeless shelter after being caught drinking beer at the facility. Staff failed to call the county’s psychiatric bed board to find appropriate placement. She showed up at the shelter confused, incontinent, and carrying a large bag of medications — unclear about where she was or who had brought her there. Shelter staff called the fire department. By the time CMS published its report, neither the facility nor federal inspectors could locate the woman.

In another case documented by a December 2025 CMS inspection, a man who had lived at the Laurels of Hillsboro for 22 years was discharged to a shelter after his insurance stopped paying — without the legally required 30-day notice, without his medications, and without identification documents. Staff reportedly told him he was being taken to an assisted living apartment. He arrived at an emergency shelter without insulin needles, struggling to see due to cataracts.

His former roommate told inspectors: “I can’t believe they would do someone dirty like that.”

Why This Is Happening

The short answer is money. Medicaid, which pays for most nursing home care, is under significant financial pressure as federal lawmakers reduce program funding. When a resident’s Medicaid or Medicare benefits are cut — or when a resident is deemed difficult due to behavioral issues — facilities sometimes look for the fastest exit, regardless of whether it’s safe or legal.

Chip Wilkins, who leads Dayton’s Long Term Care Ombudsman program, told reporters: “We are starting to deal with it more and more. The facilities are so closely monitored on discharges, but yet they still try and send them to hospitals and not take them back. Or drop them off at homeless shelters.”

He noted a noticeable uptick in such discharges over just the preceding six months.

The profile of patients most at risk is consistent: older adults who are homeless, unemployed, and without family members checking in on them. They are precisely the people with the least ability to advocate for themselves.

Scott Wiley, CEO of the Ohio Health Care Association, acknowledged in a statement that the issue has been growing as more residents face unstable housing — but also pointed to the need for state-level resources and collaborative solutions, noting that individual nursing facilities are “not equipped to manage” the problem on their own.

The Danger of Shelter Discharges

Homeless shelters are not medical facilities. They are not equipped to manage patients who take 10 to 20 medications daily, rely on wheelchairs or walkers, require wound care, or need assistance with basic tasks. Some shelters require residents to climb to a top bunk — an impossible ask for a patient recovering from a fracture or managing severe arthritis.

According to ombudsman Chip Wilkins, the outcome is almost always the same: “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.”

Marcus Roth of the Coalition on Homelessness and Housing in Ohio put it plainly: shelters are the de facto safety net, but they’re being asked to handle a population they were never designed to serve.

What the Law Says — And When Facilities Break It

Federal law is clear on this: nursing home residents must receive at least 30 days’ written notice before an involuntary discharge, except in cases involving an immediate health or safety emergency. Facilities are also required to ensure that any discharge is both “safe and appropriate” for the resident’s needs.

In several of the cases documented by CMS, those rules were violated outright:

• Meadowbrook Manor in Trumbull County issued a 30-day discharge notice but sent a medically complex patient to a shelter just 20 days later — with no prescriptions, no medical appointments, and no care plan.
• New Lebanon Rehabilitation and Healthcare Center gave a resident roughly 24 hours’ notice instead of 30 days before discharging her to a shelter. The social services director admitted he didn’t know where she went.
• Eastland Rehabilitation and Nursing Center discharged a patient without exploring appropriate alternatives, skipping required steps entirely.

These aren’t technicalities. They’re legal violations that directly endangered people’s lives.

The CMS Care Compare database allows families to look up inspection records and citations for nursing facilities across the country — including discharge-related violations.

Red Flags Families Should Watch For

If your loved one is in a nursing home, certain warning signs may indicate they are at risk of an improper discharge:

• Insurance or Medicaid coverage changes — Facilities sometimes accelerate discharge timelines when benefits are reduced or terminated.
• Discharge notices without clear placement plans — A lawful discharge requires a specific, safe destination, not just a shelter address.
• Vague explanations about where a resident is being sent — Misrepresentation, like what happened at Laurels of Hillsboro, does occur.
• Behavioral or substance-related justifications — While facilities can discharge residents for certain behavioral reasons, they are still required to find safe placement and follow proper notice procedures.
• Pressure to leave within days of a coverage decision — If notice periods are being cut short, that’s a legal red flag.

What Residents and Families Can Do

If you suspect a nursing home is planning an unsafe or illegal discharge:

1. Request the discharge notice in writing. You are entitled to see it. The notice must include the reason, the proposed discharge date, and your right to appeal.
2. Contact your state’s Long-Term Care Ombudsman. Ombudsmen are legal advocates for nursing home residents and review discharge plans for safety and appropriateness. In Ohio, the State Long-Term Care Ombudsman handles these cases. In Hawaii, the Executive Office on Aging administers similar services.
3. File a complaint with CMS. You can report violations directly through Medicare.gov’s complaint portal.
4. Consult an attorney. If a facility has already carried out an unsafe or improper discharge — or if you believe a loved one experienced neglect or harm in connection with a discharge — you may have legal recourse.

Families dealing with abuse in Honolulu nursing homes or elsewhere in Hawaii have specific rights under both state and federal law, and an experienced attorney can help navigate those options.

The Bigger Picture: Nursing Home Accountability

This issue isn’t limited to Ohio. The systemic pressures driving these discharges — Medicaid cuts, staffing shortages, and cost-cutting — affect nursing facilities nationwide, including here in Hawaii. The Kaiser Family Foundation reports that Medicaid is the primary payer for nursing facility care, covering the majority of both residents and costs. When that funding is squeezed, residents bear the burden.

Federal and state oversight bodies play a critical role — but inspections only go so far. Advocates, ombudsmen, and legal professionals provide another layer of accountability when facilities fail to follow the rules.

The residents being discharged to shelters are not abstractions. They are real people: a woman with dementia who didn’t know where she was. A man who lived in the same facility for 22 years. People who trusted a system to take care of them.

That trust deserves to be protected.