Can a Nursing Home or Assisted Living Facility Refuse to Take You Back After a Hospital Stay?

The short answer: a nursing home cannot simply decline to take a resident back from the hospital. Under federal law, a facility that decides a hospitalized resident “cannot return” has initiated a discharge, and it must give the same written notice, the same reasons, and the same appeal rights it would owe to a resident it was putting out the front door. The resident is generally entitled to return while the appeal is heard. Bed-hold rules decide who pays for the empty bed in the meantime, and those differ sharply among New Jersey, New York, and Connecticut. Assisted living is a different matter: no federal rule applies, the state rules are thinner, and in New Jersey and Connecticut a facility can lawfully refuse to take back a resident whose needs have grown beyond what its license allows, so long as it follows its own written discharge criteria and gives the notice the state requires.

This article explains why a refusal to readmit is a discharge, what a nursing home must do before it refuses, how bed holds and the right to return work in each state, how each state’s appeal works, how assisted living differs, and what to do in the hours after a hospital discharge planner says your parent has nowhere to go.

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Is Refusing to Readmit a Resident a “Discharge”?

Yes, for any nursing home that participates in Medicare or Medicaid. The federal regulation at 42 C.F.R. 483.15(e)(1)(ii) provides that “if the facility that determines that a resident who was transferred with an expectation of returning to the facility cannot return to the facility, the facility must comply with the requirements of paragraph (c) as they apply to discharges.” Paragraph (c) is the transfer and discharge rule. The surveyor guidance that federal and state inspectors apply, in Appendix PP of the State Operations Manual at tag F626, is blunter: “When a facility does not allow the resident to return, the facility has initiated a discharge, and the facility must comply with Transfer and Discharge Requirements at §483.15(c). The resident must be permitted to return and resume residence in the facility while an appeal of the discharge is pending.”

That reframing is the whole point. Facilities that refuse readmission usually present it as a fact about the hospital: the hospital says he needs more care now, we cannot take him. The law treats it as a decision by the facility, and a decision the facility has to justify.

What Must a Nursing Home Do Before It Refuses?

The same things it must do before any involuntary discharge, under 42 C.F.R. 483.15(c).

Have one of six reasons. The facility “must permit each resident to remain in the facility” unless the resident’s needs cannot be met in the facility, the resident’s health has improved so that the services are no longer needed, the safety or the health of others is endangered, the resident has failed to pay “after reasonable and appropriate notice,” or the facility is closing. When the reason is that needs cannot be met, the surveyor guidance at F622 requires the facility to have evidence that “the resident’s status at the time the resident seeks to return to the facility (not at the time the resident was transferred for acute care)” meets the criterion. A resident who was sent out in crisis but has stabilized in the hospital is judged on the day of return.

Give written notice. Under 483.15(c)(3), the notice goes to the resident and the resident’s representative “in a language and manner they understand,” and “the facility must send a copy of the notice to a representative of the Office of the State Long-Term Care Ombudsman.” Under 483.15(c)(5), it must state the reason, the effective date, the destination, the resident’s appeal rights with the contact information for the appeal agency, and the Ombudsman’s contact information.

Give 30 days. Under 483.15(c)(4), notice must be given “at least 30 days before the resident is transferred or discharged,” with exceptions allowing notice “as soon as practicable” where the safety or health of others is endangered, where health has improved enough for immediate discharge, where urgent medical needs require it, or where “a resident has not resided in the facility for 30 days.”

Wait for the appeal. Under 483.15(c)(1)(ii), the facility “may not transfer or discharge the resident while the appeal is pending” when the resident appeals a notice, “unless the failure to discharge or transfer would endanger the health or safety of the resident or other individuals in the facility.” The F622 guidance applies this to hospitalized residents directly: a facility “must allow the resident to return pending their appeal, unless there is evidence that the facility cannot meet the resident’s needs, or the resident’s return would pose a danger.”

A facility that says, by telephone, that it will not take a resident back has done none of this. The first response is a written request for the notice the regulation requires.

How Do Bed Holds and the Right to Return Work?

Two separate questions hide inside “will they hold the bed.” One is whether the resident has a right to come back. The other is who pays for the empty bed while the resident is away. Federal law answers the first and leaves the second to each state’s Medicaid program.

On the right to return, 42 C.F.R. 483.15(d) requires the facility, before any hospital transfer, to give written notice of the state’s bed-hold policy, the facility’s own policy, and the resident’s return rights, and to repeat that notice at the time of transfer. Under 483.15(e)(1)(i), a resident whose hospital stay outlasts the bed-hold period “returns to the facility to their previous room if available or immediately upon the first availability of a bed in a semi-private room” if the resident still needs the facility’s services and is eligible for Medicare or Medicaid nursing facility coverage. The right to the next available bed does not depend on anyone having paid to hold the old one.

On who pays, the three states diverge.

New Jersey. Under N.J.A.C. 10:166-1.14(a), a nursing facility “shall reserve and hold the same room and the same bed of the Medicaid beneficiary transferred to a general or psychiatric hospital for a period not to exceed 10 days,” and Medicaid reimburses those days “at 50 percent of the rate the NF received prior to the transfer.” If the resident is not ready to return within the 10 days, “the next available bed shall be given to the Medicaid beneficiary.” Therapeutic leave, meaning visits home rather than hospital stays, is reimbursed up to 24 days a calendar year. A private-pay resident’s bed hold is whatever the admission agreement says, and it is usually the full daily rate.

New York. New York Medicaid does not pay to hold a bed during a hospital stay. Under 18 NYCRR 505.9(d)(1), “the department will not pay to reserve an NF bed for a recipient 21 years of age or older who is temporarily hospitalized unless such recipient is receiving hospice services within the NF.” Leaves of absence for non-medical reasons are paid at 95 percent of the rate, with the first 18 days in a 12-month period needing no prior authorization, and only for a resident who has been in the facility at least 30 days and a unit with a vacancy rate of 5 percent or less. What New York gives instead is priority. Under 505.9(d)(6)(ii), where no bed is reserved, “the recipient must be given priority in readmission to the institution over persons referred to the institution for their first admissions,” and under 10 NYCRR 415.3(i)(3)(iv), a resident of 30 days or more who is hospitalized without a bed hold and is Medicaid-eligible “is readmitted to the facility immediately upon the first availability of a bed in a semi-private room.”

Connecticut. Connecticut writes the hold into statute. Under General Statutes 19a-537(c), “a nursing home shall reserve, for at least fifteen days, the bed of a resident who is a recipient of medical assistance and who is absent from such home due to hospitalization unless the nursing home documents that it has objective information from the hospital confirming that the resident will not return” within that time. The Department of Social Services pays for up to 15 hospital days in two tranches under 19a-537(d), and up to 21 days a year of home leave, each subject to a vacancy test. After the hold lapses, under 19a-537(e), the home “shall, upon receipt of notification from the hospital that a resident is medically ready for discharge, provide the resident with the first bed available in a semiprivate room,” with “priority of admission over applicants for first admission.” A resident refused readmission in violation of the section “shall retain the right to be readmitted.” And under 19a-537(g), a home that has concerns about readmitting a resident must, within 24 hours, request a consultation with the hospital and “shall reserve the resident’s bed until completion of the consultation process,” which the statute limits to three business days. Connecticut, in other words, does not let a nursing home decide the question alone.

How Do You Appeal in Each State?

The federal rule guarantees a hearing; each state runs it. The deadlines are short and the one that preserves the resident’s place is shorter than the one that preserves the appeal.

New Jersey. New Jersey’s nursing home resident rights regulation, N.J.A.C. 8:39-4.1(a)31, allows transfer or discharge only in an emergency, “for medical reasons or to protect the resident’s welfare or the welfare of others,” to comply with the resident’s documented choice, or “for nonpayment of fees, in situations not prohibited by law,” and subsection (a)32 requires “written notice at least 30 days in advance” that includes the Long-Term Care Ombudsman’s contact information and goes to the next of kin or guardian as well. For a Medicaid resident, N.J.A.C. 10:166-1.10(g) provides the hearing: the notice must advise of the right to a hearing and where to request it, and “if the beneficiary requests a hearing within 30 days of the date of the written notice, the transfer is stayed pending the decision following the hearing.” Hearings follow the Medicaid fair hearing procedures described in our article on what to do when a Medicaid application is denied. A private-pay New Jersey resident has the federal notice and appeal rights but no separate state hearing regulation that we have identified; the practical routes are a complaint to the Department of Health at 1-800-792-9770, the Ombudsman at 1-877-582-6995, and, if necessary, the Superior Court.

New York. Under 10 NYCRR 415.3(i), the notice must state that “the resident has the right to appeal the action to the State Department of Health.” The resident may request a hearing “within 60 days from the date the notice is received,” but may “remain in the facility pending an appeal determination” only “if the appeal request is made within 15 days of the date of receipt of the transfer or discharge notice.” At the hearing “the nursing home shall have the burden of proof that the discharge or transfer is/was necessary,” and a resident who wins is entitled to “return to the facility to the first available semi-private bed” before anyone else is admitted. The Department’s Nursing Home Complaint and Discharge Appeal Hotline is 1-888-201-4563, and the Long Term Care Ombudsman Program is at 1-855-582-6769.

Connecticut. General Statutes 19a-535 governs. Notice must be given “at least thirty days and no more than sixty days” before the transfer, except where health or safety is endangered, and under 19a-535(c)(3) a facility’s failure to notify the State Ombudsman “shall invalidate any notice of the proposed involuntary transfer or discharge.” The resident may appeal to the Commissioner of Social Services within 60 days, but “in order to stay a proposed transfer or discharge, the resident must initiate an appeal not later than twenty days after the date the resident receives the notice.” The hearing is held between 10 and 30 days after the request, the facility “shall prove by a preponderance of the evidence that it has complied with the provisions of this section,” the transfer is stayed pending the decision, and the Commissioner “may require the facility to readmit the resident to a bed in a semiprivate room.” The Long-Term Care Ombudsman is at 1-866-388-1888.

How Is Assisted Living Different?

None of the federal rules above applies to assisted living, which is licensed by each state. The same scenario, a resident hospitalized and then told not to come back, plays out under state law, and the answer differs in each.

New Jersey. An assisted living residence or comprehensive personal care home may discharge a resident only “upon grounds contained in the facility’s or program’s policies and procedures,” under N.J.A.C. 8:36-5.14(a), and the notice “shall be given at least 30 days in advance and shall include the reason for discharge and the resident’s right to appeal.” The 30 days do not apply, however, where the discharge is for one of the higher-care conditions listed in N.J.A.C. 8:36-5.1(d), which include a resident who needs 24-hour nursing supervision, has been “bedridden for more than 14 consecutive days,” is totally dependent in four or more activities of daily living, needs more than “assistance with transfer,” or is “a danger to self or others,” or in an emergency for the protection of life and safety, in which case the Department must be notified. A hospital stay that leaves a resident meeting one of those descriptions is the most common basis for a refusal to readmit, and it can be lawful if the facility’s admission agreement said, as N.J.A.C. 8:36-5.1(e) requires, whether it would retain residents with that condition. The regulations state a right to appeal an involuntary discharge at 8:36-4.1(a)10 but do not identify who hears the appeal or on what timeline, so the practical remedies are a written demand for the reasons and the reassessment, a complaint to the Department of Health at 1-800-792-9770, and the Ombudsman, who investigates assisted living as well as nursing homes.

New York. New York gives assisted living residents the strongest protection of the three states. Under 18 NYCRR 487.5(f), which the assisted living regulations incorporate, an operator may end a residency only with “at least 30 days’ written notice, on a form prescribed by the department,” and the notice must tell the resident that if they object they “may remain in the facility while the operator commences a court proceeding, and unless the court finds in favor of the operator.” Social Services Law 461-g requires the notice to state that “the operator, in order to terminate the admission agreement and discharge the resident, will be required to originate a proceeding” under section 461-h, and 487.5(f)(9) provides that the operator “shall readmit” a hospitalized resident “even if involuntary termination proceedings have begun.” A New York assisted living residence that tells a hospital it will not take a resident back is, without a court order, in the wrong. Complaints about adult care facilities and assisted living go to the Department of Health’s centralized intake line at 1-866-893-6772.

Connecticut. Connecticut separates the apartment from the care. The resident of a managed residential community is a tenant, with the rights of a tenant under section 19a-694, so the housing cannot be ended except as the residency agreement and landlord-tenant law allow, and the agreement must state, under section 19a-700(a)(8), “the conditions under which the agreement can be terminated by either party.” The care, delivered by a licensed assisted living services agency, is another matter. Under Regulation 19-13-D105(d)(9), the agency may discharge a client for a “change in client’s condition,” meaning “when the client’s condition is no longer chronic and stable,” and for “financial discharge” when “insurance benefits or financial resources have been exhausted,” and the regulation sets no advance notice period for those discharges. A Connecticut resident can therefore return from the hospital to an apartment whose care agency will no longer serve them, which is a refusal to readmit in everything but name. The residency agreement’s termination clause and the service agency’s own discharge policy, both of which the family should have in hand before any hospitalization, decide the outcome.

What Should You Do When the Hospital Says Your Parent Cannot Go Back?

The pressure comes from two directions at once: the hospital wants the bed, and the facility wants the problem to go away. The steps, in order:

1. Do not agree to a discharge to a different facility under pressure. Accepting a bed elsewhere can be treated as a voluntary move and can end the right to return. Say, in writing, that the resident intends to return to the facility.
2. Demand the written notice. Ask the facility for the transfer or discharge notice that 42 C.F.R. 483.15(c) requires, with the reason, the effective date, and the appeal information, and ask whether the Ombudsman has been sent a copy. A facility that has not issued one has not discharged anyone.
3. File the appeal immediately. Fifteen days in New York and 20 days in Connecticut are the windows that keep the resident’s place; 30 days in New Jersey stays a Medicaid transfer. Send the request in writing, keep proof, and do not wait for the facility to reconsider.
4. Call the Ombudsman the same day. The Long-Term Care Ombudsman in each state has authority to intervene with the facility and the hospital, and in Connecticut a notice the Ombudsman never received is void.
5. Use the hospital’s own appeal if the hospital is pushing the resident out. A Medicare patient receives a notice titled “An Important Message from Medicare about Your Rights” within two days of admission and again before discharge. If the patient disagrees with the discharge and asks for a fast review by the Beneficiary and Family Centered Care Quality Improvement Organization within the time stated on the notice, Medicare’s appeals publication says “you can stay in the hospital while you wait” for the decision. The contractor for New Jersey and New York is Commence Health, formerly Livanta, and for Connecticut it is Acentra Health; the notice itself gives the current number.
6. Get the facts on paper. Ask the hospital for the discharge summary and current care needs, and ask the facility for the reassessment it relied on. If the facility’s reason is that it cannot meet the resident’s needs, those two documents are the evidence at the hearing, and the surveyor guidance requires the facility to judge the resident’s condition on the day of return, not the day of transfer.
7. File a complaint with the licensing agency in parallel. Complaints trigger surveys, and a survey citing a facility for an improper discharge changes the facility’s posture quickly.

How Do You Prevent This at Admission?

Most readmission fights are lost at the admissions desk months earlier. When signing a nursing home agreement, read the bed-hold and return provisions against the federal rule, and make sure the agreement does not require the family to pay a private bed-hold rate beyond what the resident can afford or treat a hospitalization as a voluntary discharge. When signing an assisted living agreement, read the discharge criteria, ask the facility to state in writing that a hospital stay does not end the residency, and ask what reassessment will be done before any refusal to readmit. Our article on whether a nursing home can hold family members responsible covers the related question of who is liable for the bill during the dispute, and our article on what to do first when a parent enters a nursing home covers the documents to gather before any crisis.

Above all, have a durable power of attorney and a health care directive in place before the hospitalization. The person fighting a refusal to readmit needs the legal authority to sign the appeal, obtain the records, and speak for the resident, and a family member without that authority will be told, correctly, that the facility cannot deal with them.

Plan Well. Live Better.

A hospital stay should not cost a person their home, and in a nursing home the law says it does not. At Milvidskiy Law Group, we help families assert a resident’s right to return, file the appeals on time, and negotiate with facilities and hospitals when a discharge planner says there is nowhere to go, and we review admission agreements before they are signed so the question never arises. Learn more about our elder law services.

This article is for general informational purposes only and does not constitute legal advice. Reading it does not create an attorney-client relationship. Transfer, discharge, bed-hold, and appeal rules depend on the facility’s licensure and certification, the resident’s payment source, and the state, and they change. The federal regulations and surveyor guidance, and the New Jersey, New York, and Connecticut statutes and regulations described, were verified in September 2026; telephone numbers and Medicare contractor names change and should be confirmed before relying on them.