Can a Memory Care Facility Kick You Out? Reasons and Appeals

A memory care facility can make you leave, but only for a short list of legally recognized reasons, and only after following specific notice and appeal procedures. How strong those protections are depends on one thing: whether the memory care unit sits inside a Medicare- or Medicaid-certified nursing facility, where federal law governs, or inside a state-licensed assisted living community, where the rules come from the state and the admission agreement.

Federal Rules Only Cover Some Memory Care

This is the detail families miss most often. The federal discharge protections in 42 CFR 483.15 apply only to skilled nursing facilities and nursing facilities certified for Medicare or Medicaid.¹ Memory care units inside those buildings carry the full federal protections: mandatory notice periods, appeal rights, and safe-transfer requirements.

A large share of memory care in the United States, though, operates inside assisted living facilities regulated by individual states. About 45 states and the District of Columbia require assisted living facilities to give notice before an involuntary discharge, but five states have no such requirement. Assisted living residents also generally lack a standardized federal appeals process and the guaranteed safe-discharge protections that nursing home residents receive. If your loved one is in assisted living memory care, your protections come from state law and the contract they signed on move-in, both of which vary widely. The federal standards below are the floor families should expect from a certified nursing facility, and a useful benchmark for what a fair process looks like anywhere else.

The Six Legal Reasons for Discharge

Federal law limits involuntary discharge from a certified nursing facility to six situations.¹ A facility cannot invent a reason or discharge someone because they are difficult to care for. The allowable grounds are:

The facility cannot meet the resident’s needs, such as when a medical condition exceeds what the facility is licensed or equipped to handle.
The resident’s health has improved to the point they no longer need the services provided. This rarely applies in memory care but exists in the statute.
The resident’s clinical or behavioral status endangers the safety of other residents or staff.
The resident poses a health risk to others, such as through a communicable condition.
Non-payment, after reasonable notice, or refusal to pay after a third-party payer like Medicare or Medicaid has denied a claim.
The facility closes entirely.

Nothing outside these six categories is legally sufficient. A facility trying to remove a resident for complaining, for being “too much work,” or for anything else is acting outside the law.

The facility also has to back its reason with paperwork. For an “unmet needs” discharge, the record must show what needs the facility could not meet, what it tried, and what the receiving facility can provide.¹ For a safety or health discharge, a physician must document the clinical or behavioral basis. Ask for copies. A thin or vague file weakens the facility’s position at appeal.

What the Notice Must Say

Before a discharge takes effect, the facility must give written notice to the resident and their representative at least 30 days ahead of the proposed date.¹ The notice has to be in a language the family can understand and must include the reason, the effective date, the specific place the resident will go, information on the right to appeal and request a hearing, contact details for the state long-term care ombudsman, and, where relevant, contact information for the state agency that advocates for people with intellectual, developmental, or mental health disabilities.

A notice missing any of these pieces is deficient, and that alone is a reason to challenge the discharge.

The 30-day window can be shortened when a resident’s behavior creates an immediate danger to others. Even then, the facility still has to provide written notice, document the danger, and ensure the resident lands somewhere appropriate. Emergency does not mean the process disappears; it means the clock compresses.

Running Out of Money Is Not a Legal Reason

Families often worry that the switch from private pay to Medicaid will trigger a discharge. Federal law says otherwise. A certified nursing facility must maintain identical policies and practices for residents regardless of payment source.¹ A facility cannot push someone out simply because they moved from paying privately to paying through Medicaid.

The regulations go further. A facility cannot discharge a resident while Medicaid eligibility is being processed.² Once a resident becomes Medicaid-eligible, the facility can only charge allowable Medicaid rates going forward.¹ Some facilities still pressure families to leave “voluntarily” when the private funds run out. That pressure does not change what the law says.

Hospital Stays and Bed-Hold Rights

One quiet way residents get “kicked out” is during a hospitalization. Federal law requires the nursing facility to give written notice of its bed-hold policy before any transfer to a hospital or therapeutic leave.¹ The notice must state how long the facility will hold the bed and what state rules allow.

Even if the hospitalization runs past the bed-hold period, the resident still has the right to return when a bed opens, as long as they still need and qualify for the facility’s services. They go back to their previous room if it is open, or to the first available semi-private room. If the facility decides it will not take the resident back, it has to go through the full formal discharge process with written notice and appeal rights. A facility that quietly fills the room and tells the family the resident is no longer welcome is violating federal law.

“Voluntary” Discharges and Retaliation

Not every removal starts with a formal notice. Some facilities pressure families to take the resident home “voluntarily” without ever triggering the paperwork. Staff might say the resident “isn’t a good fit,” suggest the family “explore other options,” or warn that discharge could follow if behavior doesn’t change. These conversations are designed to move the family before the formal process starts, which erases the right to appeal.

Facilities also sometimes use the threat of discharge to punish residents or families who complain about care or report safety concerns. Retaliation is not on the list of six permissible grounds, and a facility that retaliates is violating federal regulations. If you feel pressured to leave without receiving a written discharge notice, do not agree to a voluntary move. Contact the state long-term care ombudsman program and ask the facility to put its concerns in writing through the formal notice process.

How the Appeal Works

Residents and their representatives can appeal any involuntary discharge. The appeal goes to the state agency that oversees long-term care facilities, not to the facility itself. Filing windows vary by state, generally somewhere between 10 and 90 days after the notice.

The most valuable protection in the appeal is the right to stay. Federal law prohibits a facility from discharging a resident while an appeal is pending, unless keeping them would endanger the health or safety of the resident or others.¹ A facility claiming that safety exception has to document the specific danger. File the appeal as fast as you can, because some states only grant the automatic stay when the appeal comes in within a short window after the notice.

At the hearing, the facility carries the burden of proving legitimate grounds. A hearing officer reviews the evidence and both sides get to present. The long-term care ombudsman can advocate for the resident throughout.

Where the resident is going matters too. Even a legally justified discharge has to be to a specific, appropriate, and available location, and the receiving setting has to agree to take the resident.¹ Sending a memory care resident to a homeless shelter, a motel, or a family home with no confirmed caregivers fails that standard. If the proposed destination is inadequate, that is itself a ground to challenge the discharge.

What To Do in the First Few Days

The steps you take right after a discharge notice arrives often decide the outcome.

Read the notice carefully and confirm it includes the reason, the proposed destination, and appeal instructions. A deficient notice is grounds to challenge the process.
File the appeal immediately. The right to stay pending appeal can hinge on filing within a very short window, sometimes as few as 10 days.
Contact the long-term care ombudsman program. Ombudsmen are empowered by law to advocate for residents facing discharge and can connect you with legal help. You can find your local program through the National Ombudsman Resource Center at ltcombudsman.org.
Request the medical documentation the facility is relying on. For unmet needs, the record should show what the facility tried. For safety, a physician has to have documented the specific danger.
Do not sign voluntary discharge paperwork. Signing waives the appeal rights. If you think the discharge is unjustified, insist on the formal process.

If your loved one is in an assisted living memory care community rather than a certified nursing facility, these same steps still make sense, but the specific rights and timelines will depend on your state’s assisted living laws and the admission contract. Read the contract for the facility’s stated discharge policies, and call your state’s assisted living licensing agency to find out what protections apply where you live.