A Skilled Nursing Facility (SNF) provides short-term, post-acute medical treatment and intensive rehabilitation, distinct from the permanent residential care offered by a traditional nursing home. The primary function of an SNF is to deliver care following a qualifying hospital stay. Patients receive daily skilled services, such as physical, occupational, or speech therapy, complex wound care, or intravenous medication management. The stay in an SNF is temporary, aiming to help the patient recover independence and return to a less intensive setting, often home, rather than providing long-term residence.
Voluntary Discharge: Leaving By Choice
An alert and oriented patient has the fundamental right to refuse medical treatment and is free to leave a Skilled Nursing Facility (SNF) at any time, protected by federal regulation 42 CFR 483.10. This decision can be a coordinated transition or an immediate departure.
A planned discharge occurs when the medical team determines the patient has met recovery goals or reached a safe point for transition. The facility works with the patient to organize a smooth move to a home setting or another care environment. This process involves the interdisciplinary team developing a comprehensive discharge plan that secures necessary follow-up care and equipment.
Leaving Against Medical Advice (AMA) happens when the patient chooses to depart before the medical team believes it is safe or before the care plan is complete. While the facility cannot physically detain a patient, staff must document the risks associated with leaving prematurely. The patient is required to sign forms acknowledging they understand the potential negative health consequences, such as a relapse or incomplete recovery.
Even when a patient leaves AMA, the facility must provide the individual with detailed discharge instructions and prescriptions to ensure the safest possible transition. Staff must record extensive progress notes detailing discussions with the patient, or their representative, about the risks of leaving. This documentation protects the facility against liability should the patient experience a negative outcome after departure.
Patient Protections Against Involuntary Discharge
A Skilled Nursing Facility cannot discharge a patient without a legally permissible reason and a formal process. Federal regulations (42 CFR 483.15(c)) strictly limit the circumstances under which a facility can initiate an involuntary discharge or transfer. Five specific reasons permit a facility-initiated discharge:
- The patient’s welfare requires it because their needs cannot be met.
- The patient’s health has improved and they no longer require the facility’s level of skilled services.
- Non-payment for a stay after reasonable notice.
- A threat to the safety or health of other individuals in the facility.
- The facility ceases to operate.
When an SNF decides to involuntarily discharge a resident, it must provide a written notice at least 30 days before the planned date. This notice must state the reason for the transfer, the effective date, and the patient’s right to appeal the decision. A copy of this notice must also be sent to the State Long-Term Care Ombudsman.
The patient has the right to appeal the facility’s decision to the State Medicaid agency or a similar designated body. If a timely appeal is filed, the facility is prohibited from discharging the resident while the appeal process is pending. The only exception is if the delay would endanger the health or safety of the resident or other individuals in the facility.
Coverage Consequences of Leaving Early
The financial implications of leaving a Skilled Nursing Facility are tied directly to the requirements of Medicare Part A, which is the primary payer for short-term SNF stays. Medicare Part A only covers SNF care if the patient requires and receives daily skilled nursing or rehabilitation services that are medically necessary. If a patient leaves AMA, they are effectively refusing the daily skilled services that justify the Medicare coverage.
For a patient departing AMA, Medicare coverage for that stay often terminates on the day of departure because the patient is no longer participating in necessary medical care. This immediate termination shifts the full financial responsibility for the daily rate and co-payments to the patient, effective from the date they leave. The facility must ensure the patient understands that refusing care also means refusing the insurance coverage that pays for it.
This financial consequence contrasts with a properly planned discharge, where Medicare coverage continues until the medical team certifies the patient no longer meets skilled care requirements. Under Medicare rules, the first 20 days of a qualified SNF stay are covered in full. Days 21 through 100 require a daily coinsurance payment, which is $209.50 per day in 2025.
If a patient leaves and needs to return to an SNF later, they must meet all initial Medicare criteria again, including a qualifying three-day hospital stay, unless they return within 30 days. Medicaid can cover long-term care for financially eligible individuals, but its requirements are separate from Medicare’s short-term, rehabilitation-focused coverage.