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Room-to-Room (Intra-Facility) Transfers in Nursing Homes

Room-to-Room (Intra-Facility) Transfers in Nursing Homes

June 2018

Overview

Connecticut state law and federal law prohibit forced room-to-room transfers (also referred to as "intra-facility transfers") with very few exceptions. The law recognizes that involuntary transfers may be disruptive or harmful for residents and generally permits a resident to stay put. The law always requires nursing homes to provide advance written notice of any proposed transfer and allows residents to sue nursing homes for violations of the law. Below is an explanation of the law on room-to-room transfers.

When are room-to-room transfers permitted?

In most situations, room-to-room transfers are unlawful.

The need for particular types of medical care should never be the basis for a transfer since nurses, doctors and therapists can always go the resident. Staffing levels should never be a factor. Federal law requires that appropriate, individualized care be provided to every resident of every nursing home, regardless of where the resident is located within a facility. Nursing homes are always required to adjust the staffing levels of nurses, therapists and aides as needed to provide optimum care for residents throughout the home.

A nursing home cannot permanently transfer residents to make changes in the facility such as the creation of specialized care units or the closing of certain wings.

Even when the law allows a transfer, a nursing home may never move a resident within the nursing home unless a doctor conducts a comprehensive evaluation and determines that the transfer would not cause transfer trauma. A transfer is only allowed if the doctor documents in the medical records that a transfer will not "cause new symptoms or exacerbate present symptoms beyond a reasonable adjustment period resulting in a prolonged or significant negative outcome that could not be ameliorated through care plan intervention."

Under federal law, residents have an absolute right to refuse to accept (1) a transfer from the portion of a nursing home designated as the Medicare wing or Medicare "distinct part" to any other portion of the home or (2) a transfer from the portion of a nursing home designated as the Medicaid wing or Medicaid "distinct part" to any other portion of the home.

A room-to-room transfer is permitted only in following instances:

  • If it is necessary to promote the patient's well-being. This would include situations where a transfer is needed to isolate a resident to prevent the spread of an infectious disease or necessary specialized equipment is needed that can not be brought to the resident’s current room.
  • If roommates are so incompatible that a resident is at risk.
  • If a temporary transfer is needed to make repairs or renovations. A transfer in this situation is only allowed if the transfer will promote the resident’s well-being. The resident has the right to return as soon as the repairs or renovations are completed.
  • If the transfer is necessary to permit the admission of a resident of the opposite sex. This is allowed only when (1) there are two persons of the same sex living alone in double rooms, (2) there is no applicant of that sex seeking admission and (3) the transfer of one of the two patients of the same sex into one room would allow admission of patients of the opposite sex.
  • If (1) the patient no longer needs specialized medical equipment that cannot be moved from the patient’s room, (2) another patient needs access to that equipment and (3) the transfer would improve the well-being of the resident being transferred.
  • If the patient no longer needs the specialized services or programming that is the focus of the area of the facility in which the patient is located and the transfer would improve the resident’s well-being.
  • If facility wants to transfer a Medicaid recipient from a private room to a non-private room.
  • If a temporary transfer is necessary because of an emergency. This includes transfer (1) to protect the resident or others from physical harm, (2) to control the spread of an infectious disease, or (3) because of a building or environmental emergency or other situation that threatens the resident’s health or safety.

What procedures must be followed before a resident can be transferred?

Even when a room-to-room transfer is legally permissible, the nursing home must usually provide advance written notice to the resident and the resident’s family.  In most cases, the resident must be asked about transferring and, if the resident does not consent to the transfer, there must be a meeting with the resident, the resident’s family, the resident’s doctor and nursing home staff.  The consultation is to determine if the move is necessary and whether there are alternatives to a transfer.  The specific rules on notice and consultations vary depending on the reason for the proposed transfer.  In emergency situations, for example, the resident can be moved before there is written notice or a consultative process.

How can residents challenge transfers?

The facility has the obligation to tell residents how to challenge proposed transfers.

42 Code of Federal Regulations § 483.10 (b). Resident rights.

Connecticut General Statutes § 19a-550 (b) (5).  Patients' Bill of Rights.

Facilities that attempt to transfer residents in violation of the law or without providing them with the required advance written notice can be sued. The courts are authorized to issue injunctions to prevent transfers, to order facilities to reverse transfer, and to make nursing homes pay compensatory and punitive damages. Residents may also file complaints with the Connecticut Department of Public Health against nursing homes and nursing home administrators that violate these rights.

What are the laws regarding room-to-room transfers?

Room-to-room transfers are covered by the following state law and federal regulations.

Connecticut General Statutes § 19a-550 (b) (23), (c), (d) and (e). Patients’ Bill of Rights.

42 United States Code § 1395i-3 (c) (1) (A) (x). Requirements for, and assuring quality of care in, skilled nursing facilities. Requirements relating to residents' rights. Refusal of certain transfers.

42 United States Code § 1395i-3 (c) (1) (A) (v).  Requirements for, and assuring quality of care in, skilled nursing facilities. Requirements relating to residents' rights. Accommodation of needs.

42 Code of Federal Regulations § 483.10 (o). Resident rights. Refusal of certain transfers.

42 Code of Federal Regulations § 483.15 (e) (2). Quality of life. Accommodation of needs.

Where can I get advice and help?

Additional information and assistance can be obtained from the Office of the Long-Term Care Ombudsman or from Connecticut’s Legal Services organizations.

Visit the Nursing Home Advocacy section of this web site.

These laws can be found at:

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