Patti Smith has a song called “People Have The Power.” Unfortunately, this song is elusive for anyone who has been through the hospital discharge to a nursing home process.

Every day across this country, hundreds of aged adults transfer from acute care hospitals to nursing homes or long-term acute care hospitals (LTACHs), many of which are dangerously understaffed and substandard.

These transfers are initiated by hospital discharge planners (sometimes called case managers) whose sole function is to empty hospital beds. In my 50 years of advocating for the rights of the elderly, I’ve met many discharge planners who are professional and caring. But unfortunately, I’ve met many that use abhorrent techniques to force elders into substandard nursing homes. These include:

  • Sending assessment forms in bulk (in NY, these are called PRIs) to many nursing homes regardless of location, rating, or ability to handle the resident. The process of sending these forms to facilities is now computerized. A discharge planner can directly send these to hundreds of facilities in one shot. They then pressure the patient to accept the first available bed.
  • They are falsifying assessment forms to make patients look more attractive.
  • They are placing enormous pressure on families to go to inferior nursing homes but not allowing them to see these facilities before discharge.
  • They are denying patients their right to a Medicare Appeal.
  • They threaten patients and their families with lawsuits, guardianships, legal fees, discontinuation of care, and outright eviction.
  • They are lying about bed availability in better nursing homes.


Some nursing homes buy expensive gifts for hospital discharge planners to steer patients to their facilities exclusively.

Please don’t give any financial information to a hospital unless it WHAT IS A FAMILY TO DO? JUST SAY NO. OR GET AN ADVOCATE TO SAY NO ON YOUR BEHALF.

Just say NO to any discharge that you disagree with. Just say NO to pressure, lies, threats, and bullying.

  • The My Elder Rule Of Thumb about discharge planning is to assume that everything a hospital discharge planner tells you is a lie and proceed from there. There is nothing they can do to force you into an unsafe discharge if you don’t let them. So don’t buckle under their threats and pressure.
  • Hospitals have more and better-qualified staff than nursing homes. Just because a hospital has a substandard nursing home willing to admit your elder does not mean it’s a safe discharge.
  • A hospital can only send an assessment form (required for admission to a nursing home) to a facility with your permission.
  • Only sign something after you check with an advocate.
  • relates directly to this hospitalization.
  • Keep information private, even if a hospital employee seems trustworthy. For example, if the hospital refers someone to you like a Rabbi, Priest, or a “hospital advocate,” don’t discuss discharge-related information. This statement might sound harsh but remember that these people work for the hospital.
  • Never take a facility recommendation at face value. YOU MUST SEE THE PLACE YOURSELF or consult an advocate. In addition, the hospital must allow you to visit the facility.
  • Ask for a copy of the assessment form (in NY, it’s called a PRI or patient review instrument). If they tell you that you must go to the medical records department, tell them your elder will stay in the hospital until you get it. Check the form for accuracy and make them correct any mistakes.
  • If you get just one thing from this discussion, it is this. Don’t be aggressive, argumentative, abusive, or threatening in any way. If you can record the conversation, do so. You can inform the discharge planner that you are recording the conversation. If they refuse, don’t go ahead with the conversation.


Be strong, decisive, careful, and diligent. Just say NO until you are sure that a discharge is safe.

CALL JACK HALPERN AT MY ELDER. Our number is 212-945-7550. We save lives every day. We are a fee-for-service company, and our rates are reasonable. Our email address is jhalpern@myelder.com.