An unsafe discharge occurs when a patient is released without adequate arrangements for their ongoing care needs. Examples include: sending a patient home who cannot perform basic self-care without a caregiver; discharging to a facility that cannot provide the required level of medical support; releasing a patient before a medication plan is in place; or discharging a dementia patient to an unsupervised environment.

Hospitals can discharge a patient once they are deemed medically stable, even if the family disagrees. However, Medicare patients have the right to appeal this decision through the BFCC-QIO. For non-Medicare patients, options are more limited but include speaking to a patient advocate, filing a grievance, or consulting an elder law attorney. The key is acting quickly — often the same day the discharge notice is received.

The Beneficiary and Family Centered Care Quality Improvement Organization (BFCC-QIO) reviews Medicare discharge decisions. In Texas, this organization is Livanta. If you believe a discharge is premature, call Livanta before midnight on the day you receive the Important Message from Medicare. They will review the case and the hospital must keep your loved one during that review at no cost to you.

A HINN is a notice the hospital gives Medicare patients when it determines that continued inpatient care is no longer covered by Medicare. Receiving a HINN does not mean you must leave immediately. You can appeal to the BFCC-QIO. If the appeal is filed quickly, the hospital cannot charge you for the days under review. Always read this notice carefully and act the same day you receive it.

Act immediately. Request a meeting with the charge nurse, the attending physician, and the social worker. Ask specifically: what criteria were used to determine medical stability? What ongoing care needs exist? What will happen if those needs are not met at home? Document everything in writing. If Medicare is involved, prepare to file a BFCC-QIO appeal by midnight. Call a placement agent to start identifying alternative care options simultaneously.

You have the right to choose where your loved one goes for post-acute care. The hospital discharge planner may present a limited list, but you are not required to accept it. Ask for a full list of Medicare-certified facilities in your area. Research ratings on Medicare’s Care Compare website. You can also work with a placement agent who knows local facilities and can recommend options based on quality, not just availability.

If you genuinely cannot provide or arrange safe care at home, tell the discharge planner immediately and put it in writing. The hospital has a duty not to discharge to an unsafe situation. Request a social work consultation and a care conference. If the patient is a Medicare beneficiary, you can also contact your local Area Agency on Aging for guidance on what resources and protections are available.

Do not accept a placement you believe is inadequate. Visit the facility before agreeing. Ask specifically: do they have staff trained to handle this diagnosis? What is the nurse-to-patient ratio? Have they cared for patients with this condition before? Can they manage current medications and therapies? If the facility cannot confidently answer yes to these questions, ask the discharge planner for alternatives or consult a placement agent.

File a complaint with the Texas Health and Human Services Commission (HHSC), which oversees hospital licensing. You can also file with The Joint Commission if the hospital is accredited. For Medicare patients, complaints about discharge decisions go through the BFCC-QIO (Livanta). Document everything: dates, times, names of staff involved, what was said, and what written notices were provided.

A placement agent can serve as a rapid-response advocate. They can assess what level of care is actually needed, identify appropriate facilities quickly, communicate with the discharge team about care requirements, and help the family make a sound decision under pressure. Most importantly, they provide an independent perspective that is not influenced by hospital contracts or bed management pressures.

If your loved one was recently discharged and their condition worsens, call their physician immediately. If there is a clinical crisis, call 911. Once stable, document what happened and consider filing a complaint with HHSC about the original discharge. If a return hospitalization was required within 30 days, this is tracked as a readmission and may support your complaint about premature discharge.

Texas Health and Safety Code Chapter 166 protects patients’ rights to participate in their own discharge planning. The Texas Patient Bill of Rights requires hospitals to provide information about discharge options and referrals to appropriate services. Federal Conditions of Participation for Medicare also require hospitals to have discharge planning processes that include family input and assess patient safety. An elder law attorney can advise on enforcement.