When a Nursing Home Closes and Residents Must Move

Call 1: The Long-Term Care Ombudsman, Today

Make this call first. It is free, it is confidential, and the ombudsman program exists precisely for this.

Every state operates a Long-Term Care Ombudsman program under the Older Americans Act, with local ombudsmen who advocate for residents, investigate complaints, and are typically involved directly in facility closures. They frequently know about a closure before families do, sit in on relocation planning, and can advocate for a resident’s placement preference in a way an individual family cannot.

Ask exactly this: "This facility has announced a closure. Have you seen the relocation plan, what notice date is on file with the state, and will you be involved in my parent’s transfer?"

Then ask: "What are the resident’s rights here that the facility may not be honoring?" The ombudsman knows the specific state requirements that layer on top of the federal ones.

Two things to know about how they work. Ombudsmen act on the resident’s direction and keep complaints confidential unless the resident consents — which means they will want the resident’s authorization to act. And they are advocates, not regulators; they cannot cite or fine a facility. That is Call 3.

What the program can and cannot do is set out in the ombudsman explained. Find yours through the state’s aging services agency or the Eldercare Locator.

Call 2: The Facility Administrator and Social Worker, in Writing

The facility is required to plan and execute a safe transfer, and it is required to give you information. Put the request in writing so there is a record, and follow it with a call.

Ask exactly this, in one letter:

• What is the closure date, and what date was written notice given to residents, families and the state?
• Please provide a copy of the state-approved relocation plan.
• Who is the designated staff member coordinating my parent’s transfer?
• Which facilities are accepting residents, and which of them are Medicaid-certified and have a bed for this resident’s level of care?
• Please provide the current care plan, the medication list, recent progress notes and the most recent MDS assessment for the receiving facility.
• Please provide a final accounting of my parent’s personal funds account and confirm when the balance will be returned or transferred.

That last item is missed constantly. Facilities hold residents’ personal funds and must account for them; ask for a written statement, not a verbal assurance.

Also ask about the belongings. Who is packing, who is liable for loss, and what the timeline is. Take photographs of the room and inventory everything, particularly hearing aids, glasses, dentures and jewelry, which are the items that disappear in a move.

Call 3: The State Survey Agency and Licensing Authority

This is the regulator. The survey agency licenses and inspects nursing facilities, receives the closure notice, and approves the relocation plan.

Ask exactly this: "Has this facility filed a closure notice, on what date, and has the relocation plan been approved? Is the closure voluntary or connected to enforcement action?"

That last question matters. A voluntary closure for business reasons and a closure following termination from the Medicare and Medicaid programs are different situations with different timelines and, in a termination, different notice arrangements. Knowing which one you are in tells you how much time actually exists.

Then ask: "Where can I get the inspection history for the facilities we are considering?" Survey findings are public documents. CMS also publishes ratings, staffing data and inspection results on Care Compare, and maintains a Special Focus Facility list identifying facilities with persistent quality problems. Do not move a parent into a building you have not checked — the pressure to accept the first available bed is exactly how people end up somewhere worse.

If the facility is not complying with the notice or the plan, this is where you file a complaint. Ombudsman advocacy and a survey agency complaint work well in parallel; they are not alternatives.

Background on the worst-performing category of facility is at what a Special Focus Facility is.

Order	Who to call	The exact question	Why first
1	Long-Term Care Ombudsman	Have you seen the relocation plan and what notice date is on file?	Free advocate already involved in closures
2	Administrator and social worker, in writing	Closure date, relocation plan, records, personal funds accounting	Creates the paper record you will need
3	State survey agency	Is the closure voluntary or enforcement-related, and is the plan approved?	Tells you how much time actually exists
4	Candidate facilities	Medicaid-certified? Night staffing? Full rate schedule?	Prevents a second move in eighteen months
5	Medicaid caseworker or business office	Does authorization transfer, and does patient liability change?	Payment gaps stall admissions
6	Physician, pharmacy, hospice	Who follows the resident, and who has the medication list?	The first 72 hours are the clinical risk window

Call 4: Candidate Facilities — Five Questions Each

You are shopping under time pressure, which is the worst condition for this decision. Standardize the call so you can compare.

Ask every candidate the same five questions:

• Do you have a bed available for this level of care, and when?
• Are you Medicaid-certified, and will you accept this resident under Medicaid now or later if private funds run out?
• What is the actual staffing on the night shift for this unit?
• What is the full rate schedule, including care-level tiers and any medication administration charge, and what notice do you give before a rate increase?
• What is your process for admitting a resident from a closing facility, and will you accept the transfer records directly?

The Medicaid question is the one that determines whether you will be doing this again in eighteen months. Get the answer in writing in the admission agreement, not verbally at the tour.

Then visit, unannounced if possible, at a shift change or a mealtime. Look at whether call lights are being answered and whether residents are up, dressed and engaged. A structured list of what to look for is at what to ask when touring a nursing home.

Ask the ombudsman what they know about each candidate. They will usually tell you.

Call 5: The Medicaid Caseworker or the Private-Pay Business Office

Money follows the resident, but not automatically, and a gap in payment authorization can stall an admission.

If Medicaid is paying, call the caseworker and ask: does the authorization transfer to a new facility, what paperwork does the new facility need, does the patient liability amount change, and is there anything the family must file. Ask specifically whether a level-of-care assessment must be repeated. Do not assume the two facilities will handle it between themselves.

If the resident is private pay, ask the current facility’s business office for a final itemized bill and a prorated refund of any prepaid amounts, and ask the new facility what deposit it requires. Recent published cost-of-care survey medians put a semi-private nursing home room near $9,300 a month and a private room near $10,600, with very wide variation by state — a move can change the monthly cost materially, so get the new rate in writing before agreeing.

If a Medicaid application is pending, tell the caseworker about the closure immediately. Pending applications and facility changes interact badly if nobody is told.

Also ask what deductions from patient liability the state permits; many states allow certain uncovered medical expenses to reduce the amount owed to the facility, and that is a recurring saving nobody applies for by default. See how the Medicaid spend-down works.

Call 6: The Physician, the Pharmacy and the Hospice, Before Moving Day

Clinical continuity is where a relocation actually goes wrong, and it is nobody’s designated job.

The attending physician: ask whether they will continue to follow the resident at the new facility, and if not, who will. Ask for orders to be transmitted directly to the receiving facility rather than relying on the transfer packet. Medication errors in the first 72 hours after a transfer are a well-documented risk.

The pharmacy: long-term care pharmacies serve specific buildings. Confirm the new facility’s pharmacy has the resident’s full medication list and any prior authorizations already in place, and ask what will happen to medications currently on hand.

Hospice, if enrolled: hospice election generally continues through a move, but the hospice may or may not serve the new facility. Call the hospice and ask directly. If it does not serve the new building, ask what the transfer to a different hospice involves and whether a new election is required.

Therapy and equipment: confirm which durable medical equipment belongs to the resident and which belongs to the closing facility. Wheelchairs, specialty mattresses and oxygen concentrators are frequently facility property, and the replacement has to be arranged before the move, not after.

Put all of this in a single one-page transfer summary that travels with the resident, in the family’s own hands as well as in the facility packet. Facility packets get lost. See how to appeal an involuntary discharge if the facility tries to move a resident somewhere the family objects to.

Call 7: A Policy Review — But Only If the Money Is the Problem

A closure is a housing and clinical crisis, not usually a liquidity crisis. Keep the two separate.

The policy is irrelevant here if the resident is on Medicaid and the transfer is between two Medicaid-certified facilities. Nothing about the closure changes the policy question, and this is not the week to make an irreversible financial decision under pressure. Do not let anyone use the disruption to push a transaction.

Selling is specifically the wrong answer when the face amount is under roughly $100,000, where the market rarely has interest; when the contract is a small burial or final-expense policy already sitting inside a state’s burial exclusion, where cashing it in can actively damage eligibility; when the insured is in reasonably good health for their age; or when a surviving spouse still needs the death benefit. And if a Medicaid application is pending, converting a policy mid-application can create a look-back problem — talk to an elder law attorney first, and confirm the state’s face-value threshold, commonly $1,500, with the state Medicaid agency.

The policy becomes relevant only if the new facility costs materially more, the resident is private pay, and the runway now runs out sooner than it did. In that case the honest options are the same as ever: keep paying, use an accelerated death benefit or chronic illness rider already in the contract, take reduced paid-up coverage, surrender for cash value, or explore a market sale. Check the riders first, because using one already in the policy costs nothing and requires no buyer.

Note that proceeds from any sale interact with a Medicaid resident’s patient liability calculation — see how proceeds affect patient liability before assuming money received simply stays with the family.

If a genuine question exists, a free review of the policy cover page and current premium notice will tell you where things stand — call (732) 978-9575. Do it after the move, not during it.

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Frequently Asked Questions

How much notice must a nursing home give before closing?

Federal nursing home requirements generally require the administrator to give at least 60 days’ written notice before a closure to residents, their legal representatives and the state, along with a state-approved relocation plan ensuring safe and orderly transfers. Where closure follows enforcement action the arrangements can differ. Confirm what was filed and when with the state survey agency.

Can the facility move my parent anywhere it chooses?

The relocation plan must provide for safe and orderly transfer, and residents and families should have input into placement. If a proposed placement is unsuitable, raise it immediately with the ombudsman and the state survey agency, and put your objection in writing to the administrator. Do not accept the first available bed without checking the facility’s inspection history.

What happens to the money in my parent’s personal funds account?

The facility holds those funds in trust and must account for them. Ask in writing for a final statement of the personal funds account and confirmation of when the balance will be returned or transferred to the new facility. Get it in writing rather than accepting a verbal assurance, and follow up if the statement does not arrive before the move.

Does Medicaid coverage transfer automatically to the new facility?

Not automatically. Call the caseworker and ask what paperwork the new facility needs, whether a level-of-care assessment must be repeated, and whether the patient liability amount changes. Tell the caseworker about the closure immediately if an application is still pending, because facility changes and pending applications interact badly when nobody is informed.

Is relocation actually harmful to residents?

Adverse effects from involuntary transfer of frail residents are well documented in the gerontology literature, sometimes described as transfer trauma or relocation stress. That is a reason to plan the clinical handover carefully rather than a reason to panic. Focus on medication continuity, familiar possessions, consistent visitors and a single written transfer summary the family carries.

Should we sell a life insurance policy because of the move?

Generally no, and certainly not under time pressure. A closure is a housing and clinical crisis, not a liquidity crisis, especially where Medicaid pays and both facilities are certified. Selling is the wrong answer for small face amounts, burial policies inside an asset-test exclusion, healthy insureds, or where a spouse still needs the benefit. Revisit it after the move.

Related Reading

• What Is A Long Term Care Ombudsman
• Appealing An Involuntary Discharge
• Touring A Nursing Home What To Ask
• What Is A Nursing Home Staffing Ratio
• Assisted Living To Nursing Home Transfer
• Proceeds And A Nursing Home Patient Liability
• Nursing Home Medicaid Spend Down
• What Is A Special Focus Facility

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Pine Lake Legacy does not purchase life insurance policies and does not provide legal, tax, or investment advice. Information provided is for educational purposes only. Eligibility for any option, including life settlements, is not guaranteed and depends on individual circumstances, policy terms, underwriting, and market conditions. Consult independent legal, tax, or financial professionals before making decisions regarding a life insurance policy.