Moving a loved one into an assisted living facility is one of the hardest decisions a family can make. You trust that the facility will recognize your loved one’s changing needs and provide appropriate care. Most importantly, you trust that their safety and well-being will come before anything else.
Unfortunately, that does not always happen.
In some cases, assisted living facilities continue housing residents whose needs have progressed beyond what the facility can safely manage. Instead of transferring residents to a skilled nursing facility, they keep them in place even as their medical or cognitive challenges increase. The reasons can vary, but one reality is difficult to ignore: every resident represents revenue.
When facilities place financial interests above resident safety, the consequences can be devastating. Falls, wandering incidents, untreated medical conditions, and avoidable injuries may follow. In many situations, inappropriate retention can amount to neglect under Georgia law.
If you believe a facility is failing to meet your loved one’s needs, an assisted living negligence attorney can help you understand your options and protect their rights. Contact us today for a confidential consultation.
Understanding the Difference Between Assisted Living and Skilled Nursing Care
Assisted living is designed for people who remain relatively independent but need help with certain daily activities, such as:
- Bathing
- Dressing
- Medication reminders
- Meal preparation
- Housekeeping
- Transportation assistance
Skilled nursing facilities provide a much higher level of care. They offer 24-hour medical supervision and have licensed staff trained to address complex health needs that assisted living facilities generally cannot accommodate.
Under Ga. Comp. R. & Regs. § 111-8-63-.29, assisted living facilities must transfer or discharge residents when the facility can no longer safely meet their needs. This is not merely a recommendation. It is a legal obligation.
Facilities are also expected to monitor residents for significant changes in their condition. A noticeable decline in mobility, cognition, medical stability, or ability to perform daily activities should prompt a reassessment of whether the resident can continue to live safely in the assisted living setting. When staff recognize those warning signs but fail to escalate care appropriately, inappropriate retention may occur.
When Does a Resident Need a Higher Level of Care?
There is rarely a single moment when a resident clearly transitions from assisted living to skilled nursing care. More often, the change happens gradually. Even so, there are warning signs that facilities should recognize.
Advanced Cognitive Decline
Residents living with dementia or Alzheimer’s disease may eventually require constant supervision.
A transfer may become necessary when a resident:
- Wanders frequently or attempts to leave the facility unsupervised
- Cannot recognize dangerous situations
- Experiences confusion or disorientation
- Has repeated falls related to wandering or poor judgment
Without specialized supervision, these residents may face serious injury or even death.
Increased Dependence With Daily Activities
Assisted living facilities can assist, but there are limits. Residents may require skilled nursing care if they become unable to safely:
- Eat without assistance
- Transfer from bed to wheelchair
- Reposition themselves
- Dress or bathe without hands-on support
- Manage toileting needs
When residents become completely dependent on staff for these activities, the facility may no longer be equipped to provide appropriate care.
Complex Medical Needs
Some medical conditions require services beyond the scope of assisted living.
Examples include residents who need:
- Intravenous (IV) medications
- Advanced wound care for pressure injuries
- Tracheostomy care
- Complex catheter management
- Frequent monitoring of unstable medical conditions
- Skilled rehabilitation services
- Ongoing assessments by licensed nursing staff
Attempting to manage these needs without proper staffing and resources can place residents at risk.
Why Would a Facility Delay a Transfer?
Families often ask the same question: if a transfer is necessary, why wouldn’t the facility arrange one?
In some situations, staff may underestimate how quickly a resident’s condition has declined. Staffing shortages, communication failures, or delayed reassessments may also contribute to transfer delays. But when those delays continue despite clear warning signs, they can become inappropriate retention.
However, financial considerations can also play a role. Every occupied room generates revenue, and transferring a resident to a skilled nursing facility often means losing that income.
Sometimes, the issue is not an outright refusal to transfer a resident but a decision to keep waiting despite mounting warning signs, such as repeated falls, wandering episodes, weight loss, infections, or increasing dependence.
Investigative reporting has raised concerns that some long-term care providers may delay transfers or minimize residents’ changing needs rather than acknowledge the need for a higher level of care.
Regardless of the reason, keeping residents in an environment that cannot adequately address their medical or cognitive needs can have devastating consequences.
How Can Families Prove the Facility Knew?
One of the most important issues in an inappropriate retention case is whether the facility knew, or should have known, that the resident required more care than it could safely provide.
Facilities routinely document residents’ conditions through assessments and care records. Those records can reveal if warning signs were ignored.
Evidence may include:
- Care plans documenting cognitive or physical decline
- Incident reports involving falls or wandering
- Medical records showing worsening conditions
- Physician recommendations for additional care
- Emails, notes, or conversations with family members
- Staffing records showing inadequate supervision
- State inspection reports and deficiency citations
- Nursing notes reflecting ongoing deterioration over weeks or months
- Documentation showing repeated declines despite interventions
Unlike sudden accidents, inappropriate retention often unfolds over time. A series of falls, escalating confusion, worsening pressure injuries, repeated infections, or increasing dependence may collectively demonstrate that the resident’s needs had surpassed what the facility could safely provide.
A facility cannot simply claim ignorance when its own records demonstrate that a resident’s needs had clearly outgrown the services it provided.
Proving neglect does not require showing that the facility intended to harm the resident. Under Georgia negligence law, liability may arise when a facility breaches its duty of reasonable care, and that failure contributes to a resident’s injuries.
What Can Families Do?
If you believe your loved one is being retained in an inappropriate setting, taking action may help protect both their safety and their legal rights.
Document Your Concerns
Keep detailed notes about changes in your loved one’s condition, incidents involving falls or wandering, and conversations with staff.
Request copies of:
- Care plans
- Incident reports
- Medical records
- Assessment records
Photographs of injuries or unsafe conditions can also be helpful.
File a Complaint
Families can report concerns to the Georgia Department of Community Health. They can also seek assistance from the Georgia Long-Term Care Ombudsman Program, which advocates for residents of long-term care facilities.
These complaints may trigger investigations and help identify ongoing safety concerns.
Speak With an Attorney
If your loved one suffered harm because an assisted living facility failed to transfer them when appropriate, you may have grounds for a legal claim.
An attorney can investigate whether the facility violated the standard of care, obtain critical records, work with medical experts, and pursue compensation for the harm your loved one has suffered.
Your Loved One Deserves Appropriate Care
Families place enormous trust in assisted living facilities. They expect those facilities to recognize when a resident’s needs have changed and to act in their best interests.
Assisted living facilities have an obligation to recognize when a resident’s needs exceed the care they can safely provide. Holding onto residents after that point may expose them to preventable harm and deprive them of the higher level of care they need.
When facilities prioritize occupancy over resident safety, that trust is broken, and families deserve answers and accountability.
At Prieto, DelCampo, Lopez, & Marigliano LLC, we understand the devastating impact of inappropriate retention on residents and their families. If you believe your loved one was harmed because an assisted living facility failed to transfer them to an appropriate level of care, our team can help you understand your options and pursue accountability.
Contact us today for a free consultation.