By Austin Senior Advisor Care Team · October 5, 2026
Texas nursing facilities can discharge a resident only for seven listed reasons, usually with 30 days' written notice and a 90-day appeal right. Here is how to read the letter, who to call in Austin, and when to file.
The letter arrives, and the date on it matters more than the reason
Picture a Tuesday afternoon. Your mother has lived in a nursing facility in north Austin for fourteen months. A social worker calls and says a letter is coming. It says the facility intends to discharge her to another building, or to a family member's home, in a few weeks. You are standing in a parking lot with a work phone in your other hand.
Take a breath. A nursing facility in Texas does not get to move a resident whenever it likes. Federal rules, and Texas rules for Medicaid-certified facilities, list the reasons a discharge is allowed. They set a notice period. They give your mother, or whoever acts for her, a right to appeal. The facility has to follow all three.
This post is about nursing facilities. Assisted living works differently. If your parent is in assisted living, read our guide to the 30-day discharge notice in assisted living instead. And if the move is coming from a hospital, not a nursing facility, the process is different again, covered in how to appeal a hospital discharge.
The first thing to do with the letter is to find two dates: the date on the notice and the date the facility says the discharge will happen. Write both on the envelope. The appeal clock and the notice period both run from them.
The seven reasons a facility is allowed to discharge
Texas rule 26 TAC 554.502 lists when a Medicaid-certified nursing facility may transfer or discharge a resident. There are seven reasons, and the facility must have one of them. The first is that the move is necessary for the resident's welfare because her needs cannot be met in that facility. The second is that her health has improved enough that she no longer needs nursing facility services. The third is that the safety of other people in the building is endangered by her clinical or behavioral status. The fourth is that the health of other people would otherwise be endangered.
The fifth is nonpayment after reasonable notice, which includes a failed Medicaid claim. The sixth is that the resident or her representative asks to leave. The seventh is that the facility is closing as a nursing facility.
Read the reason in the letter against that list. Some reasons families hear are not on it. "We are short-staffed." "She is a lot of work." "We need the bed for a short-term rehab patient." "Her family complains too much." None of those is a permitted reason by itself. If the letter says her needs cannot be met, ask which needs, and ask what the facility tried before reaching that conclusion.
The words that carry the most weight are "cannot be met." A facility that says it cannot meet a need should be able to name the need in plain language. Dementia-related behavior, a feeding tube, bariatric care and complex wound care all come up. If the facility has been meeting the need for a year and the letter appears right after a family complaint or a change in payer, that sequence is worth writing down with dates.
Thirty days, and the four times it shrinks
The standard rule is written notice at least 30 days before the discharge. The rule says the notice has to be in a language and manner the resident can understand. A dense form handed to a resident with dementia and no copy sent to her family does not meet that test in spirit, and you can say so.
There are exceptions where notice may be given "as soon as practicable" instead. They apply when the safety or health of others in the building is endangered, when the resident's health has improved enough for an immediate discharge, when her urgent medical needs require an immediate transfer, and when she has lived in the facility for fewer than 30 days.
Those exceptions are narrow, but they are real, and they are why you should not assume you have a full month. If the letter claims one of them, ask which one in writing. A facility that skips the 30 days has to be able to say why.
Do not confuse a discharge with a trip to the hospital. If your mother is sent to an Austin emergency room and the facility later says it will not take her back, that is a separate fight, and the bed-hold question comes first. Our guide to bed holds when a parent goes to the hospital covers it.
What the notice must say, and what its absence tells you
A valid notice is not one paragraph. Under the Texas rule it has to state the reason, the effective date, and the place she is being moved to. It has to include a statement of her appeal rights, with the 90-day window. It has to include the name, address, email address and telephone number of the managing local ombudsman, and the toll-free number for the Texas Long-Term Care Ombudsman Program. The federal rule also requires the facility to send a copy of the notice to a representative of the state ombudsman office.
Austin is served by the Capital Area Area Agency on Aging ombudsman program, not the agency in Belton. The Capital Area managing local ombudsman can be reached at 512-916-6054 or 888-622-9111, option 3, at 6800 Burleson Rd., Bldg. 310, Ste. 165, Austin 78744. Their region covers Travis, Williamson, Hays, Bastrop and several neighboring counties. The state toll-free line is 1-800-252-2412.
Check the letter for those contact details. If the Belton number is on it, or no ombudsman is named at all, the notice is defective on its face. That is worth a phone call to the right office the same day. Ombudsman services are free and confidential, and the ombudsman acts only with your mother's consent or yours as her representative.
The notice also has to name where she is going. "A facility to be determined" is not a destination. If the place named is two counties away, or has no bed for her, the safe-discharge duty applies, which we get to below.
Appealing: ninety days, and the part that lets her stay
A discharge decision from a nursing facility is an appealable action in the Texas Medicaid fair hearing system. The window is 90 calendar days, counted from the effective date of the action or from the date of the notice, whichever is later. HHSC's handbook says appeals can be made in writing or orally.
Here is the part that matters most. If the resident appeals before the discharge date, she can generally remain in the facility while the appeal is pending, and Medicaid vendor payments and eligibility continue until the hearing officer decides. HHSC's own provider guidance says the facility may not discharge a resident while an appeal is pending, with exceptions for safety risks, nonpayment, and stays under 30 days.
So the practical advice is to appeal early, not on day 89. An appeal filed after she has already left does not carry the same protection. Ask the facility, the ombudsman or the hearing office exactly how to file, and keep proof that you filed: a dated copy, a confirmation number, or a name and time for a phone call.
At the hearing, the facility carries the burden. HHSC's provider letter says it must send an evidence packet to the hearing officer and the resident at least five business days before the hearing, showing the discharge met the criteria. If the hearing officer finds the discharge was inappropriate, the facility must readmit the resident immediately or to the next available bed.
I could not find a published statistic on how often Austin-area residents win these hearings, and I will not guess at one. What the rules do show is that a facility has to prove its case, and that residents who file early keep their bed while it happens.
A safe discharge is a legal duty, not a courtesy
Even a lawful discharge has to be safe and orderly. The Texas rule says a facility must provide and document sufficient preparation and orientation to the resident. HHSC's guidance adds explaining the discharge in terms she can understand, returning her belongings, and giving a discharge summary with a plan for care afterward.
Ask for that plan early. Who is the receiving provider? Is there a confirmed bed, or only a hope? Will her medications be reconciled with the new doctor? If she is going home, who is arranging home health and equipment, and when does the first visit happen? A discharge date with no answers to those questions is not ready, whatever the letter says.
If your mother is going home, the Austin resources in the other direction start to matter. The Austin senior care guide lists the local agencies that can arrange care at home, and our money is running out page covers what to do if cost is the real driver. A move for nonpayment is a different conversation, and a Medicaid application in progress is often the answer.
If she is being sent to a facility that you have not toured, tour it, or have a relative do it. Our guide to reading an HHSC inspection report shows how to check the receiving facility's record before she arrives.
Who to call, in what order, this week
First, call the ombudsman, 512-916-6054 for the Austin area. They have seen this letter before and can tell you quickly whether the reason, the timing and the contents hold up. Second, ask the facility's administrator, in writing, for the specific reason, the clinical records behind it, and the care plan history. You are generally entitled to your mother's records, and the request itself changes the tone of the conversation.
Third, file the appeal if the answers are weak. You can always withdraw an appeal. You cannot easily recover the days you did not use. Fourth, if you think the facility is doing something wrong in how it treats her, as opposed to how it is discharging her, the complaint line is HHSC Complaint and Incident Intake at 1-800-458-9858. Adult Protective Services at 1-800-252-5400 handles abuse in community settings, not licensed facilities. Many families call the wrong one and lose a day.
Fifth, if real money or a house is involved, or if your mother has a guardian, a Texas elder law attorney is worth the consult. The rules above are a floor, not a full legal opinion on your mother's case, and I am not a lawyer. Our directory of Texas ombudsman help explains what the program does and does not do.
Last, write down what you were told and when. Names, dates, what was promised. Whatever happens in the hearing, a clean timeline is the most useful thing a family can bring to it.
