Nursing homes across Ohio have been quietly transferring their most vulnerable residents — elderly patients with dementia, diabetes, mobility disorders and no family support — directly to homeless shelters. Federal inspectors have cited at least seven facilities in recent years, and advocates say the practice is accelerating as Medicaid funding shrinks and facilities look for ways to move out residents whose insurance has lapsed.
What is driving the discharges
The pattern is consistent across cases: a resident’s insurance — typically Medicaid or Medicare — stops covering their stay. The facility, unwilling to absorb the cost, initiates an involuntary discharge. Rather than securing a safe alternative placement, staff route the patient to a homeless shelter, sometimes without proper notice, medications, or any documentation.
Ohio law, mirroring federal requirements, mandates at least 30 days’ notice before an involuntary discharge except in health and safety emergencies. In multiple inspected cases, that notice was either shortened to hours or bypassed entirely. Patients arrived at shelters without insulin needles, prescription refills, care plans, or even identification.
“We are starting to deal with it more and more. The facilities are so closely monitored on discharges, but yet they still try and send them to hospitals and not take them back. Or drop them off at homeless shelters.”
— Chip Wilkins, Dayton Long Term Care Ombudsman
Documented cases
A woman with alcohol-related dementia, a tibia fracture and diabetes was dropped at a homeless shelter after being caught drinking beer. She was left outside in summer heat. Her whereabouts were never confirmed.
A man who had lived at the facility for 22 years was discharged without notice after his insurance lapsed. Staff told him he was going to an assisted living apartment. He arrived at an emergency shelter with no needles for his insulin, no ID and no documents.
A patient was sent to a shelter 20 days into a 30-day notice period, with only two weeks of medications and no prescriptions or follow-up care plan. The shelter flagged he couldn't climb to a top bunk. The facility refused to take him back.
A woman with spinal disorders, depression and arthritis was given roughly 24 hours' notice before discharge — instead of the legally required 30 days. The facility's social services director said he did not know where she ended up.
Shelters are not equipped for this
Emergency shelters are not medical facilities. Some require residents to climb to a top bunk — a barrier for patients using walkers or wheelchairs. Staff are not trained to administer or monitor complex medication schedules. Advocates say that within two to three days of arrival, most discharged nursing home patients end up in a hospital emergency room because the shelter cannot meet their needs.
“Invariably, that ends up being a horrible experience for the individual because they’ll go to the shelter, and typically, within two to three days, the shelter will send them to the hospital because they can’t meet their needs.”
— Chip Wilkins, Dayton Long Term Care Ombudsman
Marcus Roth of the Coalition on Homelessness and Housing in Ohio acknowledged the difficult position shelters are placed in — simultaneously ill-equipped to handle medically complex residents and yet the only available fallback when every other option has been exhausted.
A system under financial strain
The broader context is one of mounting fiscal pressure. Medicaid, which funds the majority of nursing home care in the United States, has faced repeated federal funding reductions. Ohio facilities are managing that pressure in part by clearing out residents whose coverage has ended — and the most isolated patients, with no family to advocate for them, are the ones bearing that cost.
Ohio’s statewide long-term care ombudsman estimated that roughly 13,000 residents are discharged from Ohio nursing homes every month. Shelter discharges remain a fraction of that total, but advocates say the frequency is climbing — and the consequences for those affected are severe.
“I can’t believe they would do someone dirty like that.”
— Former roommate of a patient discharged after 22 years