¹ 447 U.S. 773 (1980).

² The Supreme Court defines “transfer trauma” as the “increas[ed]… possibility of death or serious illness for elderly, infirm patients” that allegedly occurs when the elderly are removed to another home. Town Court, 447 U.S. at 784 n.16 (1980).

³ Hitov, , Transfer Trauma: Its Impact on the Elderly, 8 CLEARINGHOUSE REV. 846, 846–47 (1975).Google Scholar The transfer trauma dilemma has also been discussed in a legislative context. See, e.g., 120 CONG. REC. S25693 (daily ed. July 30, 1974) (statement of Sen. Percy). Morbidity is the “rate of disease or proportion of diseased persons in a given locality, nation, etc.” WEBSTER's DELUXE UNABRIDGED DICTIONARY 1168 (2d ed. 1983). Mortality is “the proportion of deaths from a particular disease.” Id. at 1171.

⁴ Transfer trauma has been raised in cases involving: (1) voluntary withdrawal by the facility from participation in the Medicare or Medicaid programs—Bumpus v. Clark, 681 F.2d 679 (9th Cir. 1982); Newfield House v. Mass. Dep't. of Pub. Welfare, 651 F.2d 32 (1st Cir. 1981); and Roberson v. Wood, 500 F. Supp. 854 (S.D. 111. 1980); (2) closure of an obsolete facility—Punikaia v. Clark, 720 F.2d 564 (9th Cir. 1983); Brede v. Director for Dep't. of Health, etc., 616 F.2d 407 (9th Cir. 1980); and Bell v. Thornburgh, 491 Pa. 263, 420 A.2d 443 (1980), opinion on remand, 422 A.2d 738 (1980); (3) closure of a facility because of financial collapse—Cornell v. Creasey, 491 F. Supp. 124 (N.D. Ohio 1980); (4) decertification or involuntary closure—O'Bannon v. Town Court Nursing Center, Inc., 447 U.S. 773 (1980); Klein v. Calif'ano, 586 F.2d 250 (3d Cir. 1978); Bracco v. Lackner, 462 F. Supp. 436 (N.D. Cal. 1978); Schwartzberg v. Califano, 453 F. Supp. 1042 (S.D.N.Y. 1978); (5) changes in patient classifications under Medicaid—Blum v. Yaretzky, 457 U.S. 991 (1982); Burchette v. Dumpson, 387 F. Supp. 812 (E.D.N.Y. 1974); Williams v. Commonwealth of Pennsylvania, 58 Pa. 1161, 427 A.2d 319 (1981); and (6) involuntary transfer of patients to other facilities for various reasons—Stewart v. Bernstein, 769 F.2d 1088 (5th Cir. 1985); Hanke v. Walters, 740 F.2d 654 (8th Cir. 1984); and MacLeod v. Miller, 44 Colo. App. 313, 612 P.2d 1158 (1980). In addition, transfer trauma has been used as an argument to support state regulations requiring nursing homes to care for a reasonable number of indigent patients in receipt of Medicaid benefits. In re Health Care Administration Bd., 83 N.J. 67, 415 A.2d 1147 (1980), cert. denied, Wayne Nursing Home v. Finley, 449 U.S. 944 (1980).

⁵ See, e.g., Blum, 457 U.S. at 1002-12.

⁶ See, e.g., Blum, 457 U.S. 991; Town Court, 447 U.S. 773.

⁷ 447 U.S. 773.

⁸ 457 U.S. 991.

⁹ Town Court, 447 U.S. at 785.

¹⁰ Id. at 784.

¹¹ Note, O'Bannon v. Town Court Nursing Center, Inc.: Limiting the Due Process Rights of Nursing Home Residents, 24 ST. LOUIS U. LJ. 828, 851 (1981).Google Scholar See 447 U.S. at 789 (“[Decertification of a home may lead to severe hardship for some of its elderly residents … .“).

¹² 447 U.S. at 787.

¹³ Id. at 787, 789.

¹⁴ Id. at 804.

¹⁵ Note, supra note 11, at 851.

¹⁶ 457 U.S. 991 (1982).

¹⁷ Id. at 1002.

¹⁸ Id. at 991.

¹⁹ Id. at 992.

²⁰ Id.

²¹ Id.

²² Id. at 1001 (quoting Golden v. Zwickler, 394 U.S. 103, 108 (1969)).

²³ Id. at 1002.

²⁴ Id.

²⁵ Id. at 1001 n.13.

²⁶ See generally Stewart, 769 F.2d 1088; Hanke, 740 F.2d 654; Punikaia, 720 F.2d 564; Bumpus, 681 F.2d 679; Williams, 58 Pa. 1161, 427 A.2d 319. In Blum, 457 U.S. 991, another post-Town Court case, litigants of the transfer trauma argument “contendfed] that all transfers threaten elderly patients with physical or psychological trauma … .” Id. at 1002.

²⁷ See infra notes 29-79 and accompanying text.

²⁸ Id.

²⁹ See, e.g., Coffraan, , Relocation and Survival of Institutionalized Aged: A Reexamination of the Evidence, 21 THE GERONTOLOGIST 483 (1981)Google Scholar; Schulz, & Brenner, , Relocation of the Aged: A Review and Theoretical Anaylsis, 32 J. OF GERONTOLOGY 323 (1977).CrossRefGoogle Scholar See also infra notes 60-62, 65, 68.

³⁰ Aleksandrowicz, , Fire and Its Aftermath on a Geriatric Ward, 25 BULLETIN OF THE MEN - NINGER CLINIC 23 (1961).Google Scholar

³¹ Lieberman, , Relationship of Mortality Rates to Entrance to a Home For the Aged, 16 GERIATRICS 515 (1961).Google Scholar

³² Aldrich, , Personality Factors and Mortality in the Relocation of the Aged, 4 THE GERONTOLOGIST 92 (1964)CrossRefGoogle Scholar; Aldrich, & Mendkoff, , Relocation of the Aged and Disabled: A Mortality Study, 11 J. OF THE AMERICAN GERIATRICS SOCIETY 185 (1963)CrossRefGoogle Scholar; Amenta, Weiner, & Amenta, , Successful Relocation of Elderly Residents, 5 GERIATRIC NURSING 356 (1984).CrossRefGoogle Scholar Blenkner, , Environmental Change and the Aging Individual, 7 THE GERONTOLOGIST 101 (1967)CrossRefGoogle Scholar; Borup, , Relocation Attitudes, Information Network and Problems Encountered, 21 THE GERONTOLOGIST 501 (1981)CrossRefGoogle Scholar; Borup, & Gallego, , Mortality As Affected by Interinstitutional Relocation: Update and Assessment, 21 THE GERONTOLOGIST 8 (1981).CrossRefGoogle Scholar

³³ See, e.g., Coffman, supra note 29, at 484-85.

³⁴ Town Court, 447 U.S. at 804.

³⁵ Id. at 785.

³⁶ Id. at 785-86.

³⁷ Id. at 786-89.

³⁸ See supra note 26.

³⁹ Coffman, supra note 29, at 484-90.

⁴⁰ Id. at 489-90.

⁴¹ Id. at 485-90.

⁴² Id. at 488.

⁴³ Id.

⁴⁴ A test of significance is a judgment that a conclusion from research findings falls within a range of possibilities that is satisfactory. Such tests are usually expressed in percentages. For example, a 50% range would be a reasonable test of significance for predicting or measuring the number of heads that would turn up by flipping a coin 100 times.

⁴⁵ See Coffman, supra note 29, at 486-87 (tables of research results) and 496-98 (description of different research studies).

⁴⁶ Pre-comparisons and post-comparisons are used where an intervening event is alleged to have caused some change. For example, such comparisons would be used in comparing reaction time before and after imbibing two ounces of whiskey.

⁴⁷ See Coffman, supra note 29, at 486-87.

⁴⁸ A common index of mortality is an index of death rates among several studies which are calculated on a common statistical basis (e.g., matched groups, comparisons against the general population, pre/post studies using a common baseline period). Using different bases for comparisons can magnify errors.

⁴⁹ See Coffman, supra note 29, at 486-87.

⁵⁰ Z-ratios are calculations which bring disparate measures into a common standard for purposes of comparison with one another.

⁵¹ See Coffman, supra note 29, at 489-90.

⁵² Id. at 488-91.

⁵³ A criterion of confidence is the standard set for test of significance. Many statistical studies of human populations use a confidence level of 0.05, meaning that only five per cent of the variance can be accounted for by chance.

⁵⁴ A two-tailed test is a test of the results indicating that the findings are valid for both greater and lesser amounts, i.e. plus or minus. A one-tailed test would test for validity only in one direction.

⁵⁵ See Coffman, supra note 29, at 491.

⁵⁶ Id.

⁵⁷ Id. at 491-92.

⁵⁸ Id. at 493.

⁵⁹ See id. at 491-93.

⁶⁰ Carp, , The Impact of the Environment on Old People, 7 THE GERONTOLOGIST 106, 106–08 (1967).CrossRefGoogle Scholar

⁶¹ Lawton, & Cohen, , The Generality of Housing Impact on the Well-Being of Older People, 29 J. OF GERONTOLOGY 194 (1974).CrossRefGoogle Scholar

⁶² Kasl, Ostfeld, Brody, Snell & Price, Effects of “Involuntary” Relocation on the Health and Behavior of the Elderly, in SECOND CONFERENCE ON THE EPIDEMIOLOGY OF AGING 211 (S.G. Haynes & M. Feinleib eds. 1980) [hereinafter cited as Kasl].

⁶³ Carp, supra note 60, at 108-09. Findings similar to Carp's were reported by Sherwood and her advocates following research on the impact of a move into a medically oriented apartment complex. S. SHERWOOD, P.S. GREER, J.N. MORRIS, V. MOR & ASSOCIATES, AN ALTERNATIVE TO INSTITUTIONALIZATION (1981). Additional studies showing no adverse effects of relocation on morbidity are: Storandt, & Wittels, , Maintenance of Function in Relocation of Community-Dwelling Older Adults, 30 J. OF GERONTOLOGY 608 (1975)CrossRefGoogle Scholar; Lawton, & Yaffe, , Mortality, Morbidity and Voluntary Change of Residence by Older People, 18 J. AM. GERIATRICS SOC'Y 823 (1970)CrossRefGoogle Scholar; and Wittels, & Botwinick, , Survival in Relocation, 29 J. OF GERONTOLOGY 440 (1974).CrossRefGoogle Scholar Whether these moves were voluntary or not is not clear from the studies. However, Brand and Smith's study of involuntary moves resulting from urban renewal indicates no increased morbidity although some increased personal adjustment was manifested. Brand, & Smith, , Life, Adjustment & Relocation of the Elderly, 29 J. OF GERONTOLOGY 336 (1974).CrossRefGoogle Scholar

⁶⁴ Lawton & Cohen, supra note 61, at 202.

⁶⁵ Ferraro, , The Health Consequences of Relocation Among the Aged in the Community, 38 J. OF GERONTOLOGY 90, 94 (1982).CrossRefGoogle Scholar

⁶⁶ Id.

⁶⁷ Id.

⁶⁸ Pastalan, Environmental Displacement: A Literature Reflecting Old Person Environment Transactions, in AGING AND MILIEU: ENVIRONMENTAL PERSPECTIVES ON GROWING OLD 189 (G. Rawles & R. Ohts eds. 1982).

⁶⁹ Characteristics of elderly persons being transferred include frailty, morbidity, age and degree of dementia.

⁷⁰ Pastalan, supra note 68, at 190.

⁷¹ R. CRANDALLS, GERONTOLOGY: A BEHAVIORAL SCIENCE APPROACH 85-89 (1980).

⁷² Id. at 85.

⁷³ The pre-move experience base of a given population refers to the death rates that existed for that population before being moved.

⁷⁴ R. CRANDALLS, supra note 7 1, at 85-86.

⁷⁵ Id. at 89.

⁷⁶ Id.

⁷⁷ Id.

⁷⁸ Id.

⁷⁹ Id.

⁸⁰ Town Court, 447 U.S. at 784-85 n.16.

⁸¹ See supra note 4.

⁸² MacLeod v. Miller, 44 Colo. App. 313, 612 P.2d 1158 (Colo. Ct. App. 1980); Matter of Review of Health Care Admin., 83 NJ. 67, 415 A.2d 1147 (1980); Bell v. Thornburgh, 491 Pa. 263, 420 A.2d 443 (1980); Williams v. Commonwealth of Pennsylvania, 58 Pa. Commw. 116, 427 A.2d 319 (Pa. Commw. Ct. 1981).

⁸³ 58 Pa. Commw. 116, 427 A.2d 319 (Pa. Commw. Ct. 1981).

⁸⁴ 491 Pa. 263, 420 A.2d 443 (1980).

⁸⁵ 44 Colo. App. 313, 612 P.2d 1158 (Colo. Ct. App. 1980).

⁸⁶ 83 NJ. 67, 415 A.2d 1147 (1980).

⁸⁷ 83 N.J. at 79, 415 A.2d at 1153.

⁸⁸ In Goldberg v. Kelly, 397 U.S. 254 (1970), the Supreme Court held that a welfare recipient, whose benefits were to be terminated on the recommendation of a caseworker and the caseworker's unit supervisor, was entitled to a pre-termination evidentiary hearing. The minimum standards set out by the Court to guarantee due process were “timely and adequate notice detailing the reasons for a proposed termination, and an effective opportunity to defend by confronting any adverse witnesses and by presenting his own arguments and evidence orally.” Id. at 267-68.

⁸⁹ Roberson v. Wood, 500 F. Supp. 854 (S.D. 111. 1980).

⁹⁰ Punikaia v. Clark, 720 F.2d 564 (9th Cir. 1983).

⁹¹ Punikaia, 720 F.2d 564; Cornell, 491 F. Supp. 124.

⁹² Town Court, 447 U.S. 773; Klein v. Califano, 586 F.2d 250 (3rd Cir. 1978); Bracco v. Lackner, 462 F. Supp. 436 (N.D. Cal. 1978); Schwartzberg v. Califano, 453 F. Supp. 1042 (S.D.N.Y. 1978).

⁹³ Blum v. Yaretsky, 457 U.S. 991 (1982).

⁹⁴ Under the Medicaid scheme, both providers and patients are classified in terms of skilled or intermediate care. Roughly, skilled care is that requiring the supervision, care and attention of a registered nurse, while intermediate care is care requiring the supervision, care and attention of a practical nurse. States designate facilities as SNFs or ICFs based upon their staffing, equipment, physical facilities and other programmatic elements. Similarly, states set the Medicaid rates they will pay on behalf of patients eligible for Medicaid. Based upon an assessment of patient need for care and service, each patient is classified as an ICF or SNF patient. The payment rate to a facility is designated as qualified to provide care and service at least to the particular level of patient classification. Thus, an SNF can be paid for care to both patients classified as needing skilled care and intermediate care, although for intermediate care patients it will receive only the intermediate care rate. On the other hand, an ICF will receive only the intermediate care rate regardless of whether the patient requires skilled or intermediate care. The rates are determined by the state agency and by law must reflect reasonable costs.

⁹⁵ Town Court, 447 U.S. 773.

⁹⁶ Id. at 785-86.

⁹⁷ Id. at 786-89.

⁹⁸ Id. See supra note 9 and accompanying text.

⁹⁹ The outcome in Roberson, 500 F. Supp. 854, appeared to be determined by the Supreme Court's decision in Town Court. The Roberson court held that “[fjederal law and regulations nowhere provide that once a provider takes on patients, it can never withdraw from the program unless it is decertified by the government. Restrictions on the withdrawal of a provider can only possibly lie … in the contract between the patients and the provider or in State law.” Id. at 860.

Both Newfield House v. Mass. Dept. of Pub. Welfare, 651 F.2d 32 (1st Cir. 1981) and Bumpus v. Clark, 681 F.2d 679 (9th Cir. 1982), were decided on other grounds. In Newfield House, the court found the state's obligation to reimburse the home to rest on “essentially contractual dealings with the home.” 651 F.2d at 35. In Bumpus, the court considered and dismissed plaintiffs’ claims under Title XIX of the Social Security Act, and under Medicaid regulations. 681 F.2d at 682-85.

¹⁰⁰ Newfield House, 651 F.2d at 33-34.

¹⁰¹ Id. at 33.

¹⁰² Id. at 33-34.

¹⁰³ In a footnote, the court noted the “significant policy interest in reducing ‘the transfer trauma’ suffered by many nursing home residents upon relocation.” Id. at 37 n.7.

¹⁰⁴ Id. at 35.

¹⁰⁵ Bumpus, 681 F.2d at 681-82.

¹⁰⁶ Id. The district court dismissed plaintiffs’ federal claims on grounds of failure to state a claim on which relief could be granted and dismissed the pendent state claims. Id. at 682.

¹⁰⁷ Id. at 687.

¹⁰⁸ 42 U.S.C. §§ 1396-97 (1982).

¹⁰⁹ Id. at 682 (citing Roberson, 500 F. Supp. at 860).

¹¹⁰ Id. The court interpreted strictly the language of section 1396a(a)(23) of the Social Security Act confining the matter of a patient's free choice of provider to that qualified provider who “undertakes to provide him services.” Bumpus, 681 F.2d at 682 (quoting 42 U.S.C. § 1396a(a)(23) (1982)).

¹¹¹ Restrictions on reasons for transfers or discharges were held to apply only where services were ongoing, and in no way limited a provider's right to withdraw. Id. at 693.

¹¹² Id. at 684.

¹¹³ Id. The alternative of a forced buyout by the state was considered to be equally as onerous for providers who may suffer significant involuntary losses. A forced buyout would also place a major capital burden on states and would reduce availability of funds for other services. Id.

¹¹⁴ 42 U.S.C. § 1396a(a)(19) (1982).

¹¹⁵ 681 F.2d at 683 (citing Pennhurst State School and Hosp. v. Halderman, 451 U.S. 1, 17, 24 (1981)).

¹¹⁶ Id.

¹¹⁷ Id.

¹¹⁸ The court foreclosed a claim that the state be required to take over the home, reasoning that the ambiguous language of the statute would not compel such a result. Id. at 683-84.

¹¹⁹ Id.

¹²⁰ The court's final consideration of Title XIX obligations for Medicaid providers focused on section 1396a(a)(19) of the Social Security Act. 42 U.S.C. § 1396a(a)(19) (1982). Section 1396a(a)(19) of the Social Security Act requires those states receiving federal Medicaid grants to:

According to the court, if the “best interests” requirement of section 1396a(a)(19) was construed so as to require preservation of the status quo in voluntary withdrawal, then states would be similarly obligated when withdrawal was involuntary. Bumpus, 681 F.2d at 684. After all, from the patient's perspective of transfer trauma, the reason for transfer matters little.

¹²¹ 616 F.2d 407 (9th Cir. 1980).

¹²² 720 F.2d 564 (9th Cir. 1983), cert, denied, 469 U.S. 816 (1984).

¹²³ 616 F.2dat 412.

¹²⁴ Id.

¹²⁵ Id.

¹²⁶ 720 F.2d at 568.

¹²⁷ Id.

¹²⁸ See, e.g., 42 U.S.C. §§ 1395x(j), 1396d(c) (1982). Requirements for maintenance of a skilled nursing facility and an intermediate care facility, for example, are set out in sections 1395x(j) and 1396d(c) of the Social Security Act.

¹²⁹ 453 F. Supp. 1042 (S.D.N.Y. 1978).

¹³⁰ The case turned on whether the provision of a sixty-nine page report of deficiencies together with an opportunity to reply, a reinspection by allegedly disinterested inspectors and the appearance of owners and operators before the decisionmaker to argue their position prior to termination of the provider agreement, complied with the requirement of due process. Id. at 1045.

¹³¹ Id. at 1047.

¹³² Id.

¹³³ 462 p. Supp. 436 (N.D. Cal. 1978). In Bracco, plaintiffs also pleaded that redassification represented a reduction in benefits which entitled them to a pretermination due process hearing. The defendant Department of Health conceded the validity of this claim. This element, however, is not a major one in this case and it is for that reason that it is not included with the cases concerning redassification.

¹³⁴ Id. at 441.

¹³⁵ Following the issuance of temporary restraining orders, a hearing to show cause produced sufficient agreement among counsel to cause the court to initiate settlement procedures. Id. at 440. When these procedures broke down, the court was confronted with near impossible time constraints. It appeared that the Center would close for lack of funds at the end of the third day following a hearing on the motion for a preliminary injunction. For reasons not apparent in the opinion, defendant State of California refused to agree to continue payments for the one week the court deemed reasonable for consideration of the matter. Id. The court perceived this as a “squeeze play” by the state, or an effort to preempt the court by an effective fait accompli. The court did, in fact, decide the issue within those time constraints and granted the preliminary injunction. Id.

In July 1977, the Center's operation was taken over by Quality Care, which was issued a six-month provisional license. Id. at 441. The Department refused to renew the license because ensuing inspections revealed a failure by the Center to correct conditions. Id. at 441-42. Upon petition of the Department in California Superior Court for an injunction against future operation of the Center, that court issued an “Interim Order re Issuance of License,” requiring the Department to issue a provisional license and requiring Quality Care to attempt the sale or transfer by April 15, 1978. The Superior Court also ordered Quality Care to hire additional staff and maintain the Center at a level in compliance with state standards. In the event the sale or transfer could not take place, the court would have ordered implementation of a patient transfer plan. The Superior Court retained jurisdiction to issue additional orders necessary to ensure the health and welfare of the patients. Id. at 442.

Until mid-February 1978, the Center housed 300 patients. By early March the Center's population was reduced to 220 patients and further to 150 patients by the end of March. In its review of the facts of the case, it was clear that the court did not find the Department's evidence persuasive. At no point was there any action taken to forestall possible harm to the 150 patients moved during the sixty days of February and March nor was any remedy sought or mentioned for them in the opinion. After reciting a litany of serious deficiencies in hygiene, patient care, lack of cleanliness, failure to follow therapeutic diets, failure of nursing staff to assess patient needs and changes in patient conditions, failure to notify physicians and to implement the physicians’ orders promptly, the Bracco court pointed out that the Department itself indicated a significant improvement over these past failures. Id. at 447.

¹³⁶ Id.

¹³⁷ Id.

¹³⁸ Town Court, 447 U.S. 773, 802-03.

¹³⁹ 491 Pa. 263, 420 A.2d 443 (1980), opinion on remand, 54 Pa. Commw. 628, 422 A.2d 738 (Pa. Comm. Ct. 1980).

¹⁴⁰ 491 Pa. at 273, 420 A.2d at 448.

¹⁴¹ 491 Pa. at 274, 420 A.2d at 448 (citing Town Court, 447 U.S. at 787). The Bell court noted that:

491 Pa. at 274-75, 420 A.2d at 449 (citing Town Court, 447 U.S. at 787.)

¹⁴² Bell, 491 Pa. at 255, 420 A.2d at 449.

¹⁴³ Id.

¹⁴⁴ 491 Pa. at 278, 420 A.2d at 450.

¹⁴⁵ 491 Pa. at 277, 420 A.2d at 450.

¹⁴⁶ 586 F.2d 250 (3d Cir. 1978). O'Bannon v. Town Court Nursing Center, Inc. was reported at 586 F.2d 266 (3d. Cir. 1978), sub nom. Town Court Nursing Center, Inc. v. Beal, on the same day as Klein. Klein is cited in Town Court, 447 U.S. at 779, 781, 805.

¹⁴⁷ Schwartzberg, 453 F. Supp. 1042.

¹⁴⁸ 42 C.F.R. § 405.1133(1) (1982).

¹⁴⁹ 387 F. Supp. 812, 817 (E.D.N.Y. 1974).

¹⁵⁰ Blum, 457 U.S. 991 (1982).

¹⁵¹ F. Supp. at 819.

¹⁵² Id. The United States District Court for the Eastern District of New York held that plaintiffs lacked standing to raise a constitutional challenge to New York regulations relating to notice where interested parties had been afforded notice and full hearing. The court also stated that a class action was not maintainable due to possible variations in factual situations relating to relocation. Id. at 820.

¹⁵³ 457 U.S. 991.

¹⁵⁴ See notes 175-89 and accompanying text.

¹⁵⁵ See cases cited supra note 4.

¹⁵⁶ 58 Pa. Commw. 116, 427 A.2d 319 (Pa. Commw. Ct. 1981).

¹⁵⁷ Id. at 119,427 A.2dat 321.

¹⁵⁸ Id.

¹⁵⁹ 740 F.2d 654 (8th Cir. 1984).

¹⁶⁰ Id. at 656 (citing 38 U.S.C. § 620(a)(2)(i) (1982)).

¹⁶¹ Id.; see also Parham v. J.R., 442 U.S. 584, 606-17 (1979).

¹⁶² 769 F.2d 1088 (5th Cir. 1985).

¹⁶³ Id. at 1089.

¹⁶⁴ Id. at 1090.

¹⁶⁵ Id. at 1093 n.7.

¹⁶⁶ Id.

¹⁶⁷ Bell, 491 Pa. 263, 268-72, 420 A.2d 443, 446-48.

¹⁶⁸ F. Supp. 124 (N.D. Ohio 1978).

¹⁶⁹ MacLeod, 44 Colo. App. 313, 612 P.2d 1158 (Colo. Ct. App. 1980).

¹⁷⁰ Bracco, 462 F. Supp. 436.

¹⁷¹ Klein, 586 F.2d 250.

¹⁷² Town Court, 447 U.S. 773.

¹⁷³ Blum, 457 U.S. 991.

¹⁷⁴ See, e.g., Bracco, 462 F. Supp. 436 (N.D. Cal. 1978); Schwartzberg, 453 F. Supp. 1042 (S.D.N.Y. 1978); Burchette, 387 F. Supp. 812 (E.D.N.Y. 1974); MacLeod, 44 Colo. App. 313, 612 P.2d 1158 (Colo. Ct. App. 1980).

¹⁷⁵ For examples of states’ exercise of regulatory power see, e.g., CONN. GEN. STAT. ANN. 19a-490 to -503 (West Supp. 1985); Wis. STAT. ANN. §§ 50.01-50.12 (West Supp. 1985).

¹⁷⁶ Id.

¹⁷⁷ See, e.g., Wis. STAT. ANN. § 50.03.

¹⁷⁸ Id. at §§50.01-50.14.

¹⁷⁹ Id. at § 50.03 (5m).

¹⁸⁰ Id. at §50.03 (5m)(b).

¹⁸¹ Id.

¹⁸² Id. at §50.03 (5m)(c).

¹⁸³ 3Id. at §§ 50.03 (5m)(c)-(5m)(d).

¹⁸⁴ Id. at §50.03 (5m)(d).

¹⁸⁵ Id.

¹⁸⁶ Id. at § 50.03 (5m)(e).

¹⁸⁷ Id. at § 50.03(5m)(d).

¹⁸⁸ Id.

¹⁸⁹ With regard to provision of transfer services that help mitigate the effects of relocation by increasing resident understanding of the transfer, only a few states provide such services by statute. See Wis. STAT. ANN. §§ 50.03 (5m)(c)-(5m)(e) (West Supp. 1985); CONN. GEN. STAT. ANN. § 19a-535(b) (West Supp. 1985). Wisconsin is relatively unique in its progressive treatment of institutional resident removal and relocation. “Many … statutes do not require notice to the resident, and few require more than a mere statement of the impending event (termination of provider status, home closing, or discharge).” Note, Involuntary Relocation of Nursing Home Residents and Transfer Trauma, 24 ST. LOUIS U.L.J. 758, 772 (1981).Google Scholar In addition, “[w]hen an involuntary transfer is pending, few statutes and regulations explicitly grant the resident a right to a hearing, except in a narrow range of fact situations.” Id. at 774.

Although federal statutes do not expressly require transfer services, Medicare and Medicaid skilled nursing facilities regulations do. 42 C.F.R. §405.1133 (1985) (Medicare skilled nursing facilities), 42 C.F.R. § 442.202(c) (1985) (Medicaid skilled nursing facilities). The regulations require that written policies concerning the nursing, medical and/or other services the facility provides embody concern and respect for the medical and emotional needs of patients. Id.

The federal regulations, like the state statutes and regulations, do not address the transfer trauma phenomenon, but rather are efforts at improving the transfer process in general. This Article accepts the Supreme Court's conclusion that transfer trauma has not as yet been scientifically proven and, therefore, it does not address legislative efforts to improve the relocation process. For in-depth discussion of legislative treatment of problems in the relocation process, see Note, Missouri's Transfer and Discharge Standards for Nursing Home Residents: A Much Needed Tool, 24 ST. LOUIS U.L.J. 784 (1981).Google Scholar

¹⁹⁰ Barry, & Ham, , Geriatric Education: What the Medical Schools are Doing Now, 33 J. AM. GERIATRICS SOC'Y 133 (1985)CrossRefGoogle Scholar; Pfeiffer, , Some Bask Principles of Working with Older Patients, 33 J. AM. GERIATRICS SOC'Y 44, 46 (1985)CrossRefGoogle Scholar; Williams, , A Perspective on Training for Academic Leadership in Geriatrics, 33 J. AM. GERIATRICS SOC'Y 163, 166 (1985)CrossRefGoogle Scholar; Williams, , Teaching Nursing Homes: Their Impact on Public Policy, Patient Care, and Medical Education, 33 J. AM. GERIATRICS SOC'Y 189, 191 (1985).CrossRefGoogle Scholar