There are few moments more unsettling than hearing that a rehab or skilled nursing facility has declined your parent. You have been juggling discharge planning, medications, emotions, and decisions you were never trained to make. Then the hospital calls or the case manager approaches and tells you the facility cannot take your parent. Suddenly the entire plan collapses.
Families often feel blindsided because they were never told what might cause a facility to say no. They were never taught how the placement system works. And no one explains what questions you can ask to get the truth instead of a short answer that tells you nothing.
This guide gives you calm clarity in a moment that usually feels chaotic. It walks you through the exact questions that uncover the real reasons behind a denial and how to move forward with confidence instead of panic.
If you want to understand the entire discharge process more clearly, visit the Care System Education Hub.
Why Facilities Say No More Often Than Families Realize
When a facility declines a patient, it is not personal. It is not a statement about your parent. It is almost always a logistical, clinical, staffing, or insurance issue.
Common reasons include:
- The facility believes it cannot meet the medical needs
- Therapy notes or clinical information are incomplete
- Insurance has not authorized the stay
- The facility has no available beds for the required level of care
- The patient needs a different type of environment such as memory care
- The workload or staffing ratio is too high for the patient’s needs
- There is a misunderstanding about the patient’s baseline
- The facility has internal restrictions you would never know about
None of these reasons mean your parent cannot receive care. They simply mean this particular facility cannot provide it. Your job is to understand why so you can decide the next step.
These questions help you do exactly that.
Question One What part of the referral prevented admission
Every facility decision is based on the referral packet sent by the hospital. This packet includes:
- Recent nursing notes
- Therapy evaluations
- Medical history
- Lab results
- Imaging
- Medication lists
- Safety concerns
- Expected care needs
If the facility declined, something in this packet raised a concern. Ask directly:
What information made the patient not appropriate for admission
This single question often reveals more than anything else.
Question Two Which specific care needs were considered too difficult or unsafe
Facilities match patients to what they can safely support. If they say no, they likely identified a need they cannot manage.
Common examples include:
- A patient who needs the assistance of two people for transfers
- A need for continuous oxygen monitoring
- IV medications the facility cannot administer
- Advanced wound care beyond their staffing level
- Behavioral changes due to dementia that need more supervision
- Frequent falls or unpredictability
- A need for a very high level of physical therapy
Ask the facility:
Which part of the care plan could not be supported here
This helps you understand whether a different facility might be a better match.
Question Three Is the denial related to insurance authorization
This is one of the most common hidden reasons for denial. Sometimes the facility wants to accept the patient but cannot proceed because the insurance company has not approved the stay.
Ask:
Is the insurance authorization missing
Is it pending
Has it been denied
Is more clinical information needed
Has the facility submitted the request to insurance
Insurance issues often have nothing to do with the patient and everything to do with paperwork.
If insurance is the barrier, the hospital case manager can push the authorization through or gather additional documentation.
For more guidance, see When the Case Manager Says Youre All Set.
Question Four Was the referral packet incomplete
Many families do not know this, but facilities routinely decline because required documents were missing. This does not mean the patient is too complicated. It simply means the facility did not get enough information to accept them.
Ask:
Was the therapy evaluation included
Were the most recent nursing notes included
Were the hospitalist notes included
Were the lab results included
Did you receive the imaging
Was the reason for transfer clearly documented
If documentation is the issue, the hospital can update the referral immediately.
Question Five Do you have an available bed for the level of care needed
Facilities often have open beds, but not for every type of care. There are different bed categories.
Examples:
- Short term rehabilitation beds
- Skilled nursing beds
- Memory care rehabilitation beds
- High acuity beds
- Behavioral support beds
Ask:
Do you have a bed available for the specific level of care my parent needs
If the answer is no, this is a temporary barrier, not a permanent one.
Question Six Are there safety concerns with the patient entering the facility
Facilities evaluate whether they can keep a patient safe based on staffing ratios, building layout, and available support.
Ask:
What safety concerns did your team identify
This could include:
- Wandering risk
- Fall risk
- Severe weakness
- Sudden behavioral changes
- Medical instability
- Need for constant reorientation
Understanding the safety concerns helps find a facility better prepared for the patient’s needs.
Question Seven Would additional equipment or support change your decision
Sometimes a facility would accept a patient if a specific support was added.
Examples:
- A specialized bed
- A bedside sitter
- A mobility aide
- Additional wound supplies
- A clear behavioral support plan
Ask:
Is there anything that could be added to help your team safely support my parent
If the answer is yes, the hospital may be able to provide that support before transfer.
Question Eight Is this a temporary refusal or a permanent one
This matters more than any other question.
A temporary denial means:
- No beds until tomorrow or later this week
- Insurance has not responded yet
- Therapy notes need to be updated
- Staffing levels are short today
- The referral needs clarification
A permanent denial means:
- The facility does not provide the required level of care
- They cannot staff the needs
- They do not accept the insurance
- They cannot accommodate the safety concerns
Ask:
Is this a temporary issue or a long term one
This tells you whether to wait or move on.
What to Do After You Understand the Reason for Denial
Once you know why the facility declined, you can move forward with a plan.
Step One Contact the hospital case manager and share what you learned
Case managers often get more details than the family does, but they sometimes receive only brief explanations. When you provide the specifics, they can act immediately.
Ask the case manager:
Can we correct the referral
Can we send updates to the facility
Can we submit to additional facilities right away
Does my parent need a different level of care
Case managers navigate this process every day. Use their expertise.
Step Two Request referrals to additional facilities immediately
Do not wait for one facility to reconsider. Ask the case manager to send referrals to several facilities at the same time. This speeds up acceptance dramatically.
Tell the case manager:
Please send the referral to multiple facilities at once so we avoid delays
This prevents you from losing days while waiting for one decision.
Step Three Clarify the correct level of care
If several facilities decline, it often means the level of care requested does not match the patient’s current needs.
Examples:
- If the patient needs significant supervision, memory care rehabilitation may be more appropriate
- If they need major physical assistance, a high acuity skilled nursing facility may be the best fit
- If they need specialized wound care, a facility with advanced wound teams may be required
Ask the case manager:
Do we need to modify the level of care request based on the feedback
Matching level of care to needs avoids repeated denials.
Step Four Contact the primary care doctor or hospitalist for clarification
Physicians can update notes, clarify the medical plan, and support the case manager with documentation. They can also advocate with insurance if necessary.
Ask the provider:
Can you update the clinical information to help with placement
Can you clarify the patient’s baseline
Can you support the request for a different level of care
Physician documentation often makes a significant difference.
Step Five Prepare temporary support at home if needed
If there is a delay in placement, ask:
Can home health be arranged
Can the hospital extend the stay
Can therapy reassess the patient
Can equipment be delivered to the home
Can family or hired caregivers support short term needs
The goal is not to panic. It is to create a safe bridge between the hospital and the next level of care.
The Most Effective Sentences to Use During These Conversations
Use calm, direct language that invites clarity.
I want to understand what prevented admission so we can make the right plan.
Or
What would need to change for acceptance to be possible.
These questions open doors instead of creating conflict.
You Are Not Doing Anything Wrong
Families often feel guilty or confused when a facility says no. They wonder if they missed something or if their parent is now out of options.
None of that is true.
You were not given the training to navigate this system. You were not taught what facilities look for. And you were never told how complicated placement can be behind the scenes.
You are not failing.
The system is simply complex.
You can get through this with clarity, step by step.
When You Need Help Navigating This Stage
If you want guidance, advocacy, and a clear plan through the entire placement process:
Book a 1 to 1 Concierge Nursing Session
I can help you:
- Understand the denial
- Communicate with facilities
- Work with the case manager
- Determine the right level of care
- Review the discharge instructions
- Create a safe transition plan
- Reduce delays
- Avoid unsafe decisions
You do not have to do this alone.
Screenshot This Quick List
What to ask when a facility says they cannot accept your parent
- What part of the referral prevented admission
- What care needs were considered too high
- Is the insurance authorization approved
- Was the referral packet incomplete
- Are there beds for this level of care
- Are there safety concerns
- Is this temporary or permanent
- What would make acceptance possible
