Salt Lake City, Utah — When a man’s discharge date arrived at a Utah long-term care facility, he had no home, no family, and no plan. Staff walked him outside without his walker and offered to call him an Uber. He said he’d hitchhike instead. They let him go.
He ended up in a homeless shelter.
That story, recounted by Alianne Sipes, Utah’s Long-Term Care Ombudsman, captures a problem that’s been quietly growing across the country. Nursing homes are legally required to find a safe discharge destination for every resident leaving their care. But a new investigation by industry reports found that a rising number of older adults are being discharged directly into homelessness — and the system has no real mechanism to stop it.
“Nobody’s really talking about it,” Sipes said. “It’s a silent issue.”
The Numbers Behind the Problem
Utah’s ombudsman office began tracking these discharges in March 2024. Since then, it found that 57 nursing home residents received discharge notices listing a shelter or hotel as their next destination. Another 34 were discharged to “unknown” locations. The office was able to intervene and prevent nine of those discharges.
The cases aren’t abstract. A man with dementia was discharged from a Salt Lake City nursing home to a hotel. He ended up in the emergency room after being found wandering the streets in the rain, knocking on the door of his childhood home. A 73-year-old woman — admitted to a nursing home while recovering from a toe amputation caused by frostbite she suffered while homeless — was dropped off at a bus station with no follow-up care plan.
“They came from homelessness,” Sipes said. “Sometimes the default thought is, ‘Well, they can just go back to homelessness.'”
A Housing Crisis Meets an Aging Crisis
The problem is getting worse as Utah’s senior population grows and affordable housing becomes harder to find. Data from last year’s Point in Time Count showed that the population of homeless adults over 64 grew 42% in a single year — from 251 people to 356.
Michelle Flynn, CEO of The Road Home, a homeless services provider, said demand from older adults has surged. “Many of our older adults have lived stably in the community for many years on their Social Security income,” she said. “And when their rent raises $200 a month, they can no longer afford it.”
That dynamic creates a feedback loop. Older adults lose housing, end up in nursing homes, and then get discharged back into homelessness when their Medicare or Medicaid coverage runs out — often with new or worsening health conditions that make stable housing even harder to maintain.
It’s a pattern that connects to the broader mental health crisis playing out inside nursing homes, where vulnerable residents with complex needs are increasingly falling through the cracks.
What Facilities Say
The Utah Health Care Association, which represents the state’s long-term care industry, said providers genuinely try to find solutions. Some facilities keep residents longer than they’re reimbursed for while searching for placement options.
“When a discharge ends up being to a shelter or temporary setting, that’s not something facilities want,” said Allison Spangler, the group’s president and CEO. “It usually reflects bigger challenges we’re seeing in Utah, especially around affordable housing, behavioral health resources, and limited community placements.”
Sipes envisions a more coordinated approach — one where homeless service providers get involved in discharge planning from the moment a resident is admitted, not the day before they leave.
“Ideally, when people are finished with their stay at a skilled nursing facility, it would be supportive housing or senior housing that they would move into,” she said.
For now, that’s more aspiration than reality.
