OH BOY, OH BOY, OH BOY, I could tell you some stories!
Back in the early 90's I was a cna in cali. We had some patients that were a definite risk to the other patients. We had a man in his early 30's, brain injured, who was a gang banger in his healthy life. We had to be vigilant to make sure he did not injure any of the other frail elderly patients when he got pissed of and started kicking at anything he could because he could not get another cigarette.
Had a woman come in needing a place for her elderly father with dementia. He was healthy physically, so the DON thought he would be a good catch. WRONG! Come to find out he was a sex offender who acted out inappropriately (thats the nice wording) in the lobby, urging others to join the fun.
On the other hand, we did have a patient who went to the hospital that in all fairness we could have said, nope, not taking her back. She had dementia, and was kind of annoying at times, and we had to be careful who we put in her room, as she could be violent. But we realized that if she went to another facility that did not know her and how to effectively manage her behavior, it would be more damaging. So the administrator told the daughter no matter how long it takes, we will hold her bed. Medi-cal pays 7 days to hold the bed when the patient is hospitalized. Many times the patient was no problem, it was a simple matter of economics. Empty bed, no money. Filled bed, money.
Another thing that amazes me is how these agencies expect facilities to stay in business when the reimbursement is less then the cost of the care. Would you take a job that payed you less then your expenses? NO! So why is it any different then a business.