Involuntary discharge of nursing home (NH) residents is a prominent reason for NH complaints in the United States, but little is known about facility-initiated involuntary discharge (FID). A literature review was conducted to improve understanding of FID. The findings distinguish between six types of FID, identify populations at risk of FID, and differentiate between legal and unlawful FID practices and processes. The findings also characterize common FID destinations; show how policy, regulatory, and financial factors impact FID; and indicate that FID outcomes are commonly detrimental to the health and well-being of NH residents. Findings highlight challenges with understanding FID, including differentiating legal from unlawful FID. Although more research about NH FID is needed, the current study indicates that FID outcomes are regularly adverse, protections against unlawful FID are needed for Medicaid beneficiaries and NH residents with dementia, and stronger enforcement of existing policies and regulations regarding NH FID-including NH bed-hold requirements-are needed. [Journal of Gerontological Nursing, 45(8), 23-31.]. Copyright 2019, SLACK Incorporated.