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Avoidability of Hospital Transfers of Nursing Home Residents: Perspectives of Frontline Staff

The Issue

According to research published in the Journal of the American Geriatric Society, an estimated 40 percent to 67 percent of hospitalizations of nursing home residents are avoidable. Numerous nonmedical factors are involved in decisions to transfer residents to hospitals, including the personal preferences of residents and their families, nursing home culture, and concerns about legal liability. Frontline nursing home staff are often the first caregivers to identify a change in residents' status, thereby initiating a chain of events that may potentially lead to hospital transfer. However, little is known about what these staff think about the avoidability of hospital transfers. 

What the Study Found

This Commonwealth Fund–supported study examined data from 26 nursing homes involved in the Interventions to Reduce Care Transfers (INTERACT II) program, which provides nursing homes with training, tools, and resources for reducing unnecessary hospitalization. Staff at the homes rated 76 percent of hospital transfers as unavoidable—higher than published estimates. Common reasons cited were acute change in resident status, family insistence, and physicians' orders. These same reasons, however, were also given for transfers rated as avoidable, suggesting a lack of clarity and consistency in how staff ascertain avoidability.


Caregivers are involved in the many steps of the nursing home-to-hospital transfer process, from the early recognition of symptoms to addressing family member requests and discussing advance directives. Approaches to reducing hospitalization that focus solely on medical treatment or diagnosis do not capture these factors or the complexity of the transfer process.

Publication Details



G. Lamb, R. Tappen, S. Diaz et al, "Avoidability of Hospital Transfers of Nursing Home Residents: Perspectives of Frontline Staff," Journal of the American Geriatrics Society, first published online Aug. 24, 2011.