Hospitalizations for Nursing Home Residents Are Often Avoidable, Study Finds

Nursing home staffing shortages may be exacerbating the problem of unnecessary hospitalizations among residents.

More than one-third of hospital visits among severely impaired or terminally ill nursing home residents could have been prevented with proper on-site care, according to new research.

According to findings published in the September 2025 edition of JAMDA, the Journal of the Post-Acute and Long Term Care Association, in some cases up to 80% of nursing home resident emergency visits could be considered avoidable, with improved care and prevention strategies.

The study identified pneumonia, urinary tract infections, seizures, heart failure and acute kidney failure as among the most common conditions driving unnecessary transfers. 

Researchers warned that better preventive care inside nursing homes could avoid many of these cases, as hospitalization itself often carries added dangers for frail residents, including infections, medication errors, falls and delirium, which can worsen their overall health.

In the study, researchers from Florida Atlantic University’s Schmidt College of Medicine and Christine E. Lynn College of Nursing analyzed data from the Interventions to Reduce Acute Care Transfers (INTERACT) randomized trial, which implemented a 12-month quality improvement program in 264 nursing homes.

Led by Dr. Joseph G. Ouslander, the team then analyzed two groups of nursing home residents: those with severe impairment of cognitive and physical functioning, and those with terminal illness. The data indicated that 40% of nursing home resident hospitalizations were avoidable among both groups.

Among 6,000 severely impaired residents 34% were hospitalized and 18% had at least one emergency room visit without being admitted. Among those hospitalized, only one-third met the criteria for avoidable hospitalizations. Nearly 70% of residents treated in the ER had conditions that were preventable, researchers concluded.

The data indicates the most common reasons severely impaired nursing home residents were hospitalized involved feeding tubes becoming blocked or dislodged, and infections.

Of the more than 5,100 residents who were terminally ill, 14% were hospitalized and 8% were treated in the ER. One-third of the hospitalizations were avoidable and nearly 80% of the ER visits were for conditions that could be prevented, they determined.

The most common diagnoses among severely impaired residents included UTIs, seizures and low blood pressure, conditions that are largely preventable and can allow residents to avoid hospitalization.

Many terminally ill nursing home residents also suffered trauma from falls and fractures, pneumonia, UTI’s, acute kidney failure, heart failure, infections, breathing difficulties and altered mental status.

Nursing Home Staffing Shortages

Researchers emphasized that conditions like these are largely preventable and can be managed with standard medical practices. However, they said many nursing homes fail to follow established guidelines and do not consistently apply basic preventive strategies, leading to unnecessary hospitalizations.

Making the issues more difficult to address are nursing home staffing shortages that first began during the COVID-19 pandemic, and continue to persist. These nursing home staffing shortages make it difficult for hospitals to discharge recovering patients into facilities that have adequate care and supervision.

In 2023, one-third of all U.S. nursing homes lacked a medical director on staff to oversee residents’ medical needs and offer proactive care strategies like those needed to prevent hospitalizations.

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