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Updated: Jan 8, 2026

Assessment of Dependence in Activities of Daily Living Among Older Patients in an Acute Care Unit
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Resource Factors Associated With Avoidable Transfers in Nursing Homes.

Matthew S Farmer1, Alisha H Johnson1, Kimberly R Powell1

  • 1Sinclair School of Nursing, University of Missouri, Columbia, MO, USA.

Journal of the American Medical Directors Association
|December 22, 2025
PubMed
Summary

Avoidable nursing home transfers are linked to staff discomfort and limited advanced practice registered nurse (APRN) availability. Improving these resources can reduce unnecessary hospitalizations for nursing home residents.

Keywords:
Nursing home transfersadvanced practice registered nursesavoidable hospitalization

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Area of Science:

  • Gerontology
  • Health Services Research
  • Nursing

Background:

  • Reducing avoidable hospital transfers from nursing homes (NHs) is a priority, as 20%-67% are potentially preventable.
  • Inadequate staffing and diagnostic capabilities in NHs contribute to these transfers, despite evidence that embedded advanced practice registered nurses (APRNs) and enhanced resources can reduce them.

Purpose of the Study:

  • To examine resource constraints contributing to avoidable hospital transfers among NH residents with dementia.

Main Methods:

  • Cross-sectional analysis of 3683 hospital transfer events from 16 Missouri NHs (2016-2020).
  • Data collected via APRN-completed INTERACT surveys on resource availability and transfer context.
  • Bayesian generalized linear mixed models assessed associations between resource domains and avoidable transfers.

Main Results:

  • 50.2% of transfers were deemed avoidable.
  • Limited APRN availability and staff discomfort significantly increased odds of avoidable transfers (OR ≈1.7).
  • Lack of on-site clinicians/equipment was associated with non-avoidable transfers (OR ≈0.37); facility-level factors also influenced decisions.

Conclusions:

  • Avoidable NH transfers are driven by staff discomfort and limited APRN availability, highlighting gaps in nursing scope and decision-making.
  • Policy reforms should enhance APRN access, diagnostic partnerships, telehealth, and closed provider models to improve resident care and reduce transfers.