Terminally ill patients in nursing homes are facing needless emergency room visits and hospital stays – about 80% of ER visits by this population is potentially avoidable.

Furthermore, nearly one-third of hospitalizations among terminally ill nursing home residents was needless, according to a study published by the Journal of the American Medical Directors Association (JAMDA) earlier this month.

Among the severely impaired, 70% of ER visits were avoidable, compared to the terminally ill. Feeding tube problems were the most common reason for ER visits among this population.

More common causes of trips to the hospital among terminally ill and severely impaired patients was from pneumonia, urinary tract infections (UTIs), sepsis, kidney failure and heart failure, but study researchers argued better care and management within the nursing home could have kept many of these people out of the hospital.

“These are conditions we know how to manage better in nursing homes, using existing guidelines, care paths and preventive strategies,” said Dr. Joseph Ouslander, senior researcher for the study and professor of geriatric medicine at Florida Atlantic University’s Schmidt College of Medicine in Boca Raton, said in a news release. “With the right tools and staffing, many of these hospital transfers could be avoided, reducing both resident suffering and unnecessary health care costs.”

Clearer care protocols and timely symptom management are places to start, Ouslander said, and communicating health care preferences with families and residents could make a big difference too.

Documented care preferences avoids crisis-driven decisions, according to the study, and also reduces needless transfers. There needs to be a strengthening of nursing home staff to achieve this, he said, and the industry needs to see more active involvement from medical directors and clinicians.

“This isn’t just about individual effort – it requires support from nursing homes, provider organizations and policymakers,” Ouslander said. “We need bold changes, like pragmatic national staffing standards, better-resourced facilities for complex care, and payment models that truly support high-quality, person-centered care for the most vulnerable residents.”

Data tied to more than 6,000 severely impaired residents of 264 nursing homes was drawn for the study; more than 5,800 of these residents were considered terminally ill. One in three of these residents were hospitalized during the 12-month study.