From evidence to action: a nursing home–hospital partnership informing aging-in-place policy

Population aging is reshaping health systems globally, with more older adults residing in nursing homes and other types of long-term care facilities. Nursing homes residents experience high rates of emergency department (ED) transfers, many of which are potentially avoidable and associated with adverse outcomes (Keerthana et al., 2024; Turbow et al., 2023; Zuniga et al., 2022). Preventing unnecessary hospitalizations is therefore a priority for improving care quality, lowering costs, and supporting system sustainability (Lyhne et al., 2022; Ouslander, 2019; Rantz et al., 2017). Evidence shows that many ED visits can be prevented through timely clinical assessment, advance care planning, and access to geriatric specialty services (Ellis et al., 2014; Lemoyne et al., 2019). However, translating this evidence into practice has been hindered by fragmentation between hospitals and long-term care facilities, and misaligned financing and regulatory incentives (Joo, 2023; Snow et al., 2020). These challenges highlight the need for policy-relevant models that bridge evidence and practice (Szanton et al., 2022).