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When I was growing up, my aunts in Montevideo had a code for emergencies: Call Yosi. My seide Simón — my grandfather — would resist seeing a doctor, resist the hospital most of all, especially when my father was traveling, and someone had to talk him into going.
Even then, I understood him. Nothing about a hospital felt safe to a man his age: the strangers, the fluorescent hallways, the waiting. He always came back smaller. Years later, working in skilled nursing, I learned the part that stays with me: For our residents, many of those trips never need to happen at all.
Every avoidable hospital transfer of a nursing home resident is two failures at once. It is a clinical failure: Transfers expose frail residents to delirium, falls, pressure injuries and the disorientation of an emergency department at 2 a.m. And it is a financial failure borne by the resident and the facility under value-based purchasing and Medicare.