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Background: Concerns have been raised over the practice of transferring nursing home residents to hospital at their end of life. Objective: To examine the family and facility factors that may influence the decision to transfer nursing home residents to hospital in the last month of life. Research design: Secondary data analysis includes a sample of 119 bereaved family members from 21 nursing homes located in Central Canada. Method: A binary logistic regression analysis was conducted to explore the predictors for hospital transfers. Results: Terminal hospital transfers were common: 70% of nursing home residents were sent to hospitals in the last month of their life, and the likelihood of terminal hospital transfers increased by having an adult child as decision-maker (odds ratio (OR) = 5.03; 95% confidence interval (CI) = 1.6, 16; significance level/probability value (p) = 0.007) or having a lower family income (OR = 2.9; 95% CI =1.1, 2.9; p = 0.027). Discussion and implications: The identified predictors for terminal hospital transfers are helpful in targeting and developing interventions to improve end-of-life care. Particular emphasis should therefore be placed on targeting families with low income and children of the nursing home residents for educational initiatives such as advance care planning awareness, in order to prevent terminal hospital transfers. It is hoped that policy-makers and practitioners can start addressing the findings of this study to reduce terminal hospital transfers at end of life and promote quality end-of-life care in nursing homes. [ABSTRACT FROM AUTHOR]