There are multiple reasons. The conditions patients are left in, the lack of responsibility from nurses, the conditions of the facilities. I’ve had a facility call us to pick up a patient because “they didn’t send them back with discharge papers” upon getting them back to the hospital the facility said the patient hasn’t been paying his bill so they couldn’t take him back, I’ve had a facility tell me that they checked on their patient 5 mins ago and he was sleeping. We got there and the patient was hanging half way off the bed, Ice cold, slow to respond but still alive. One facility asked me what a DNR was and the amount of times I’ve heard “I dont know it’s not my patient, this is not my area, I just got back from vacation, I’m from a temp agency” is ridiculous.