Aim To explore the challenges and facilitators of managing acutely unwell residents in their residential aged‐care facilities (RACF) and transferring RACF residents to the emergency department of a tertiary referral hospital in Australia. Methods This exploratory study used a qualitative descriptive approach incorporating structured focus group interviews with nursing staff from RACFs and General Practitioners (GPs) within the local area. Four focus groups were held with staff from RACFs and one with GPs who visited one or more of the facilities during 2010. The interview data were analysed for themes relating to the study aims. Results Findings revealed both challenges and facilitators associated with managing acutely unwell older people including, communication, nursing staffing mix and numbers, use of advanced care directives, responsibilities of GPs and awareness of community services. Conclusion From these findings it is possible to make recommendations for alternative ways of practising and/or new models of care.