How many family caregivers have visited an emergency room (ER) or emergency department (ED) in the past year with our senior loved ones?
No matter how many of you raised your hands it’s too many — and, worse, too much pain for too many older loved ones.
We dread it and what it means, but there are times when it simply can’t be avoided.
Family caregivers of seniors visit the ER pretty frequently, according to the Centers for Disease Control and Prevention (CDC) National Center for Health Statistics, which tracks this data. As a matter of fact, during 2012–2013, there were an estimated 5.2 million ED visits per yeaer for injury and 15.5 million ED visits for illness among adults aged 65 and over.
The number certainly has increased and will continue to increase since that data was collected due to the increasing senior population.
Emergency Room Frustrations
There are many frustrations for family caregivers who sit in the waiting room for extended periods with seniors who may not understand why they are even there, not to mention the pain they may be experiencing that brought them there in the first place.
Older adults can be overstimulated by the hustle and bustle of a busy ER leading to increased confusion and even delirium.
Family caregivers are worried about their loved ones but also the jobs or the kids left behind to wait in the ER with grandma. We fear for the consequences of this injury or illness, worry about the next fall or medical crisis or how this might change our senior’s life and living arrangements.
Creature comforts are a concern as well for family caregivers and our seniors. It may be too cold or too hot in the waiting room, the noise level can be unnerving, seniors may be missing scheduled medication doses while they wait, they may be hungry or thirsty, they may have trouble using the restroom or are bored even though we try to keep them entertained.
All these scenarios are a recipe for disaster.
Specially Equipped Senior Emergency Rooms
There is a trend crossing the nation in the healthcare system, moving toward better meeting the needs of our senior loved ones, and is a change that is overdue.
Senior-friendly ERs are specially equipped to meet the needs and wants of seniors and their family caregivers.
A few modifications to be found there include:
- Specially trained personnel, including geriatricians (doctors who specialize in senior medical care) who understand the special needs of older adults, including dementia care
- Trained individuals who can counsel caregivers and our seniors about advance directives
- Slip resistant floors with low glare surfaces and improved traction
- More comfortable mattresses that are thicker to protect fragile skin
- More lighting in walkways and landscape to prevent falls in those with diminished vision
- Handrails and grab bars in more places, including rooms and hallways
- Larger clocks
- Bigger TV screens, often with closed captions on
- Blankets that have been warmed in warmers to comfort vulnerable seniors
- Call bell alerts for staff that are easier for less mobile or arthritic hands to push
- More calming décor colors including walls and furniture instead of institutional hues
- Acoustics to reduce excessive noise
- If wait time is expected to be long, they move the senior to a quiet room to reduce distractions that could lead to delirium
- Reduced number of transitions from ER to discharge, including fewer room changes that lead to confusion
- Thorough and frequent medication review to limit drug errors, interactions and severe medication side effects or adverse reactions
- Natural light to reduce confusion and delirium
- Chairs that are easier to transfer into and out of by seniors
- Equipment available to meet needs, such as bedside commodes
- Extra seating for family members
- Wipe off boards with information and reminders
- Sensitivity training for all staff for better communication and coping skills
- Discharge planning assistance with clear instructions and appointment scheduling
If your hometown ER is not specifically designed for senior care, advocate for the adoption of age friendly strategies for the seniors in your community.
Other Special Services in the Senior-Friendly ER
In addition to the actual facilities and staff, there are also positive differences in an ER that is specially designed for seniors.
Many healthcare systems have created ERs that go a step beyond when providing emergent care to people over 65. Services include staff trained to complete individual assessments on the elder in addition to addressing the reason that brings them for emergency care.
- Depression scale is performed to determine if there may be problems affecting overall health and care.
- Assessments of the elders functional status are performed in order to determine if there are further safety measures or equipment interventions that would benefit seniors when they return home to keep them safe.
- Medication lists are reviewed and chronic disease management protocols are reviewed to be sure treatment plans are being followed correctly for health and safety as well.
- Trained personnel ask questions about current living situations, support systems in the home, and listen to the stories told by the elders in their own words. This takes some listening skills and problem solving experience to be sure all needs are being met. If not, the unmet needs are addressed prior to discharge.
- In addition to the other assessments, a cognitive screening is performed to determine if deficits are apparent that might require further intervention from medical professionals in follow-up.
Caring for the Whole Senior
Senior-friendly ERs don’t want to simply treat the illness or injury, prescribe more medications and send the elder home. They want to be sure that the senior is safe at home, managing their health and will be able to live their lives to the fullest.
Care managers can help fill any deficits by scheduling after-care appointments to further investigate unmet needs. They also follow-up the next day to be sure all instructions are understood and no other problems arise.
Healthcare providers in specially designed Senior-friendly ERs look at the whole person and take time to listen. Many seniors are vulnerable and require an extra level of attention to stay safe and well.
It has been shown that this type of intervention does not lengthen the amount of time spent in the ER because the care is coordinated. Partnering with the Emergency Medical Service (EMS) personnel helps with performing some of the assessments. EMS can look at the home environment, including food in the refrigerator or other areas of concern, while they are performing their in-home assessment prior to transport. This includes seniors who live in facilities other than home.
Senior-friendly ERs should also ask about how the family caregiver is coping. If the caregiver is nearing burnout, the senior will not be safe to return home. It is important that healthcare providers identify areas that can support caregivers keep the senior safe and healthy at home to avoid crises that lead to ER visits.
We hope to see more emergency rooms become senior-friendly to better serve the needs of our senior loved ones!