When Harold Richards, 81, arrived at the hospital emergency room in Ann Arbor, Mich., he expected a long wait. After all, he’d been through the emergency room drill before. The patient in the worst condition would be seen first, he knew, and the waiting time could be indeterminable. The rush, the harsh lights, the white walls and bright floors — everything about the place seemed designed to confuse and frighten elderly patients like him.
But this time was different. Mr. Richards was taken to one of the nation’s few senior emergency rooms, a new wing specially designated for older adults at St. Joseph Mercy Ann Arbor. Handrails line each wall, and a nonskid floor resembling hardwood reduces the risk of falls. Every bed has a thicker, pressure-reducing mattress and can be set to sound an alarm if a patient prone to wandering gets up. Room lighting is softer, and the clocks are larger. Each room comes furnished with a walker; patients can request reading glasses or hearing devices.
Mr. Richards was taken back by the differences: “Priorities are a little different, I guess.”
Hospitals nationwide are trying to redefine the E.R. experience for the elderly by building facilities dedicated solely to their needs. St. Joseph Mercy’s parent company, Trinity Health System, opened the nation’s first senior E.R. at Holy Cross Hospital in Silver Spring, Md., in 2008 and plans to put one in 19 other hospitals by 2013. Senior E.R.’s, also called geriatric emergency departments, also have opened in Texas, New Jersey, Missouri and Kansas. By year’s end, Mount Sinai Medical Center plans to open Manhattan’s first such facility.
“We’re going to have an increase in people over the age of 65 who are going to take their medical problems with them to hospital emergency departments,” said Dr. Georges Benjamin, executive director of the American Public Health Association. “The fact that we’re really preparing for that wave, I think, is important.”
The drive to build senior E.R.’s is motivated in part by hospitals’ desire to find an edge in the increasingly competitive health care marketplace.
“When you talk about marketing hospitals, there’s a saying that kind of everybody knows, which is, ‘The emergency room is your hospital’s front door,’ ” said Dr. Bill Thomas, a geriatrician who helped open the first senior emergency room in the country. “Among the most vocal users of that front door, and the people who sometimes have the strongest opinions of that front door, are elders.”
The hope among physicians is that senior E.R.’s will help lower readmission rates and reduce the risk of harmful drug interactions.
“If you’re not going to address and attract that population of aging adults, you’re going to lose out,” said Dr. Ula Hwang, assistant professor in the department of emergency medicine at the Mount Sinai School of Medicine in New York. “Your hospital is going to be behind the ball.”
Physicians and nurses at St. Joseph Mercy took workshops in sensory appreciation and ageism to learn how to better communicate with older adults and their caregivers. Nurses are told to take time with each patient to fully assess his condition.
On the day Mr. Richards checked in, he passed a cognitive test given as part of a standard screening. It required him to remember three words: “baseball,” “dog” and “farm.” Mr. Richards repeated them, slyly and unasked, every time the nurse stopped by his room.
The cognitive screening helps identify conditions that might have been missed in a traditional E.R. Since the unit opened last October, nurses have spotted previously undiagnosed cases of depression and dementia.
Carolyn Bell, a social worker in the senior E.R. at St. Joseph Mercy, recalls a patient in her early 70s who checked in with blood sugar problems. Nurses who had seen her frequently in the traditional E.R. thought she was simply a noncompliant diabetic. But during the cognitive test, she struggled when asked to draw a clock. The problem wasn’t just diabetes.
“The family said, ‘We suspected something.’ But when they physically saw the clock” – its hands flying in all directions – “that’s when it really clicked in the daughter’s mind: ‘Oh, my goodness, something is going on here,’ ” Ms. Bell said.
Just five years ago, Dr. Hwang said, the emergency medical specialty was unenthusiastic about the idea of senior E.R.’s. But the concept is catching on even among skeptical physicians.
“There’s going to be some pushback, and there’s going to be some skepticism — ‘Why is this needed? What’s the point of this? Is this cost-saving or not?’ ” she said. “I would say whether they like it or not, this is the way things are going to be going.”
Mr. Richards said he wouldn’t like to go back to a traditional E.R. after his experience at the senior emergency room at St. Joseph Mercy. “It was much smoother, much faster and much better than before. So I’m much happier with it.”
