I came across a great New York Times article that I'd encourage all of you to read, entitled Emergency Rooms are No Place for the Elderly. My first thought was "Amen," but until I read the article in detail, I didn't realize that I had some of the wrong reasons in mind. My first thoughts were that the Emergency Room is a bad place for the elderly because of the following:
- If they're not urgent, they're likely to wait a very long time
- They'll be in a waiting area that won't necessarily be comfortable or at the right temperature for them
- They'll be surrounded by all sorts of sick people and, as such, succeptible to getting sicker, and
- ER care is very expensive
ER Care is Not Optimized for the Elderly
- Elderly care needs in the next 40 years are likely to double for patients over 65 and to triple for patients over 85
- ER staff are not well trained in setting up the follow-up care (post discharge) that an elderly person is likely to need
- The "need for speed" in the ER is justified because of the impact on speed for treating stroke, heart attack and traumatic injury, however this is the opposite of what is needed to diagnose and treat an elderly patient taking many meds and suffering from multiple chronic illnesses
- The ER environment (noise, lights, bustle) may be overwhelming for elderly patients, especially those with some cognitive impairment
- There's hope. Evidence based guidelines are being published and starting to be adopted.
The Case for Home Health in Population Health Management
Keep the Faith!
- If there's a group of nurses in the hospital providing telephonic care for at risk patients, get to know them. They are likely to agree that adding home health services, even if on an as needed basis will assist in avoiding admissions
- Talk to the discharge people and make sure that they're aware of the importance of at least one home visit to make sure that the home is safe and that the patient knows how to take their meds.
- Remember that we're still at the tip of the iceberg when it comes to the aging population.