The Seniors Emergency Center at Holy Cross Hospital in Silver Spring, Md., was designed to take a different approach to geriatric care. The lighting is more muted than the blinding bulbs of most emergency departments. It's a little quieter, and clinicians take more time with patients and families, says Bonnie Mahon, senior director of senior services at Holy Cross Hospital.
Since the center opened in November 2008 as the nation's first geriatric ED, more hospitals have followed—either allocating space for seniors in an existing emergency department or building a separate ED altogether. Park Plaza Hospital and Medical Center in Houston opened a geriatric ED in October 2010. Holy Cross Hospital's sister organization, Saint Joseph Mercy Health System in Michigan, is spending $1.4 million to open senior emergency departments in eight of its hospitals by the end of this month, ranging from three to 10 beds.
"It's more than just redecorating," says Garry Faja, president and CEO of Saint Joseph Mercy. Staff training has been crucial, particularly on assessment. If a senior comes in because of a fall, the staff has been trained to consider additional chronic diseases, as well as detect mixed-up medications and other undiagnosed conditions like dementia.
The trend stems from concerns about the unique needs of older patients and geriatric care practices. Nearly 20 percent of Medicare patients are back in the hospital after 30 days, costing $17 billion annually, according to an April 2009 study in the New England Journal of Medicine. The health reform law allows the government to recover Medicare payments for 30-day rehospitalizations of patients with some conditions.
Treating seniors in a separate emergency department is one way hospitals hope to curb rehospitalizations. So far, 30-day rehospitalizations for older patients at Holy Cross Hospital Seniors Emergency Center—half of whom come in for fall injuries—have dropped from 10.9 percent to 5.2 percent, Mahon reports.
More senior emergency departments are expected to open as another challenge looms: By 2030 the population of seniors will nearly double to 72.1 million, according to the U.S. Administration on Aging.
"As a larger portion of the population gets older, a lot of geriatric care will be paid for by the government," notes David Mendelson, M.D., vice president of medical affairs for EmCare, which provides physician staffing for 400 emergency departments nationwide. "Hospitals will want to compete for that sector of business. I wouldn't be surprised at all if Medicare and the Joint Commission began requiring emergency departments to become certified in geriatric care."