Emergency rooms are never pleasant, particularly for older people who are more easily disoriented and need special care. The ER floors are too slippery, signage too small, and mattresses too thin for delicate aging skin. Geriatric emergency departments are changing all this. Read below to find out how.
By Joanna R. Leefer
When 85-year old Clara fell, she was rushed to Mount Sinai Medical Center’s Emergency Room in Manhattan. After being processed through the regular emergency department she was wheeled into a special room for further observation.
The room contained several beds, each separated by a privacy curtain. She was transferred to a comfortable bed with a thick mattress, not like the thin mattress she experienced the last time she was in ER. Clara was surprised that there were fewer beds than in the main hall, but what really surprised her was the quiet. There was no beeping machinery. No flashing lights. No loud chatter. No crying children behind the next curtain. The room was pleasantly lit and staff was not frantically running around. The atmosphere felt almost—serene.
Clara’s cubicle was large enough to include a comfortable chair for her daughter, Sarah. There was also a TV near her bed that she could watch to help pass the time. From time to time a young volunteer would come by to check up on her. She offered Clara reading glasses to help her fill out her medical forms and asked if she needed a hearing aid so she could hear better.
This was in marked contrast to Clara’s previous emergency room experience where she had been pushed into a large, brightly lit room that was jammed with beds. Curtains separated the beds, but even when they were drawn you did not sense any privacy. The beds were so closely packed that if Clara stretched out her arms she could have touched the next bed. And the noise!
The traditional emergency room is designed primarily to allow physicians and nurses to make fast diagnoses and treat emergency medical situations. A patient’s comfort is of secondary importance. Staff rushes by with equipment, curtains are being pulled back and forth with grating shrieks, and fluorescent lights glare at all hours.
In contrast, Mount Sinai’s new geriatric emergency room, is designed with the patient who is age 65 + in mind. The Geri-Ed, as it is called, has larger signage, large-faced clocks, and large print calendars that make it much easier for older patients to read. Visual aids (e.g., glasses or magnifying lenses), adaptive equipment (e.g., telephones with large keypads; fluorescent tape on call bell), and hearing devices are available to all patients. The floor also has a non-skid surface and the halls have handrails and grab bars to prevent falls.
More impressive is the artificial skylight in the ceiling. The view shows trees back lit by the sky. The light changes as time passes, simulating evening and nighttime. This design helps to lessen a condition called “sundowning”– agitation and confusion that occurs among some older people at the end of the day.
This new Geri-Ed is the brainchild of Kevin M. Baumlin, MD, Associate Professor and Vice-Chair of Emergency Medicine at Mount Sinai School of Medicine. Dr. Baumlin converted a former office space in Mount Sinai’s geriatric division into a functioning emergency room specially designed with the older patient in mind. It is the first emergency room exclusively for patients 65 + in New York City.
The Geri-ED is staffed by a team of Mount Sinai Medical Center physicians, nurses, social workers, and support staff who are trained in understanding the needs of older patients. Dr. Baumlin also created a training program for volunteers called CARE (Care and Respect for Elderly), who assist geriatric patients while they are waiting.
While the average Emergency Room is designed to deal with immediate medical emergencies, the Geri-Ed is prepared to deal with complex medical conditions common among older clientele, such as drug interactions of multiple medications. Patients are given more extensive diagnostic testing and treatment regimens. Social service representatives evaluate the patient’s home needs and arrange for necessary services such as home care, meals on wheels, and visiting doctors and nurses.
The catalyst for Dr. Baumlin’s action was personal. Several years ago, Dr. Baumlin’s elderly grandmother fell and was taken to an emergency room in New Jersey. Dr. Baumlin remembers that when she was discharged and returned to her nursing home, she was confused and scared. It took Dr. Baumlin and a multi-disciplinary team more than two years to develop the new standard of care for older patients in this emergency department.
The U.S. Census estimates that by 2030, one in five Americans will be 65 or older. As the population ages, there will be greater need for a health care system that is sensitive to the needs of the older patient. Mount Sinai’s Geri-ED is a model that is bound to be duplicated throughout the New York City area and the rest of the country as the health care workers must adjust to the needs of the older patient.
Joanna R. Leefer is a senior care advisor and founder of ElderCareGiving, an agency that helps families get the best care for their aging loved ones when family care is no longer enough. She has been working with seniors and their families for ten years. For more information on her service, you can log onto www.joannaleefer.com. Her book Almost Like Home: A Family Guide to Navigating the Nursing Home Maze will be available next month.