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Subscribe to RSSSpearheaded by physicians, Mount Sinai in New York has opened an emergency room dedicated to seniors. NBC's Dr. Nancy Snyderman reports.
Will Turner, 94, has never had an emergency room experience quite like this.
At Mount Sinai Hospital in New York City, he found thick mattresses to prevent bedsores, skid-proof floors, and curtains designed to produce less noise. It’s only a few examples of the features designed specifically for senior citizens.
“This is very far from the tumultuous feeling you have in other emergency rooms,” Turner said. “The others, there’s clatter going on, there’s litter, and people walk by who never look in your direction to see if you need something. This is different.”
According to the Centers for Disease Control and Prevention, individuals 65 years and older typically make up nearly 25 percent of adult emergency room visits. The creation of the geriatric centered emergency department, or geri-ed, at Mount Sinai Hospital represents a shift towards catering to the health needs of the growing aging population.
Mount Sinai’s geri-ed follows the opening of a similar one at St. Joseph’s Regional Medical Center in Paterson, N.J., three years ago. More than 50 such departments will be opening in the health care system’s hospitals from New Jersey to California, according to Dr. Mark Rosenberg, the chief of geriatric emergency medicine at St. Joseph's. Rosenberg, who also serves as chairman of the American College of Emergency Medicine's (ACEP) geriatric section, has assisted many efforts to build geriatric emergency departments, from hospital systems to emergency medicine management groups.
“I predict that hundreds of ED’s will move in this direction over the next several years,” Rosenberg said.
Since the creation of Mount Sinai’s unit on Feb. 17, older patients coming to the general emergency room are moved to the geri-ed, as long as they meet a certain number of clinical criteria, such as ability to remember their names or not needing resuscitation. In each of the eight bedrooms and six exam rooms, patients experience a quieter and calmer setting where they can wait and receive care from professionals specially trained in elderly care.
Dr. Kevin Baumlin, the vice chairman of emergency medicine at Mount Sinai, received inspiration for this facility from personal experience, when his grandmother broke her pelvis and was sent to a regular emergency room.
“It was really frustrating that no one seemed to be paying attention to her, that she was kind of lost in the shuffle,” he said.
Baumlin noticed the discrepancy – pediatric emergency departments have bright primary colors, toys, and child specialists tailored towards younger patients, but nothing similar existed for the elderly, who have equally specific needs.
The geriatric emergency department Baumlin spearheaded was designed with the intention of creating a safer and calmer atmosphere for the older demographic, he said. An example of the attention to detail is highlighted by the installation of fake skylights in the unit. Elderly patients, especially if they have dementia, tend to become confused in general emergency rooms that are brightly lit 24 hours a day. The Mount Sinai geri-ed is outfitted with skylights that tell elderly brains what time of day it is, and helps them adjust their body’s sleep and wake patterns.
A unique feature of the geri-ed is what Baumlin calls the geriPad – iPads that allow the patient and nurse to videochat for clinical needs. Requesting juice or food is as easy as a touch of a button on the screen.
Response to the new unit has been positive, and patient satisfaction ratings have been very high.
Turner is one of those satisfied customers. “I’m overwhelmed at the interest, the warmth and the service at this emergency room,” he said. “This is an extraordinary experience.”
Michelle Melnick contributed to this report.
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They have ALL EMERGENCY ROOMS,constructed like that.
Read again... there are differences.
Gloria, you must go to pretty fancy emergency rooms if you're saying they're all like the first one the gentleman went to. Curtains to reduce sound quality? Not in my ER. Skid proof floors? For the most part...
Most ERs are noisy, if you have a child in a room that has a door closed and it's crying you can still hear said child outside in the waiting area in most hospitals. Hope more hospitals change for the better. They're going to need to make those ER's a little more comfy since more people will come once the new law takes affect.
Thick mattresses in the ER don't prevent bedsores unless you are there for a long time. Also, they are hard to clean which means more of a chance of getting some type of skin infection like MRSE or MRSA. Thinner disposable ones would be better for the ER.
Mattresses that prevent bedsores don't necessarily have to be thick anyway. The best ones are very thin but inflatable and float the patient on a cushion of air.
Non slip floors are not necessarily the answer either since most elderly patients need these on the floor but not necessarily in the ER. What you want is an easily cleanable and disinfect able floor, especially in the ER where blood and feces as well as serious infections are a big problem. If the ER is properly run, most patients should be out of the room in a couple of hours with rare exceptions.
The concept of a geriatric ER is also something to question since a lot of hospital are too small to separate out geriatric or pediatric patients. Not only that but cuts in Medicare make the concept more unattractive. Medicare is even about to start cutting payments on geriatric patients who return within a finite period of time.
I live on the opposite coast. My medical care is at a major university teaching facility, for the most part, where I have choices, my medical care is top class.
I had for me a radical change happen during a two hour nap, which before I had accomplished the most in the three months I had been attending a "Wellness Center," (sadly because new management focuses on Fitness rather than Wellness, another story, not the same hospital involved,)when I awakened, everything was with great difficulty, moving my body, sitting up, trying to stand up, I was dizzy and had nausea as well. I declined to tell my family, or call my primary physician as I new I would be told to go to the ER, and IMHO, no way was I going to do that again. This was a higher level as I have had similar activity leaning towards stroke three times prior and did go to this top class facility ER. First time they did not listen, observed me, declared me dehydrated, used IV's and sent me home. Second time the ER Resident decided I had a heart attack and ordered the lab work looking for cardiac enzymes. When that test came back negative, unconvinced she ordered the lab to redo the tests, again negative. Once again after many hours I was sent home. Third episode, I managed to convince them to get a neurology consultation. The neurology resident took repeated calls and 2.5 hours to walk the equivalent of a city block from the medical offices attached physically to the hospital. His attention from me was constant by his answering his cell phone. I told him, "I am your current patient, I am in front of you, stop leaving me for many minutes at a time, it was then 4. He did a bit and said, "you probably had a seizure." Again I was sent home after too many hours of being ignored. This was over the course of a few years, and I will not subject myself to such studied inattention. Offer food, what I joke, I had to ask for it after 4 or 5 hours had passed, often the kitchen was closed and they found a dry sandwich. Once they said, "not until the doctor orders it, and that never happened."
I drive 35 miles to this specific ER bypassing the one that is perhaps 5 minutes from my home and has the worst reputation, and I sadly have been there, and another 20 minutes away, a bit better, but still just an ER where unless you arrive in an ambulance, you have to take a number and wait your turn, often hours to speak with the first nurse.
Anyone aware of any Research being done between Ocular Migraine's Crescendo, and clear to me Brain negative activity? After the episodes sending me to the ER, the ocular migraines cease for extended periods of time, restart a year or so later, build up in frequency, duration, and then IMHO burst, I again head to the ER and then home. Gradually I regain stability, speech and thought process strengthen, for the last almost two years I am treated for the vertigo and cleared of that as well. Then wait until it all starts again. This time now almost 4 weeks, I am still stumbling, walk like an inebriate, type wrong keys, speak far more slowly, fail to put face and name together of long time friends, and no specialist Ocular or neurologist has a clue. ER, forget it. Yes I qualify as a senior.
Sure would have been nice to see maybe just one little photograph...
This is SO necessary! My mom took a tumble at her assisted living facility and went to the emergency room just to be sure there was no hidden damage. Her caregivers at her facility were HORRIFIED that she was returned to them five hours later at nine P.M., not having been fed dinner or given her meds. The hospital staff were P.O.d when the facility staff called to determine whether she had eaten or been given her meds. Like they expected staff to just ASSUME this had not been done.
It's good to hear that geriatric care is growing.
With us Baby Boomers getting older (and spending lots of money), it is only natural that they are starting to make accomodations. Money talks, you know!
Are you serious? My parents frequently visit the ER (unfortunately) and Medicare reimburses the hospital. If you think Medicare is "money talking" you don't know about the shockingly paltry reimbursement rates.
Unless this ER is like those suites they've put in in some hospitals where well heeled patients pay out of pocket for concierge services. Then I will agree with you that money talks.
Alice,
There is a large part of the population that have the brains to get supplimental insurance, to cover those extra costs that medicare doesn't (and they are quite affordable for most people. Notice I say most, becasue there are some who can't afford anything extra, which is, in my opinion horrible), so yes, money does talk, even when talking about medicare. I am sorry that your parents didn't figure this out ahead of time, but I don't think your parents are in the norm, and this is the reason the hospitals are beginning to pander to the geriatric set more and more, because quite frankly, there is big money into it.
So is it your opinion that some elderly folks are admitted to the geriatric ER and some are not? Based on whether or not they have supplementary insurance?
Or it's your opinion that ER visits for the elderly are being well compensated by the large portion of our elderly seniors with supplemental insurance?
Well, lucky for my parents, they get the same ER service as these brainy people with the foresight to properly compensate the hospital with their extra insurance plans. Good for them, right?
Alice,
I am saying your parents are getting the benefit of the geriatric ER services (or will be soon, when they are built in your parents area) because the majority of the Baby Boomers have paid the supplimental insurance, and because the hospitals see the sense in pandering to those people, so they are upgrading their facilities to accomodate those boomers. Just because your parents don't have the supplimental insurance, doesn't mean they should be booted out in the cold, but at the end of the day, the hospitals are all about making the largest profits possible. You parents are lucky that they benefit from others ability to get that supplimental insurance and the hospital sees the sense to create these facilities. Do I think it is fair that healthcare is a for profit business system? Not really, but it is what it is, and I don't think the advances in medicine would be anywhere near what it is now if it wasn't a for profit system. When medicine is for profit though, inequity happens as a by-product, and there is nothing we can do about it.
Even with supplemental insurance, Medicare reimburses about half what private insurers pay and this reimbursement is going down all the time.
On the other hand, there is no excuse for any medical staff member to be rude or to mistreat any patient.
All emergency rooms should have these conditions all medical personnel should treat patients as human beings. Sadly I have been incredibly mistreated in emergency rooms and in hospitals. I am sure many of you have had similar experiences.
My last experience was in a hospital in New York - Nyack Hospital. Not only did I receive downright hostile treatment, the doctors were incompetent and the nurses spent far more time gossiping just outside my room than in even talking or looking at me. They seemed to do okay with patients who only wanted pain meds and had nothing else wrong with them. Patients who really are sick don't stand a chance at Nyack.
Wish I had a videocamera with me to record the deplorable behavior.
Seriously? Some of these things need to be done in just the regular hospital for EVERYONE. You don`t go to the hospital to get better but to get over an acute situation so you can go home to get better. Hospitals, even at night, perhaps especially at night, are overly bright, overly noisy, with no little attempt to not disturb a patients sleep. Seems there is always blood to be drawn, vitals to be checked, etc. You would think in this day and age when I can futz around with my home appliances via my i-phone that they could check vitals via an iphone too.
Have you considered the thought that looking at a patient is more important that using the convenience of an iphone app to check vitals signs? and it isn't like the nurses or doctor are checking vitals and drawing labs for the fun of it, they have a reason to do so, you are in the hospital after all. On top of that if the nurse or doctor didn't do all of that, they would be sewed for not providing enough care and potentially missing something.
I get the need for sleep for patients to heal, but understand that the nurses and doctors aren't intentionally interrupting patients sleep.
When a health care provider is checking your vital signs, he/she is not merely looking at numbers. They are also looking at your skin condition, level of consciousness, demeanor, and a myriad of other seemingly "minor" things that help us pick up on changes in condition. While Ipads are cool, there is absolutely no substitute for hands on care and observation. If a person does not want to be bothered, and would like to give telemedicine a whirl, THAT can be done from home.
I agree with many of the posters here; this type of treatment is something that all ER services should strive for. Sadly, with the idea of "one size fits all" services demanded right now by the masses wanting "universal" and "single payer" health care services, the attempt to have specific, humane services for those who need it will be thrown out the window in the interest of saving money for taxpayers....and an end to urgent/emergent care in general. Have a broken arm? Wait a few months until "your turn" for services comes around.....and heaven help you if you have a heart attack!!!
Nice too see no one advocating us seniors should die off!! If everyone is lucky they get to be old!
Have a great day! 65 is a blessing.
I think this is terrific but I worry about the cost. We all want top quality health care- ordering drinks with an Ipad!- but Medicare reimbursements are ridiculously inadequate. How will we pay for this quality we demand?
Personally, I would not go near an ER unless I was in danger of death and in that case, I don't think the overhead lights would be a concern to me.
I've been in a few Emergency Rooms over the last five or then years. My perception of them is that this is what you will encounter when you go to Hell. It's not so much the lack of attention as the total chaos, confusion, and screaming, twenty four hours a day, most of which seems to come from coots like me or older. I have only one goal when I get in there - either get out as quickly as possible, or get a room.
I once spent three days in the ER due to a lack of beds, and it was pretty insane, especially when they bring in the bad trauma victims. I guess some of them are fortunate that they actually still have the capability of screaming. One doctor put it best several years ago, when she said that her advice to me was to try to stay out of hospitals. She said sometimes they do bad things to you, and sometimes they do the wrong things. I have found this out more than once. It's good advice.
As a future nurse who will work and advocate for the geriatric population it is encouraging to see that hospitals are making adjustments that will better serve the needs of these patients. Indeed, geriatric patients have
unique needs which must be addressed with evidenced based practices that work specifically for older patients. Considerations such as a calm environment and health care providers who are trained to treat an aging population are valuable benefits for patients, families, and communities.
As a granddaughter of a 92 year old grandmother with Dementia, I have witnessed poor health care practices
toward my own grandmother when she was taken to the emergency room once for respiratory distress. I wish she would have received care based on her distinctive physiological needs; care based on medical and nursing research proven to optimize the life or final days of geriatric patients. With a growing elderly population it is vital that hospitals and providers set in place financial means and practices that will enhance geriatric patient safety and care. Failure to neglect this need can easily lead to patient harm as geriatric patients are highly
physically vulnerable. Ultimately, they are our loved ones and deserve compassionate and superior care.
It's just the same as baby-proofing a residence. I love the idea. They could also pad the walls and doors to prevent injury from a fall. Also, put in recycled rubber counter tops, etc. The ideas are endless when it comes to patient safety. I also like the idea of making the rooms more like home. Not some cold ER room with rude workers. Finally, a good story on the news.
The only things I care about in an ER are top quality staff and efficiency. The best place to be in any ER is out of it. But if I could just make one improvement in the ER I've been in a couple of times, it would be better patient access to toilets and more toilets! It's humiliating to be in an ER with bloody diarrhea and no access to a toilet! And by the time I nurse could get there with a bedpan, it would be too late and sitting in dirty smelly bloody diarrhea in an adult diaper was nearly intolerable. I was cleared to go the the toilet on my own, but it was a long hike!
I'm middle-age with no specific medical problems. What makes the author think I want to go to a crowded, noisy, depressing ER??
Isn't this just age discrimination? If the "Senior area" were worse than normal, wouldn't we all be complaining about substandard care based on age?
How old do I have to be to get to go to the "quiet" area? Can I be younger if I have a more serious condition? What if I there are no enhanced facilities available for my visit? Do I have to pay the same amount for "run of the mill" accommodations?
I applaud that MSH is making their ER more comfortable, but how about if we ALL get to participate?
Whew! I was afraid they were going to tell us hospitals were going to partner with funeral homes on premises.
To Thersa Masters...what are you doing going to an ED that only does routine testing? You should be going to a large university ED or clinic. ED's aren't primary care clinics, like most people must think, as they go through them like a revolving door. I am an ED nurse, and it is our prime directive to treat emergencies, not long standing illness that should be seen by a specialist. I agree that your treatment was horrendous, and you should have been referred to a specialist ages ago. Quit wasting your time going to an ED and see a specialist. All the loveliness and fab furnishings is not a premise to excellent care, only excellent surroundings. I work my hiney off to give exempliary care to my patients despite what the surroundings are like. It's the people, good or bad that make the ED a place to go or NOT to go.
If you spent any time working in an ER, you would swear that some people get bored and come to the ER for entertainment value. The drugs are so good, that patients literally set their watch to get their next dose, even if they have to wake up, What is frightening, it happens very quickly, With in a few days of getting Dilaudid around the clock and weaned off....they show up in a the ER with a 13 on the 1-10 scale and are allergic to everything except dilaudid. We say it is so good people ask for it by name.
I have worked in ERs for 30 years. I can not find one legislator or administrator who give me or any of my staff credit for knowing what the hell we are doing in our AO. Never! All these "smart" policy makers think they know more than we do.
It entertains me to listen to people who admittedly went to the ER for non emergencies whine like little girls about how they "didn't get treated properly" First of all if you're aren't an ER nurse or doctor, how exactly do you know what proper treatment is, and second of all if you actually ever presented to the ER with an emergency, and are alive to complain about it then you're welcome. Sincerely, your local ER nurse :)
Want to keep people out of the ER??? Just take your meds at the right times and the right amounts. A MED-Q pillbox makes forgetting or double dosing impossible.
It works great
In response to all who made comments about people who didn't have sense enough to buy supplemental insurance. You make us sound like blood suckers existing off what you paid for insurance. Well let me tell you I am one of those people and I am not denying I need help at times with medical expense. You see my husband did not see the need to pay child support and I supported and raised four children by working at low paying jobs for people like you. While you made your payments off of money made off the backs of people like me who worked all the time FOR YOU while you banked the profits. I somehow managed to raise four very good professional individuals who are college graduates and give back to the communities in which they live. Incidentally I did not ask for food stamps or any other kind of handout. I worked and worked and worked. Now I ask little except for medical help SOMETIMES. AND yes, my children would pay if they knew but usually I don't. As near as I can figure people who have been self supportive all their life and have paid in their taxes with none of the breaks that wealthier people get are overdue for a little help. Where in the @@@@ do you get off saying people just didn't plan ahead enough? We were so bent over so that you could scrape the last bit of strength from us that we couldn't anything but our feet, which were swollen from the hours we worked standing on them so you could "plan ahead". Actually, you had better get to the ER so they can help pull your supplemental head out of your greedy@@@ or you will never see daylight again!
It's about time. As the article states, you see all sorts of special concessions made for the comfort of children in medical situations, but very little for the elderly. Great to see some thought being paid to them for a change.