Senior citizens have different health-care needs from, say, patients in their mid-20s. So why should they be treated in an environment that isn’t geared to those needs?
That’s the guiding question behind Michigan’s first emergency department designed specifically for patients 65 and older. Opened last year at St. Joseph Mercy facilities across Michigan, the senior emergency room is staffed by a team trained in geriatric emergency care. The six- to eight-bed departments are housed in separate, private treatment areas that — in addition to their specialized staffs — differ from the general ER even in their physical attributes.
“There’s a plethora of studies that indicate that seniors react differently to noise levels, light levels, and shadows, and [they] perceive the world differently,” says Jack Weiner, president and CEO of St. Joseph Mercy Oakland. “So you do things to make the environment more comforting.” This includes softer lighting in each private room; large, easy-to-read digital clocks; extra-thick mattresses; even non-glossy floors, he says, because seniors perceive shiny floors as slippery.
Such details are designed with one goal in mind: relaxing the patients. “Anxiety is our worst enemy,” Weiner says. “There are therapeutic effects in just the environment alone.”
In addition to the environment and specially trained personnel, the senior ER also staffs two positions that many other emergency facilities lack: a pharmacist and social worker. “Very frequently, drug interactions can complicate what’s going on or can be the cause of what’s going on,” Weiner says. The pharmacist prevents any conflicts in medication and treatment, while the social worker’s job is to support patients’ current lifestyle.
Matthew Groves Jr. visited the senior ER at St. Joseph Oakland last fall with an ankle injury. “The social worker was very good,” he says. “She fixed me up so that when I got home, I had a wheelchair and a port-a-john ready for me.”
Groves, 70, had no idea that the hospital had special accommodations for patients his age. Although the Ortonville resident lives closer to other hospitals, he says he’d go back to St. Joseph if given the choice. “I’ve been to a lot of hospitals … but I could tell the difference,” he says. “The beds are nicer. They’ve got more helpers always coming in and asking if I wanted something, instead of having to send my wife out to get a nurse.”
The senior ER idea was piloted two years ago at Holy Cross Hospital in Silver Spring, Md., in partnership with the Erickson School at the University of Maryland-Baltimore County. Dr. Bill Thomas, a geriatrician and professor at Erickson School (which focuses solely on elder care), was instrumental in developing the program. “This new emergency center for seniors, I think, is the very first example of a health-care system recalibrating and redesigning its environment and its services to meet the needs of older people specifically,” Thomas says in a video on his website.
Not everyone is so quick to jump on the trend. “I think that being sensitive to the needs of seniors is a good idea,” says Dr. Michael Maddens, a geriatrician at William Beaumont Hospital in Royal Oak. “I’d like to give my colleagues elsewhere the benefit of the doubt that it’s more than just an advertising gimmick.” But Maddens says he’s saving his judgment until after he visits one of the facilities. He has his reservations. “How old do you have to be in the senior ER? Is it 65? Is it 70? Many of these age-related changes begin in your 40s and 50s and slowly progress until they accelerate in your 70s and 80s.
“The other issue is, when you start divvying people up like that, where do you draw the line?”
Still, Beaumont is taking steps to cater to an aging population. It has enacted a fellowship program, where members of the emergency medicine faculty learn the ropes of geriatrics. They become aware of the particular health-care needs of the elderly and bring that knowledge back to the ER, Maddens says.
“Fifty percent of people who walk through our door are going to be 65 and older,” Maddens says. “I think we should make being aware of their needs a general competency.”