Denver Hospital Adds Separate ER for the Elderly

Another sign of our growing aging population: Denver's Exempla Lutheran Medical Center has converted a pediatric emergency room into an emergency room for seniors, and made a lot of changes to address their specific needs.

A hushed atmosphere, softer lighting, no-slip floors and staffers trained to screen for dementia, drug interactions and other elderly risks are sample features of the Lutheran Senior ER, launched this week. ..."This is where our market is going," said Bev White, a registered nurse who directs Lutheran's emergency trauma services.

This is a great idea. The screening helps those who don't need hospitalization get to the right place, and identifies those who do have major problems and need inpatient care. The noise of a regular ER really is disconcerting for the elderly. Here's the hospital's webpage for the senior ER. Love the graphic.

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    Needed (5.00 / 1) (#6)
    by Lora on Sun Oct 23, 2011 at 10:46:06 PM EST
    I was not allowed in to see my dad for over an hour at our local ER despite the fact that I followed the ambulance down and he was suffering from mental confusion to the extent that he was unable to communicate or fully understand what was happening.  I hope the staff of this Senior ER would understand the importance of a family advocate to be allowed in right away.

    My dad was misdiagnosed and sent home, only to be brought back down and admitted later on.  I feel that if I could have been there from the beginning to explain what was going on, there might have been a different outcome.  As it was, I believe the ER doctor had already formed his opinion and was not about to entertain any other possibility.

    Such a wide difference (none / 0) (#8)
    by gyrfalcon on Mon Oct 24, 2011 at 12:51:16 PM EST
    between hospitals on this.  I was never barred from accompanying my mother, but two of the three hospitals we dealt with treated me like a caring family member, and the last immediately absorbed me into the team as a critical member.

    So much of this I think depends on the "company culture" and style of management.


    Too true. (5.00 / 1) (#11)
    by Fabian on Mon Oct 24, 2011 at 03:10:32 PM EST
    My sister went to the ER with vaginal bleeding.  The ER doc gave her a prescription for hormones and sent her home.  

    I have no idea what the ER doc thought...but I DO know my sister would not show up in the ER unless she was absolutely convinced something major needed to be treated.

    The second time she went to the ER, she passed out from the bleeding.  THIS doc had an entirely different attitude and got her admitted for exploratory laparoscopy.

    (Diagnosis: stage II/III ovarian cancer, successfully treated - through the state programs, she had no insurance.)


    Now I feel really old. Peds. to (none / 0) (#1)
    by oculus on Sun Oct 23, 2011 at 12:27:49 PM EST
    elder care.  

    This recognizes present needs as well as (none / 0) (#2)
    by KeysDan on Sun Oct 23, 2011 at 02:46:25 PM EST
    those contemplated for patient care with intrinsic or overlapping age-related conditions.  It is good to note that in addition to changes in physical facilities and the specialized experiences of physicians, nurses and other health professionals, importance is given to care managers.

    Discharge to an appropriate environment and education of patient and/or home care givers is key to assurances of compliance with drug and other treatments as well as  for effective use of devices.  Follow-ups will be essential to both patient and the hospital with regard to avoiding re-admissions for the same or derivative conditions.  There may well be additional costs incurred initially, but care will be better and savings subsequently realized--factors too often overlooked by health insurance economists.

    Wow, what a great idea! (none / 0) (#3)
    by gyrfalcon on Sun Oct 23, 2011 at 03:23:26 PM EST
    The medical establishment had better hustle to get ready for the influx of aging Baby Boomers, and this is the first sign I've seen that somebody's doing it.

    In my mother's last years, when I had to see her through several fairly brief hospitalizations for various problems, I was really, really stunned by the utter lack of understanding of personnel, from docs to nurses to techs, of how to approach and interact with the elderly.

    Which is particularly astonishing given the high percentage of elderly people the general floors of hospitals have anyway.

    Yet none of these people had a clue how to talk to somebody who's hearing impaired or that sort of bouncing cheerfully and assertively at a frail elderly person is going to frighten them and make them shrink back from you.  Or that even with a cognitively functional person, you can't just tell the sick, hard-of-hearing, drowsy patient X, Y or Z and expect them to absorb it and remember it.  Etc.

    (And this was in a couple of the very top "patient-centered" teaching hospitals in Boston.)

    Obviously, I'm still p***ed about it.

    On top of that, the elderly oftentimes exhibit very different symptoms from younger people, and God knows they absorb drugs differently, but few non-gerontologists seem to be aware that this even might be an issue.

    Thanks, Jeralyn, for posting this.  It's a very hopeful sign.

    I'm so sorry, gyrfalcon (5.00 / 3) (#4)
    by Zorba on Sun Oct 23, 2011 at 03:43:29 PM EST
    I do have to say, at the end of both of my parents' lives, the BJC healthcare group (Barnes-Jewish-Childrens Hospitals, all associated with the Washington University Medical Center) provided my parents with truly top-notch, compassionate care.  And I have to give much of the credit to their nurses, who were really, really terrific, and kept me "in the loop," if anything, even more than the physicians, and who were really on top of, and understanding of, my parent's conditions and needs.  God bless the nurses!

    I hasten to say that (none / 0) (#7)
    by gyrfalcon on Mon Oct 24, 2011 at 12:46:04 PM EST
    the very odd thing about the whole experience is that the medical personnel were all very nice, caring, compassionate people.  It wasn't as if they were indifferent, but more as if they had never even encountered the concept of being hard of hearing, which is astonishing to me since probably the majority of the elderly have some hearing impairment, and there are a heck of a lot of them in hospitals!

    IOW, caring and knowledge are two different things and one doesn't substitute for the other.  You need both.


    I msut say that (none / 0) (#9)
    by Zorba on Mon Oct 24, 2011 at 01:04:42 PM EST
    I was amazed at how knowledgeable the staff was about the not uncommon phenomenon of Sundowners Syndrome, which seems to particularly affect the elderly when they are hospitalized.  I had only been vaguely aware of this before then.  They helped orient him as much as possible, and helped me to help orient him, as well (I spent a lot of nights there.)  My dad had shown considerable cognitive impairments after his final major cardiovascular surgery (also not uncommon), and those impairments were made worse at night.  I do think that with my grandmother, who died about ten years before my parents, there was one doctor with a clue (and he was great), but the rest of the physicians and staff were, as per your experience, relatively clueless about how to talk to her (made more difficult by the fact that, although she was quite fluent in English, it was her second language) or interact with her.  

    Sundowner's Syndrome is a new one on me (none / 0) (#12)
    by gyrfalcon on Tue Oct 25, 2011 at 12:11:32 AM EST
    Hadn't heard of that before.  I did learn about "ICU psychosis," which is pretty devastating.

    What happened to my mother, though, was that she got what I call Vicodin psychosis.  They gave her a big dose of Vicodin after a few hours of morphine post-surgery, and she rapidly became floridly paranoid.  Despite my increasing alarm, this particular hospital tried to brush it off as "confusion" until she attacked one of the nurses and drew blood with her fingernails, then tried a very slow-speed escape from the floor with her walker (after hip surgery, no less), trailing all her tubes and whatnot.  Man, that was fun.  Not.

    She was so totally paranoid, though, that she wouldn't eat or drink anything they gave her, including more Vicodin, so it passed out of her system after three really harrowing days and she was back to more or less normal, though her memory loss was greatly accelerated after that.

    Oh, the adventures we had in the medical system!


    Interesting -- we're dealing with that (none / 0) (#5)
    by Towanda on Sun Oct 23, 2011 at 10:30:43 PM EST
    today.  A family member was severely injured in an accident yesterday; Flight for Life and more were involved to get him to a great, world-class hospital here, and we know he is getting great care.

    But he is deaf, so we made sure to get someone there fast to make sure that communication to and from him is clear.  He will be in the hands of dozens of health-care workers, and although they also are world-class, we have found that those odds mean that someone will miss that line in the chart and need to be told to face our family member to be able to lip-read and the like.  

    And yes, we have to be sure that someone else hears all that is said to him, as he doesn't know when he is not hearing what he never knows was said!  You have been there; you understand.

    We're going to have a lot of time on the road to get to and fro 75 miles to world-class hospital, too, as we expect to be told tomorrow that he cannot be transferred here, home, because -- of course -- he has no health insurance, so no hospital will take him if they can avoid it.

    He finally got a job a month ago, but without health insurance.  How reassuring to know that there will be health insurance for him after the next presidential election.  Perhaps then, we finally can get him the surgery that could solve a lot of the hearing problems, we're told.  Yeh, we'll believe it when we see it.


    I'm sorry, Towanda (5.00 / 1) (#10)
    by Zorba on Mon Oct 24, 2011 at 01:15:23 PM EST
    I hope that your relative will be fine.  And I'm also sorry about the lack of health insurance, which will just unbelievably complicate things.  (Can we get single-payer, universal health care yet?  Or at least a widely-available, affordable public option?  Guess not.  Sigh.)  I think that one thing we should all take away from all of our experiences is the importance of having someone from the family (or close friends) there all the time.  And I do mean all the time.  I cannot stress this enough.  I have been part of this for family and close friends.  It doesn't matter if they're not elderly or not deaf or hard of hearing- if someone is really, really sick, set up shifts (if you can) and have someone there 24-7.  Very difficult to do (unfortunately impossible for far too many people), but it really makes a difference in quality of care.  The sick or injured person needs an advocate there pretty much at all times, to interpret, to run interference, to make sure that their needs are met, to communicate with the staff, and so on.