Emergency Rooms- Bad for Seniors
A recent NY Times article by Dr. Pauline Chen blasts the emergency room as the worst place for older adults to seek medical care. I agree- my practice has been proclaiming this message for years- but we disagree on the solution. The article recommends we try to “geriatricize” the emergency room, by training doctors, nurses and health care workers in methods that will cater to older adults’ unique needs. Dr. Chen references a study in Health Affairs that offers some suggestions: building separate emergency rooms dedicated to geriatric patients, training thousands of discharge planners who are skilled at coordinating complex care, and utilizing telemedicine technology to prevent rehospitalizations. It sounds wonderful, and costly.
Shockingly, neither the Health Affairs study nor Dr. Chen mention the best and least expensive solution to this issue: home care medicine. No matter how “senior-friendly” a hospital tries to make its emergency room, ERs will never be able to shake the pressure to “treat ‘em and street ‘em.” As the article correctly points out, speed is required in a functional emergency room, sabotaging any chance for quality geriatric care. The ER can never match the home as the ideal setting for providing urgent medical care to the older adult. Concerned that the patient with cognitive impairment can’t give an accurate history in the hectic ER? Keep him in his familiar home environment and enjoy the luxury of time to ask good questions. Worried about adequate coordination of follow-up care? Talk to the daughter who is sitting on the couch next to the patient. Nervous that the discharged patient may fall at home, or fail to take her medications properly? Look around for fall risks, and inspect her pillbox on the kitchen table. These solutions are already in place, if one chooses a doctor who makes house calls. We do exist, and we even have our own professional organization.
My practice, Doctors Making Housecalls, recently looked at our internal data, and found that we have reduced ER visits among our older patients by more than 40% over a 16 month period, when compared to a similar group who did not have a doctor who makes house calls. Efforts are being made nationwide to prove the value of home care medicine. The new health care law includes a demonstration project, Independence at Home, which seeks to do just that. The best way to improve an older adult’s ER experience is to keep them from going there in the first place. Rather than spending our limited resources trying to transform frenzied emergency rooms into comfortable senior citizen hangouts, let’s focus on providing better access to care in the place where seniors are most comfortable: their own homes.