Is the older adult you love prepared for 26 hours in an ER? You think that number was a typo. No, it’s called ER boarding and it’s an all too common problem.
ER boarding describes a situation where the doctor has determined that a patient needs to be admitted, but the patient ends up waiting for hours (sometimes more than 24 hours) in the ER perhaps on a gurney in a hallway. Shockingly, the patient may not receive food or water or get help to the bathroom. It’s estimated that older adults account for about 30-50% of those who end up boarded in the ER. According to KFF Health News, physicians who staff emergency rooms say the problem is as bad as it’s ever been — even worse than during the first years of the pandemic.
Patient Need May Not Match Hospital Priority
Zikry of UCLA Health described part of the challenge as the fact that, “ERs are designed to handle crises and stabilize patients, not to “take care of patients who we’ve already decided need to be admitted to the hospital.” The barrier is in part due to a shortage of beds in the hospital, some of which are held for patients undergoing lucrative surgeries or procedures.
In case you think this is a small or rural hospital problem, Massachusetts General Hospital in Boston, reported that as of September 2023, patients admitted to the hospital spent a median of 14 hours in the ER and 26% spent more than 24 hours.
The result of an older adult being in an ER boarding situation can cause a cascading effect to whatever the new emergency was. The compounding impact of the chaotic environment, limited food and water, minimal care and (potentially) skipped prescriptions can be life changing.
Five Emergency Room Pro Tips
These five ER tips can help increase the odds that the older adult gets the care they need:
- Physician Calls Ahead. If possible, have the older adult’s Primary Care Physician call ahead to the ER to alert them of the older adult’s expected arrival and current medical situation and/or history.
- Go With the Older Adult. Don’t let an older adult go to the ER alone. They need someone to be there to advocate well for them. (Note: the best advocate may not be their partner, who if they are also an older adult, may not do well both physically and/or mentally.)
- Pack a Go Bag. Bring the following items (for both the older adult and family advocate):
- a list of the older adult’s medications and (ideally) the medications themselves
- glasses and/or hearing aids
- water bottles
- things to pass the time like a magazine or deck of cards
- headphones, ear plugs, eye masks
- charging cords
- food (not just snacks) to eat
- medications plus over the counter pain relief
- a small overnight bag with toiletry kit
- change of clothes
- Advocate for Admission. If discharging the older adult from the ER is being discussed, but you believe an admission is more appropriate, you can use language like, “I believe this would be a premature (or negligent) discharge and would like it documented that I’ve expressed this.” This language may be enough to generate a more thorough care response. The Forbes Advisor article titled, What is an Unsafe Discharge from the Hospital? provides more information about this topic.
- Communicate Limitations of Living Situation. So a safe and responsible discharge plan can be made, communicate the details of the older adult’s living situation to the staff (e.g. mobility barriers like stairs in the home, who is able to assist with in-home care and what their capabilities are, transportation limitations, etc.). If the current living situation is no longer able to meet their current care needs, make sure that is abundantly clear so that an alternate plan can be made.
A trip to the ER for the older adults isn’t something you want to think about. But being prepared and knowing how to be a good medical advocate can make a tremendous difference.
