“In my experience, older adults tend to get sent to hospital emergency rooms to make sure there’s nothing seriously wrong,” said Leah Castle, RN, BSN, a nurse with Lifespark. “As a Mobile Urgent Responder, I can rule out those non-emergencies in the senior’s home and help them avoid an unnecessary trip to the ER.”
With early intervention, Leah said that it’s possible to diagnose and treat a wide range of medical concerns in the home, such as urinary tract infections (UTI), wounds, diabetes-related neuropathy, hypertension, congestive heart failure (CHF) exacerbation, chronic obstructive pulmonary disease (COPD) complications, fall assessments, pain flare-ups, allergic reactions, gastrointestinal problems, mental health issues, respiratory concerns, and dehydration.
“We’re able to do an exam, check their vital signs, and if appropriate, get a blood or urine sample to the lab for processing, and reassure them that they don’t need emergency care,” she said. “It’s really rewarding to offer this service to seniors and their families who can’t always be there in person.”
“By addressing a long list of health issues in the home, we can spare clients the stress and exhaustion of spending hours at the ER, getting a CT scan and some blood work, and then being sent home without any real answers,” said Wendy Laine, MD, a physician with Lifespark.
Overdependence on emergency services
Having spent 19 years on the frontlines of emergency medicine, Dr. Laine speaks from experience. Although she loved the work, the system was breaking down, even before COVID-19 flooded emergency departments and hospitals. “When I first started, if someone had to be admitted, we could get them transferred to a hospital room in less than an hour, which freed up space and staff for the next person,” she said. “But for the past five years, there’s been a boarding crisis with people waiting in the emergency department (ED) for anywhere from 12 hours to three days before an inpatient bed opens up.”
The opportunity to help older adults stay healthy at home, which would also take some pressure off emergency departments, is what drew Dr. Laine to the model of complete senior health. In spite of breakthrough medical advancements and cutting-edge technologies, older patients who have been hospitalized are at greater risk for a host of adverse health events unrelated to their original diagnosis. This phenomenon, known as “post-hospital syndrome,” is described in a study published in the New England Journal of Medicine.
Causes of post-hospital syndrome can include everything from hospital-acquired infections to sleep deprivation, inadequate nutrition to decreased mobility. Another factor may be poor communication, as Dr. Laine discovered when she visited a client in his home. “He’d been hospitalized for chest pain, diagnosed with severe reflux and esophagitis, and discharged with a cardiac diet, but when I arrived, he was drinking a large glass of orange juice,” she said. “No one at the hospital had explained to him or his daughter that he should avoid acidic foods, like orange juice and tomatoes.” This oversight could have landed him back in the hospital, she added.
Unnecessary ER visits and hospital admissions
While the majority of emergency room visits are warranted, among older adults, 32% of ER visits are for non-urgent medical concerns, meaning the care could have been delayed. Hospitals are also being overused. A survey by the Minnesota Hospital Association found that one in six days of inpatient care was deemed unnecessary. That’s a total of 65,000 days of hospitalized care that could have been avoided had the health concern been addressed at home or in another setting.
These numbers help explain why, in the current post-COVID environment, we’re still experiencing crowded ER waiting rooms, boarding crises, and higher health care costs.
Ruling out an infection at home
There is hope, however, especially for Minnesota seniors who have access to in-home acute or urgent-level care. Irene, 74, is one of those seniors. One Sunday morning, she’d woken up with a badly swollen knee. Although she considered waiting until Monday to call her primary care provider, she was afraid that bacteria from an infected tooth had migrated to her artificial knee joint. She had taken prophylactic antibiotics before and after a recent dental procedure, but her orthopedic surgeon had warned her that if left untreated, an infected implant would likely require additional surgeries.
The last thing Irene wanted was more surgery, but based on previous emergency room visits, she dreaded the thought of going to the ER. “You’re sitting for hours next to people who are sick with the flu or COVID and you’re already not feeling well yourself,” she said. “The doctors are regular GPs [general practitioners], so they’d probably just run some tests and send me home with antibiotics, which I’m already taking.” She was also concerned about the $100 co-pay, adding that she lives in low-income housing and has limited financial resources.
Instead, Irene called her nurse triage line, and an hour later, Leah was in her home. She took Irene’s vitals, drew some blood, and sent a photo of the worrisome knee to the on-call provider. After sharing her findings, they determined it wasn’t a systemic infection, which the hospital lab confirmed later that morning. In the meantime, Irene was to continue the antibiotics, take Tylenol every six hours, ice her knee, and try to keep the leg elevated. The following week, she met with her primary care provider who ordered a CT scan of her knee. “This was so much better than going to the ER,” Irene said.
Dr. Laine is quick to point out that the goal of in-home acute care is not ER avoidance. “By addressing non-urgent, non-life-threatening medical conditions in the home, we can help keep EDs available for true emergencies.”
As Dr. Laine, Leah, and many other providers point out, older adults can be better served at home by a team of providers they know and trust, especially for more urgent needs. When health issues arise in between visits, seniors need a way to connect with a clinician to rule in or rule out whether an emergency room visit is needed. As urgent care or hospital at home programs gain popularity, it’s one thing seniors can ask for when they meet with their providers – is this available and how do I get it?
Bringing urgent care into the home is better for seniors and better for EDs. Irene’s story shows us that unlike the 50s and 60s, the hospital no longer needs to be the first line of defense – house calls are making a coming back and that’s better for everyone.
Cathy Gasiorowicz, Lifespark marketing writer. More information about Lifespark.