A Silver Spring ER Aims to Serve Older Patients

By Beth Baker
Special to The Washington Post
Tuesday, January 27, 2009

When Barbara Rayner, 78, came to the emergency room at Holy Cross Hospital in Silver Spring last month with severe lower back pain, she was expecting a long wait and harried staff. But within minutes she was whisked into a separate area, called the senior emergency center. It is one of the nation's first ERs designed to serve a population 65 and older.

"It's a really forward-thinking idea," said Rayner. "I think senior citizens will appreciate it a great deal -- and their families."

Staff training in geriatrics and communication as well as a comprehensive approach to care and patient follow-up set the center apart from the typical emergency room. "They're actually structuring acute emergency services around the needs of the people they're taking care of, rather than forcing older people to conform to the operations of the hospital," said geriatrician William H. Thomas, a professor of aging studies at the University of Maryland Baltimore County's Erickson School who helped the hospital design the new area.

While patients in the main ER typically share a room crowded with monitors and equipment, separated from one another only by a flimsy curtain, each patient in the new center has an uncluttered cubicle, with a comfortable chair for a family member or visitor. Rayner said she appreciated the extra privacy. She also was grateful for the mattress -- twice as thick as other ER beds and specially designed to prevent skin breakdown that leads to bedsores, which can develop rapidly in elderly patients. There are plenty of blankets -- kept toasty in a blanket warmer -- and pillows.

Holy Cross consulted with the Erickson School on all aspects of the center and drew on experts in lighting and audiology to make the experience as soothing as possible on aging eyes and ears.

Walls are painted a warm gold, with wooden handrails for safe walking. Rather than slick linoleum, the floor is made of faux wood. Each patient has a television with headset, a large-face clock and overhead lighting controlled by a dimmer switch. There are just eight rooms, clustered near a small nurse's station. During a recent visit, the only disturbance was the squawk of the hospital-wide intercom -- and according to Bonnie Mann, director of Holy Cross's office of seniors, the center will soon switch to wireless paging to eliminate that distraction.

Staff members are given training in geriatrics, including techniques for communicating with patients whose hearing may be impaired or who process information slowly but don't want to be patronized. "Senior citizens frequently feel they're invisible," said Rayner. "People walk in front of you in line or talk over your head. No one's been condescending here. They've been respectful."

She added: "My previous experience in the emergency room certainly was not bad, but I was left alone longer. This time you had the feeling someone was paying attention the whole time."

Dolores Bartlett of Damascus was in the senior emergency center with her mother, Margaret Fenwick, 96, a fiercely independent woman who lives alone in Wheaton and still rakes her own leaves. Fenwick had fallen and fractured two ribs. She was to be admitted to the hospital and was waiting for a private room to open up.

Bartlett was impressed that the staff had brought down a hospital bed so that her mother would be more comfortable.

"The nurses have all been so pleasant, so calm, so caring," said Bartlett. When she asked to speak to the doctor, she said, "it wasn't long before he came and gave me an in-depth explanation of what was going on, in layman's terms, that encouraged me to encourage her." The staff even looked out for Bartlett, offering her a bed to nap on and bringing her a box lunch.

Bartlett's only complaint was when her mother was taken to radiology. Bartlett felt the technicians positioned her mother too roughly, causing her excessive pain.

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