Sheboygan is seeing a tremendous increase in the geriatric population.
The first year the baby boomers — born 19461964 — entered the 65 or older age bracket was 2011. That was just the beginning.
The U.S. Census Bureau projects that by 2050 the population of persons 65 and older will be nearly 90 million. This huge expansion of the geriatric population is sometimes referred to as The Silver Tsunami. Literature suggests that an emergency department visit is a critical event in a geriatric person’s life and marks early functional decline, leading to poor health outcomes, higher use of health care services and a higher cost of care. Aurora Sheboygan Memorial Medical Center recognized that with the increase in geriatric population there was an increased need for finding better ways to support this population and their families. In September 2014, the hospital created the ED Nurse Case Manager position to support the needs of the growing geriatric population. ASMMC treated more than 20,000 patients in the emergency department in 2015 with 20 percent of those patients being of geriatric age. Although the case manager is a full-time position, one person can’t do this alone. Emergency room nurses at Aurora Sheboygan Memorial Medical Center have also been educated on how to identify patients that may have additional needs for community resource support and the process that is required to obtain these services for their patients.
Upon arrival to the emergency department nurses complete an assessment tool – Identification of Seniors At Risk – on all patients 65 and older. Patients with a positive score are considered potentially high-risk individuals prompting nurses to consider additional resources and services that could support the individual upon discharge. The goal is to help individuals to stay healthy and safe upon the return home.
This led to a geriatric project that started in February 2015 in collaboration with three other Aurora sites and with support from national geriatric emergency medicine experts. The project's goal is to find ways to improve the transition of care from the emergency department back to the community. ASMMC took steps to accomplish this by implementing the utilization of the ISAR Tool, hiring an emergency department case manager, educating staff on community resources and creating a simple referral process. A sample study has shown that geriatric patients who were identified as high risk, able to benefit from additional services and willing to participate in the referral were found to be less likely to return to the emergency department within 72 hours and 30 days of discharge.
The majority of older residents wish to remain in their home but may require additional help as they age. By getting members of the community connected to available resources they are more likely to accomplish this goal.
By supporting our senior population in Sheboygan in their homes with services we are able to improve the quality of their care and ultimately fulfill our purpose — which is to help people live well.
Diane Schuh, RN, BSN, is a manager of case management and Lisa Entringer, RN, is an emergency department case manager