The Acute Care for Elders unit at San Francisco General Hospital is noticeably different from other units. The floor is furnished in comforts not usually seen in hospitals: beds located next to windows to orient patients to daylight, a communal dining area where patients dine with family and friends and walls painted in warm colors.
With the aging Baby Boomer generation set to change the face of health care as we know it, hospitals across the country have begun preparing for the influx of older patients by looking at ways to improve both care and outcomes for senior patients with programs like Acute Care for Elders.
According to the California Department of Aging, the state’s population of adults who are 65 and older is expected to grow twice as fast as the state’s total population, going from 4.3 million residents in 2010, to 8.4 million in 2030. In addition, those over the age of 85 will triple from about 500,000 to 1.5 million.
First introduced in 1989 at the University Hospitals in Cleveland, Acute Care for Elders units are designed to prevent functional decline in older patients and increase discharges to the patient’s home rather than a skilled nursing facility.
Functional decline, the loss of mobility, increased frailty and emotional distress brought on by typical hospital norms such as bed rest, is the most common side effect of hospitalization in the elderly. ACE units promote mobility rather than bed rest, emphasize a family-centered approach to care, and maintain a tranquil homelike environment with natural sunlight, and flooring that isn’t high-glare (as in most hospitals) and is easy to navigate.
Studies show that older adults have unique health care needs. They often respond to procedures and metabolize medications differently, endure one or more chronic conditions and can suffer from ailments including depression, incontinence and sleep deprivation.
San Francisco General opened California’s first Acute Care for Elders unit in 2007 and now cares for over 400 patients each year. The 22-bed inpatient unit, where all patients are 65 and older, also serves as the major site of Geriatrics teaching for medical students, interns, residents and Geriatric fellows from the University of California, San Francisco (UCSF).
Dr. Edgar Pierluissi, medical director for the SF General Acute Care for Elders or ACE Unit, says acute care units are designed to reduce complications that elderly people often experience and that can lead to dangerous and costly hospital readmissions.
“We don’t treat sleeping problems with pills and we don’t go overboard with pain medication,” says Pierluissi. “Our ACE unit is composed of an interdisciplinary team of specialists that include physicians, nurses, dieticians, therapists, social workers and pharmacists trained to care for the special needs of older adults.”
Inside the SF General Acute Care for Elders unit rooms feature special beds that can be lowered to a level that allows ease of access and a decrease in the risk associated with falls. Patients are encouraged to eat meals in high-back chairs rather than in bed, and staff help patients to the bathroom on a regular schedule so that don’t have to be fitted with catheters.
“ACE units look less like hospitals and more like homes,” Pierluissi says.
In addition to reducing hospital readmissions and patient length of stay, a 2012 study conducted at UCSF found that Acute Care for Elders units could reduce national health care costs by as much $6 billion a year. The study concluded that minor changes in the current health care model could yield significant results.
The study found that leaving patients in their hospital beds or constantly interrupting them in the middle of the night for disruptive evaluations may lead to longer recovery time and longer hospital stays.
Before adopting Acute Care for Elders units, many hospitals begin by working with the national group, Nurses Improving Care for Healthsystem Elders (NICHE) to provide their facility nurses with geriatric resource training.
Linda Bub, director of education and program of NICHE, says there are currently 22 NICHE-designated hospitals in California. The NICHE program is designed to upgrade the quality of care for older adult patients by increasing awareness of geriatric issues, improving staff competence in nursing care of the elderly, and supporting the implementation of hospital geriatric protocols.
The organization also offers a Geriatric Resource Nurse training that teaches geriatric care best practices, including prevention and management of pain, pressure ulcers, adverse medication events, delirium, urinary incontinence and falls.
In April, UC San Diego Medical Center was named was named one of nine hospitals in the nation, and the only one in California, to achieve Exemplar status from NICHE. Exemplar is the of four levels of recognition given to facilities that show progress of their nurse-driven programs in raising the level of quality in care of older adult patients.
At the UC San Diego Medical Center, the geriatric psych unit was transformed into an Acute Care for Elders unit in 2007. The unit is specifically designed for seniors, including brighter lighting that works with a patient’s circadian rhythms, and a staff that is knowledgeable about both the medical and psychiatric disorders that can affect seniors.
“Since we have seen an increase in senior patients in our health system, we plan to train an additional 40 nurses as geriatric resource nurses,” says Debbie Crutchfield, nurse manager of the senior behavioral health unit at UC San Diego Medical Center. “These nurses will help to incorporate Acute Care for Elders strategies into our new Jabobs Medical Center, set to open in 2016.”
Crutchfield notes that many educational institutions don’t have mandatory courses in caring for the elderly, even though seniors are the largest growing group of health care consumers.
“In our new hospital, we plan to have a designated geriatric resource nurse on each unit,” Crutchfield says. “These nurses are trained to identify conditions that can manifest differently in older patients such as urinary tract infections that cause symptoms including delirium and confusion in seniors. Our geriatric resource nurses will train staff on how health care can be tailored to the age of the patient.”