Finally – Carma! We have all experienced the challenges of having to transfer a resident to the ED, whether the transfer was needed due to an overall decline, a fall, or infection, it is never easy. Residents “live” in our communities, and any change in environment can cause delirium which often results in negative outcomes, treatment delays, and loss of privacy. The good news? Hospitals are required to comply with the new Medicare Age-Friendly Hospital Measure aimed at improving emergency care for older adults.
What is the new Medicare rule? CMS recently introduced its Age-Friendly Hospital Measure to enhance the care of older patients in various hospital settings, including the ED. As of January 2025, hospitals are required to attest to their processes for limiting ED total length of stay (LOS) to under 8 hours and time to admission to within 3 hours of the decision to admit. A recent study in JAMA Internal Medicine reported significant increases in the proportion of older adult patients with prolonged ED LOS and boarding time, disproportionately impacting academic hospitals. Hmmm, how can that be? What are the penalties for non-compliance? Who is auditing besides JAMA?
Worsening ED LOSs and boarding time contributes to ED crowding, reflect systemic health care dysfunction, and, most importantly, harm individual patients. Bottom line? Please educate staff on the importance of identifying subtle changes in condition earlier rather than later. Many ED transfers are related to a change in condition that our staff didn’t notice. Change in condition is one of the “top 3” areas for claims and if nothing else, it should spark your interest. Use your resources, there are tools like the SBAR, Stop and Watch, Interact, etc. that can assist your staff in detecting subtle changes. Above all, educate, educate, educate! We can make a difference even if recent analysis from McKnight’s Long-Term Care News shows ED statistics for older adults are worse now than before the initiative. The Medicare Age-Friendly Hospital Measure may be a hospital requirement, but our goal should be to keep our residents “home” whenever it’s appropriate and supports the resident’s goals of care.
Stay well and stay informed!
