Girl Scout Fieldtrip Inspires Life Devoted to Caring for Seniors
SAN FRANCISCO –Years ago, a Girl Scout Brownie troop visited patients in a nursing home in South Carolina. One of those little girls was especially impressed by the setting and enjoyed trying to engage with the patients, many whom likely suffered from dementia. Fast-forward to the present. The little girl who spent an afternoon visiting nursing home patients has dedicated her career to ensuring the special needs of older patients are carefully considered.
Wendy Zachary, M.D., is now a geriatrician and medical director of the Acute Care for the Elderly (ACE) unit at Sutter’s California Pacific Medical Center, Mission Bernal Campus hospital in San Francisco. The need for specialized care for older patients is urgent and growing larger, according to Dr. Zachary. “One of our greatest needs in medicine today is having enough physicians and nurses to care for our aging population,” she says.
Figures from the U.S. Department of Health and Human Services illustrate the size of the problem. In 2016, 49.2 million Americans (1 in 7) were 65 years and older. By 2020, there will be 56.4 million Americans over 65, with the fastest growing population being those aged 85 years and older.
Specialized Care for Older Patients Begins in the ER
The ACE unit at Mission Bernal, one of only six such units in California, was designed with the specific needs of older patients in mind. However, special care to address older patients’ needs actually begins at the point where the majority of ACE unit patients enter CPMC’s Mission Bernal Campus hospital—the emergency department.
Mission Bernal’s emergency department is the first in San Francisco to be geriatric accredited by the American College of Emergency Physicians. This accreditation is awarded to emergency departments that are set up to specifically care for older patients who may have cognitive deficits. Mission Bernal’s emergency department staff are trained to ensure that older patients are directed to the appropriate setting for their specific needs, whether they would benefit most from services provided in an outpatient setting or whether they would be best cared-for in the ACE unit.
Programs Enhance Patient Experience, Reduce Cost of Care
“You wouldn’t want your 8-year-old child to stay on a general medicine floor, you would want them to stay on a pediatrics floor,” said Dr. Zachary. “The same idea applies to older patients who have more chronic medical conditions, sensory deficits, cognitive impairment and may have need for special considerations in regards to medications. This individually-tailored care is what our physicians, staff and Hospital Elder Life Program (HELP) volunteers provide to our ACE unit patients.”
At CPMC’s Mission Bernal hospital, ACE unit patients receive tailored support through the HELP program, a comprehensive patient-centered program aimed at decreasing delirium in older hospitalized adults, thereby preserving mental and physical function. Decreasing delirium is important because it carries the same risk of mortality as a heart attack. Mission Bernal’s ACE unit is the only one in California to fully address all six key risk factors for delirium: hearing impairment, visual impairment, cognitive impairment, functional impairment, having difficulty sleeping and kidney failure due to dehydration.
The cornerstone of the HELP program is deprescribing, which is the planned and supervised process of dose reduction or stopping of medication that might be causing harm, or no longer be of benefit. This starts with normalizing sleep/wake cycles to reduce the risk of delirium in patients. To address sleep/wake cycles, the ACE unit enlists specially trained volunteers to help staff gain insights to motivations that will help mobilize a patient to keep them awake and engaged during the day so that they sleep better at night. With a better night’s sleep physicians can reduce or eliminate sleep aids and other medications, a step that is shown to lead to fewer complications, fewer falls and a reduced length of stay.
Combined, CPMC Mission Bernal’s HELP program and ACE unit have achieved notable success in the year since the hospital opened in August 2018. So far, length of stay for ACE patients our length of stay is 1.3 days less and our readmission rate is 3% less than standard of care for the older population on non ACE units. With lower length of stay and readmissions, CPMC is safely cutting the cost of care for these fragile patients by over $1 million per year.
By the Numbers
- The average age of a patient in the ACE unit is 86.
- Patients age 70 and older can be admitted to the unit for care.
- The oldest patient to be at the ACE unit was 112 and on the day of discharge this patient walked out of the hospital on their own.
- More than five percent of patient who are cared for at the ACE unit are 95 year of age or older.