Caregiver Tips for Navigating the Emergency Room

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In my book, One Caregivers Journey, I recall the various times my mother was taken by ambulance to the Emergency Room.

As time went on, these visits were more exasperating for my brother and myself. Everything was always about her being over 95, and we became accustomed to never getting straight answers from any of the medical professionals. One good thing is that today, hospitals have separate geriatric emergency rooms. Patients presenting to the main desk who are over 65 are sent to this area for triage and treatment. This option eliminates the confusion, frustration, and anxiety of being in a noisy and always busy emergency room. Elderly people have different needs than younger people who find themselves in the ER – both physically and psychologically. Younger people tend to have accidents, and older people tend to have “episodes.” Visits to the ER by the elderly often result in families being sent away disappointed without knowing what is occurring with their loved ones.  

The emergency room is fast-paced. Doctors must be equipped to handle a variety of health disorders that present themselves unannounced. Specialists, like gerontologists, generally do not provide routine emergency room care. If someone has a serious head injury, they are sent to the ICU for trauma care by people who routinely provide this care. Caregivers who accompany their elderly parents to the emergency room need to be patient while a battery of tests are performed and we wait for the results.

Here are some of the more common occurrences caregivers will experience in an Emergency Room.

Do not expect to receive a diagnosis. Elderly people will suffer multiple symptoms. 

1. Family members are often told they could be caused by “anything.” Elderly people frequent the ER because of pain, anxiety, and true medical emergencies. They also have multiple mini-strokes or other episodes which cause temporary cognitive losses.

Expect to be hospitalized. When there is a true emergency like a serious fall, heart attack, or stroke, hospitalization is expected. Treatment for elderly people is simplified, even if arriving by ambulance. 

1. ER personnel ask questions, run routine tests, and often the visits result in hospitalization for observation. That means they don’t know what happened, and you can bring your loved one home tomorrow.
2. Expect to be traumatized. Emergency rooms are noisy, busy, there is constant movement, and a lack of privacy. This can traumatize the elderly and cause problems with hearing, vision, attention span, and understanding. They are gripped with fear that can result in confusion that will inhibit them from receiving proper treatment.

Expect the ER stay to be long. In general, elderly patients have a longer stay in the emergency room and require more time for medical assessment and nursing care. 

1. They return frequently, have a higher frequency of readmissions, and generate greater pressure on the professionals who provide these services. Often, families are sent away with a “shrugged shoulder” diagnosis. Medical professionals are unable to explain to family members what occurred, and everything relates to the fact that the patient is old. I cannot tell you how many times we heard these episodes can happen for many reasons. My favorite diagnosis was “If you live long enough, anything can happen.”
2. ER health threats. If the hospital emergency room is experiencing a significant health threat, such as someone is being treated for a contagious virus, expect to be sent home in short order. Hospitals will arm families with pages of instructions on how to provide care at home in these instances.

Plan ER visits. 

1. My brother and I learned that our mother’s episodes would last for about 90 minutes. She would be incoherent, unable to communicate, and then she would regain her abilities. We made a decision not to call an ambulance when she had these episodes. She was always in bed, and we would take turns sitting quietly with her, talking quietly, diverting attention to other topics. She would always relax and talk to us. The episodes exhausted her, and she would fall into a sound sleep.

Look for Options for Assistance. Did you know that you can call 9-1-1 for a “lift assist” if your loved one falls and is not injured? It is also ok to refuse medical transport to the hospital. 

1. Be prepared to be put on the spot when you do refuse transport. This can be very trying for the caregiver, but if there is no immediate emergency, the ride in that big box with a stranger is also worse than slipping off a chair.
2. Look for medical options in Care. Today, there are many high-tech telehealth options for caregivers and elderly loved ones. There are also agencies where a physician, physician assistant, or nurse comes to the house monthly. Medicare and other health insurers have stringent regulations surrounding the need for certain medical tests to be performed as a condition of payment. A monthly physician service becomes the primary care provider. Insurers cover these services, and they eliminate the need for families to bring elderly members to multiple medical and doctor appointments. Your loved one never leaves the house, and a medical professional provides quiet care in the home.

I enlisted a physician service to provide care for my mother for the last two years of her life. A physician assistant was assigned to visit the house monthly. If there were instances where I needed someone in between, either a physician or a nurse would see. If my mother needed a blood test, the lab came to the home. I was given supplies to collect urine samples, and the lab would pick them up. This service made my life and my mother’s life much easier.

Making health decisions for a loved one in an emergency is generally not a difficult decision. Care is provided, and routine and specialized tests are performed. As our elderly family members live longer, it becomes more difficult for health care professionals to diagnose specific issues accurately. Caregivers need to educate themselves on what options are available to meet their needs in these times. Knowing what to expect in an emergency room might be the initial place to start.