Fifty percent of patients who are boarded in the emergency department in 2022 were 65 or older, Louisville Public Media reported April 22.
With the number of people over 65 growing by the day, and the rates of dementia expected to double by 2060, experts warn that hospital capacity will not keep pace.
ED boarding is the practice of holding patients in the ED, often in hallways, when they require admission but no inpatient beds are available. The Joint Commission considers boarding a patient safety risk and recommends it not exceed four hours, but the majority of ED physicians reported boarding times in their facilities exceeding 24 hours.
Here are five things to know:
1. Between 2003 and 2023, ED visits rose 30% to 40%, but staffed hospital beds dropped from 965,000 to 913,000 during the same time period. Post-pandemic, the number of staff beds fell by 16%.
2. ED boarding has become worse as about 1,000 nursing homes have closed between 2015 and 2022, and at least 15 behavioral health centers, which also help treat patients with dementia, closed in 2023 alone, according to the outlet.
3. The problem is complicated by changing metrics from CMS, which recently ended a requirement for hospitals to track median wait times in their ED. An advisory group recommended CMS adopt a new metric that would more accurately capture long ED stays, but a decision on the metric has not yet been finalized, according to the report.
4. Many older patients with dementia enter the ED looking for a psychiatric evaluation, and patients and their families reported it was common to wait for hours before being seen.
5. Behavioral health patients often bear the brunt of ED boarding, and the longest wait times due to a chronic lack of access to appropriate mental health care settings.
