Geriatric acute care

Older adult acute care resources

Care Transitions Program®
National Transitions of Care Coalition
NICHE

Existing ACE units

Highland Hospital, Rochester, NY
Improving Outcomes for Older Patients

Older adults often have medical needs requiring specialized care while they’re in the hospital. That’s why Highland Hospital opened the Acute Care for Elders (ACE) Unit. The only resource of its kind in the region, the ACE Unit was specifically designed to meet the unique needs of older patients and their loved ones.

Tending to the Little Things as Well as the Big Things

What unique needs does the ACE Unit meet? As part of our coordinated, compassionate approach to geriatric care, we tend to all the “little things” that are especially important in getting the best results for an older person, such as:

• A proper diet
• Skin care
• Keeping track of medications
• Pain management
• Timely information
• Coordination of home care

We also tend to the “big things.” In fact, Highland Hospital’s ACE Unit has more board-certified geriatricians, providing more complete care for older patients, than any other hospital in the area.

Working Together

The ACE Unit’s physicians are supported by a team of specially trained, highly dedicated medical professionals. Together they give our patients top-notch care—in the compassionate atmosphere that Highland Hospital is known for. The ACE Unit provides:

• Coordinated Care—Our physicians work closely with nurses, pharmacists, therapists, social workers, and other specialists to give our patients the very best care.
• Leading Resources—Our ACE Unit is part of the Strong Health Network and University of Rochester Medical Center. That means its doctors and staff have easy access to leading research, as well as some of the nation’s top equipment and facilities.
• Rehabilitation Services—All of our older patients participate in therapy programs (as needed) to address physical, speech, and other conditions and help them return to their normal routines as quickly as possible.
• A Team Approach—Teamwork between our doctors and medical staff, our patients, and their loved ones often results in a quicker, more complete recovery. We listen, we communicate clearly, and we involve everyone in patient care and after-care support.

Our Goal: To Help You

Our ACE Unit provides these services to help our older patients return to a productive, meaningful life as quickly as possible. To do this, we work hard to achieve these goals:

• Optimum functioning of mind and body
• Emphasis on patient dignity and comfort
• Meet both patient needs and preferences
• Simple admission/discharge processes
• Minimal stress from hospitalization
• Minimal readmissions
• Clear, constant communication
• Presentation of all relevant medical options
• Safe return to home or living facility

Summa Health Care, Akron, OH
Summa’s Acute Care for Elders Unit (ACE) is a nationally-recognized care model that helps patients maintain function, quality of life and independence during hospitalization. The ACE Unit delivers inpatient care using an interdisciplinary team that includes a:

• Geriatrician
• Geriatric-certified advanced practice nurse (APN)
• Geriatric-certified pharmacist
• Dietitian
• Social worker
• Therapist
• Patient’s primary nurse

In addition, the following units also are based on the ACE model of care:

• Heart Failure Unit – This team includes a: cardiologist, certified advance practice nurse with expertise in geriatrics and cardiology, physical therapist, pharmacist, dietitian, social worker and nursing staff trained specifically in the management of cardiac patients.
• Pulmonary Unit – Provides care for a variety of acute pulmonary illnesses including pneumonia, asthma and chronic lung disease. The team includes a: pulmonologist, pulmonary nurse case manager, nurses, respiratory therapist, dietitian and social worker.
• Stroke and Neuroscience Care Unit – Offers patients expert care from an interdisciplinary team that is trained to care for stroke patients, from diagnosis to treatment to rehabilitation. The unit also provides specialized care for trauma and neurosurgery patients.

Proposed ACE (Acute Care for the Elderly) unit services:

1. Assessment and treatment of delirium
2. Assessment and treatment of pain
3. Caregiver stress assessment and support
4. Clarification of advance directives
5. Clarification of recommended health screening/immunizations
6. Clear discharge instructions for post-hospital care
7. Coordinated referrals for post-hospital care
8. Family encouraged to bring in favorite foods during acute stay
9. Family encouraged to participate in acute and post-hospital care
10. Focus on Care Transitions pillars – medications, red flags, personal health record, physician follow-up
11. Focus on common potential hospital complications in elderly, including: falls; skin breakdown; deconditioning; catheter-associated infections (UTI); antibiotic-associated infections (C. diff)
12. Initiation of personal health record
13. Comprehensive medication review for possible adverse drug effects, therapeutic benefit, and need for preventive supplements
14. Screening for dementia
15. Screening for depression
16. Screening for falls risk
17. Screening for malnutrition

Possible discussions to have with patients/caregivers (from Older Adult Interview form):

Advance Directives
Ask: “Do you have a health care proxy form or living will?” If yes, ask for copies.  If no, ask: “Who would you want to make health decisions for you if you are not able to?  Would you ever want to have CPR, be on a ventilator or be fed by a tube?”  Get a health care proxy form and fill it out.

Ageism
Ask: “Have you ever said to yourself ‘I’m not getting any younger’ or has someone said to you ‘what do expect at your age?’?”

Caregiving / Continuum of Care
Ask: “Does someone help you with anything at least monthly? Would life be easier if you had some help?”

Change
Ask : “Has your health changed noticeably over the past week? Month? Year?”

Communication
Ask: “Do you have trouble following conversations or what is on TV? Do you have trouble expressing yourself? Do you have any vision or hearing problems?”

Dis-Ease
Ask: “Are you depressed? Lonely? Do you feel life is not worth living? Do you worry about anything? Are you afraid of anything?”

Education
Ask: “Do you understand what your doctors tell you? Do you know what all your medications are for? Do you know what your health problems are?”

Functional Ability / Safety
Ask: “Are you able to manage your affairs and perform basic daily activities (eg wash up, go to the bathroom, balance your checkbook, and buy groceries)? Do you use a cane or a walker? Are you afraid of falling? Have you fallen in the past year? Have you had any other accidents in the house or driving?”

Multiple Problems
Ask: “What have you been diagnosed with? Do you have other health problems?”

Pain
Ask: “Have you suffered from pain in the past month? How often do you have pain?”

Polypharmacy
Ask: “What medications do you take? Do you think any of the medications don’t agree with you? Do you ever miss a dose of your medication? Do you have trouble affording your medications?”

Quality of Life
Ask: “On a scale of 1 to 10, where 1 is ‘the pits’ or ‘terrible’ and 10 is ‘great’, how would you rate your life right now?”