At the heart of a growing concern within the U.S. healthcare system lies the phenomenon of “ER boarding,” where patients, particularly the elderly, endure prolonged waits in emergency rooms due to a lack of available inpatient beds. This was the unfortunate scenario for Bill Speer, a dementia patient, who spent 12 arduous hours in the emergency room of Endeavor Health’s Edward Hospital in Naperville, Illinois, awaiting a psychiatric evaluation. His daughter, Tracy Balhan, recalled the distress and indignity her father faced, a situation all too common across the nation.
ER boarding, a symptom of systemic healthcare struggles, affects one in six emergency department visits leading to hospital admissions, with waits exceeding four hours. An analysis revealed that half of these patients were 65 or older. Health experts highlight that the lack of alternative care points and hospitals reserving beds for higher-paying procedures exacerbate the issue. Additionally, the aging U.S. population, particularly those with dementia, compounds this challenge as hospital bed capacity remains stagnant despite a surge in emergency department visits over the past two decades.
For older adults with dementia, the prolonged waits can be perilous, increasing the risk of developing delirium. Dr. Shafi Siddiqui, a geriatric psychiatrist, emphasized the danger posed by boarding. Efforts by national emergency physician groups to address the issue have seen limited success due to the systemic nature of the problem. The roots of this crisis trace back to policy decisions made nearly 40 years ago that capped the number of hospital beds, a situation worsened by an increase in life expectancy and the complexity of illnesses.
In the U.S., staffed hospital beds have decreased from 965,000 in 2003 to 913,000 in 2023, with a significant reduction following the pandemic. This trend forces hospitals to prioritize scheduled care patients, as insurance companies reimburse more for non-urgent procedures, leaving emergency departments overloaded.
The lack of precise data tracking extreme emergency room stays further complicates the situation. The Centers for Medicare and Medicaid Services recently abandoned a requirement to monitor median wait times, though measures to better capture extended stays are under consideration.
Families of patients, like Nancy Fregeau from Kankakee, Illinois, often endure uncertainty and helplessness during prolonged emergency room visits. Her husband, Michael Reeman, who also suffers from dementia, faced similar experiences, sometimes waiting over 10 hours for care. Limited alternatives force families to seek out scarce resources like adult day centers, with the number of such facilities dwindling alongside nursing homes and behavioral health centers.
Balhan’s experience with her father highlights the systemic shortcomings in treating patients with dignity and respect. Hospital policies and resource constraints exacerbate the boarding issue, leaving families feeling underserved and disillusioned with the system.
Impact on Daily Life
The prevalence of ER boarding significantly impacts individuals, families, and communities, particularly those caring for older adults with dementia. Extended emergency room waits can lead to heightened anxiety and stress for families, who must navigate an already challenging healthcare landscape. The mental strain on both patients and caregivers can be considerable, affecting overall quality of life and mental well-being.
Communities may also feel the effects as local healthcare resources become stretched, and hospitals prioritize procedures that offer higher financial returns. This situation may lead to decreased access to timely care for emergencies, potentially resulting in poorer health outcomes and increased healthcare costs in the long run.
As the U.S. population continues to age, addressing the issues of hospital bed availability and emergency room efficiency becomes crucial. Policymakers, healthcare institutions, and communities must collaborate to develop systemic solutions that ensure equitable access to care for all patients, regardless of age or condition.