A true GEM at the Ross

A visit to the Emergency Department can be a stressful experience for anyone, but imagine this scenario. After a fall in your home, you're taken to the hospital to have your ankle set.  You receive the care you need, but you have trouble hearing, so you think you remember what the doctor told you about your appointment at the Fracture Clinic, but you're not sure.  It's all written on your appointment form, but your sight isn't good anymore, and it's difficult to read.  Now you need to get home. Your family doesn't live nearby, so the hospital arranges a ride for you through Community Care. Now you're home, but it's hard to get around your apartment.  You were given forms to fill out to get home care help, but you're very weary from the experience and they look complicated. They're placed on the table and remain there. You were given pain medication, and you try to remember when you were to take it.  You sit, thinking you'll feel better later, but getting up makes you very weak, and within days, you fall again. Back to Emerg.

Twenty five per cent of the patients who visit the Emergency Department are over the age of 75. And unlike people who come because they have one problem to fix and go home, these seniors' issues are complex. That's where the new Geriatric Emergency Management nurse can help.

Marsha Coombs was hired as the first GEM nurse at the Ross Memorial in October, after the province provided funding for this initiative through our Central East LHIN. Marsha's goal is to provide safe discharge for seniors out of the ER and back home with community supports and referrals. The longer they're in the Emergency Department, the more susceptible they are to catching a cold or the flu, or other viruses that can be dangerous to the elderly.

Marsha has years of experience both in the Emergency Department, and with the Community Care Access Centre, which means she knows which community supports are the most appropriate for particular patients, and more importantly, how to connect those patients to the right people. She is a specialized geriatric nurse in the ER department. She utilized and collaborates with our ER CCAC nurse to provide appropriate in-home services for our patients.

Approximately 400 patients over the age of 75 are seen in the ER department every month. She sees between 3 and 6 patients per day as well as 25 phone referrals a week, each with his or her own needs. Many aren't aware of the social supports available to them. Others think they don't need them. For some, it's a matter of getting help with paper work. For others, more help is required.

Like the lady in her eighties who came in by ambulance because she couldn't get out of bed for more than a day due to an illness. After her medical assessment and admission, this lady's condition was affected by her inability to go home and her concern for her son who has mental health issues. She was the primary caregiver for him and was very anxious about him being at home alone and her loss of contact with him. Marsha spent time in locating him and involved the crisis nurse to help assess his capabilities and needs while his mother was hospitalized. So arrangements were made to ensure that he was coping in her absence.

In another instance, Marsha and Karen, the nurse from CCAC, learned that a gentleman wasn't able to take his prescribed heart medication, because of the high cost. They worked together to connect him with social supports and helped him access resources to complete the paper work that remedied the problem.

The winter is a difficult time for seniors because the snow makes it more difficult to get around outdoors. Community Care is a valuable resource, providing Meals on Wheels, transportation, even a daily phone call. But Marsha says depression is a problem this time of year, so she also works with our Mental Health Crisis Nurse to provide support.  But because many elderly people have a multitude of health issues, what appears to be delirium can actually be attributed to a change in medications, dehydration, even constipation. By understanding how many factors impact these patients' health, Marsha can better help them get the care they need, as quickly as possible.

Marsha works with patients' family doctors, but many seniors in the community have no family doctor. They become repeat visitors to the Emergency Department. One such patient came to the ER five times in the month of November. Each time Marsha was happy to provide whatever supports this patient needed.  Many patients may want help simply to fill out applications for the Nurse Practitioners in the community. She also refers patients to the Chronic Disease Prevention & Management program for those patients with health issues such as congestive heart failure or diabetes.

The Emergency Department has also benefited from equipment that makes it more "senior friendly". Funding for the GEM program helped to buy "geri-chairs", raised toilet seats and pressure-relief mattresses that prevent skin breakdown. Soon the hospital will be acquiring bariatric equipment, including a portable lift and a specialized stretcher that can be lowered for easy use. These items serve a dual purpose. They can helpful for the elderly, but also for patients who weigh more than 500 pounds.

Marsha works closely with the Community Care Access Centre to connect patients with Long Term Care facilities, retirement homes and respite beds. But there's usually a wait involved. For seniors who have no family or social supports, having a friend in the hospital that can help them to stay healthy and safe at home, is indeed a gem.

Article submitted by Kim Coulter, Ross Memorial Hospital