Back in 2012, Skanska’s Amy Mazzo wrote a great piece for our former sister pub Healthcare Building Ideas on the shifting landscape of emergency department care. At the time, EDs were faced with a challenging future: increasing demand coupled with diminishing profit margins.

Solutions included Lean design and technology integration to deliver care faster and safer, as well as the exploration of cost-efficient standalone EDs to serve as a bridge between an outpatient clinic and acute care hospital.

But there was another topic covered pretty deeply, too: the need for geriatric EDs. Dr. Mark Rosenberg, chair of emergency services at St. Joseph’s Regional Medical Center (Paterson, N.J.), where a senior ED was established, shared the success of his hospital’s program and projected that within five years, we’d be seeing major hospitals around the country following suit.

Two years later, I don’t know that the trend has picked up quite that much, but it hasn’t exactly fallen off the radar, either. In fact, the ECRI Institute recently released its Top 10 Hospital C-Suite Watch List 2014. Among issues like healthcare-associated infections and cancer care technologies, there’s issue #3: emergency departments just for elderly patients.

The report estimates that more than 50 geriatric EDs have opened since 2011, with another 150 in the works. And it’s no wonder; the “silver tsunami” is on its way as the number of adults over the age of 60 is heading into the 70 million range. And it’s not just that a very large generation is getting older but that older adults use EDs more than younger ones.

So, issues like toilet rooms too far from the bedside causing falls, poor lighting causing disorientation, and alarm noise causing difficulty communicating all become pretty important.

For facilities wondering whether the creation of a geriatric ED is an appropriate solution, the report suggests that if a health system serves a significant number of over-65 patients, it’s time to think about creating processes, staffing models, and infrastructure to manage senior patients.

There are a lot of operational components to this plan of attack, and they make sense. ECRI recommends staff receive training specific to the patient population and that departments offer prescription management and counseling services, and provide discharge assistance and patient follow-up.  

But, largely, this transition is a physical one.

Changes to the care environment can start on the small-scale—large-face clocks, calendars, and boards; nonskid floors and handrails; speakers within pillows; soft colors—and escalate to wholesale changes in departmental layout, such as an entirely separate ED created away from the general adult area or space within the general ED that’s carved out and dedicated to senior care.

Some argue that the idea of separation is a mistake, though—that the specific design elements that support a geriatric ED environment could be beneficial to all patients. So why bother limiting scope and slapping on a “geriatric ED” label?

Either way, we know an aging population that will likely be managing chronic and degenerative disease is on its way. And we know that how a space is designed can improve outcomes. How are you addressing ED design to support the incoming wave of senior patients?