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Elderly Patients Face Prolonged Emergency Room Waits Amid Healthcare System Strains
AURORA, Ill. — Tracy Balhan, residing in Illinois, tenderly examines photographs of her late father, Bill Speer, at her mother’s residence. One image captures him beaming beside a container of chilled beverages, clad in a blue T-shirt emblazoned with the words, “Pops. The man. The myth. The legend.” Speer’s experience highlights a growing concern: prolonged emergency room (ER) waits, especially for vulnerable populations like seniors with dementia, a condition known as ER boarding.
The Agony of ER Boarding: A Personal Account
Balhan’s father passed away the previous year after battling dementia. During a particularly challenging episode, his agitation escalated to the point where he attempted to exit a moving vehicle. Balhan remembers her father — a man previously known for his steadfast and affectionate nature — shouting in distress.
Seeking immediate help, his geriatric psychiatrist advised Balhan to take him to the emergency department at Endeavor Health’s Edward Hospital in Naperville, a Chicago suburb, due to its affiliation with an inpatient behavioral health unit. Her hope was that this connection would facilitate a swift referral for specialized care.
Instead, Speer endured a grueling 12-hour wait in the emergency room. At times, hospital staff resorted to physical restraints while he awaited a psychiatric evaluation. Unbeknownst to Balhan at the time, her father’s ordeal is not an isolated incident but a widespread issue known as ER boarding, reflecting systemic problems within the healthcare system.
Data Reveals Widespread Problem of Extended ER Waits
Data analysis from The Associated Press and Side Effects Public Media reveals the alarming prevalence of ER boarding. In 2022, one in six emergency department visits resulting in hospital admission involved waits of four hours or longer. The analysis further indicated that 50% of patients subjected to any duration of ER boarding were aged 65 and older, underscoring the disproportionate impact on senior citizens.
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Healthcare experts caution that some individuals not facing immediate life-threatening emergencies may experience waits extending to weeks, illustrating the severity of the capacity crisis.
Systemic Issues Fueling ER Boarding Crisis
ER boarding is indicative of deeper issues plaguing the U.S. healthcare system. These include a reduction in accessible entry points for patients needing care outside of emergency departments, and hospitals prioritizing beds for procedures that generate higher reimbursements from insurance providers. This financial incentive system can inadvertently disadvantage patients requiring urgent mental health or behavioral care.
Experts further warn that the ER boarding problem is poised to worsen as the population of Americans aged 65 and older with dementia continues to expand in the coming years. The nation’s hospital bed capacity may not be sufficient to meet the escalating demand. Notably, between 2003 and 2023, the number of staffed hospital beds remained relatively unchanged, even as emergency department visits surged by 30% to 40% during the same period, according to data.
Dangers of Prolonged ER Stays for Dementia Patients
For older adults with dementia, ER boarding presents heightened risks, according to Dr. Shafi Siddiqui, a Chicago-based geriatric psychiatrist. A research study published in the Journal of the American Medical Association in June 2024 analyzed over 200,000 patients and discovered a correlation between extended ER stays and an increased likelihood of dementia patients developing delirium — a transient state characterized by mental disorientation and, in some cases, hallucinations.
“People should be outraged about boarding,” asserted Dr. Vicki Norton, president-elect of the American Academy of Emergency Medicine, emphasizing the urgency for action and reform.
Calls for Systemic Solutions to Address ER Boarding
National emergency physician groups have been advocating for years to mitigate ER boarding. Although some progress has been made, substantial change remains elusive, despite mounting evidence that prolonged waits contribute to adverse patient outcomes.
Dr. Alison Haddock, president of the American College of Emergency Physicians, explains that ER boarding is symptomatic of a broader healthcare system deficiency that manifests in the emergency department. Addressing it effectively necessitates a comprehensive, systemic approach that tackles the root causes.
Policy and Capacity: Historical Context of Bed Limitations
Arjun Venkatesh, an expert in emergency medicine at Yale, points to federal and state policy decisions implemented approximately 40 years ago that imposed limitations on the number of hospital beds. Coupled with an aging population living longer and experiencing more complex medical conditions, this policy has contributed to the current capacity constraints.
American Hospital Association data reveals that in 2003, there were 965,000 staffed hospital beds in the U.S., which decreased to 913,000 by 2023. Furthermore, a separate JAMA research letter published in February indicates a 16% reduction in staffed beds nationwide in the post-pandemic era, further straining resources.
Existing beds are often allocated to “scheduled care” patients undergoing non-emergency procedures like cancer treatment or orthopedic surgeries. Haddock notes that these procedures are more lucrative for hospitals under current insurance reimbursement models. Consequently, hospitals are less inclined to allocate these beds to alleviate emergency room congestion, even as ERs reach capacity.
Despite the pervasiveness of extended emergency department stays, emergency medicine experts acknowledge a lack of robust data tracking the most extreme cases, hindering a complete understanding of the problem’s full scope.
Efforts to Improve Data Collection on ER Wait Times
The Centers for Medicare and Medicaid Services (CMS) recently discontinued a requirement for hospitals to report “median” wait times in their emergency departments. However, an advisory body responsible for developing quality metrics for CMS has recommended that the agency adopt more precise measures to capture prolonged emergency department stays. This recommendation has been submitted to CMS for consideration and potential implementation.
Patient Families Seek Alternatives Amid ER Challenges
Families of patients express growing anxiety that protracted emergency room stays may worsen their loved ones’ conditions, prompting some to seek out limited alternative support and care options outside of the traditional hospital setting.
Nancy Fregeau, residing in Kankakee, Illinois, cares for her husband, Michael Reeman, who is living with dementia.
Fregeau recounts that last year, Reeman visited the Riverside Medical Center emergency department on multiple occasions. His stays frequently exceeded four hours, and in one instance, lasted over 10 hours before he was finally admitted to a behavioral health bed. Riverside Medical Center declined to provide specific comments regarding Reeman’s case.
During these extended waits, Fregeau struggles to offer her husband adequate reassurance and comfort.
“It’s challenging for anyone to be in the ER, but I cannot imagine someone with dementia experiencing that environment,” she said. “He continually asked, ‘When am I going? What’s happening?’” expressing his anxiety and confusion.
Community-Based Solutions and Shrinking Resources
Since November, Reeman has attended the MCA Senior Adult Day Center in Kankakee. Fregeau notes that Reeman approaches the day center with a sense of purpose, offering to assist with tasks like vacuuming and cleaning. Importantly, he returns home happier after spending time socializing and engaging with others outside of their home environment.
However, in Illinois, the availability of adult day centers is limited, with fewer centers than counties. Furthermore, resources for individuals with dementia are becoming increasingly scarce. A report from the American Health Care Association and the National Center for Assisted Living revealed that 1,000 nursing homes across the U.S. closed between 2015 and 2022. Adding to the strain, at least 15 behavioral health facilities, specialized in treating mental health conditions, closed in 2023.
The diminishing number of post-discharge care options contributes to longer hospital stays, thereby intensifying the ER boarding problem. Securing specialty hospital beds is becoming progressively more challenging, particularly when patients with dementia exhibit agitation or aggression.
Systemic Failures and the Human Cost of Healthcare
This was evident in the case of Balhan’s father, whose agitation escalated during his emergency room stay. Hospital staff informed Balhan that the behavioral health unit was not admitting dementia patients at that time. Speer remained in the ER for a full 24 hours until a behavioral health facility outside of the hospital system agreed to admit him.
While Endeavor Health spokesperson Spencer Walrath refrained from commenting on Speer’s specific case, he stated that their behavioral health unit typically admits geriatric psychiatry patients, including those with dementia, but admissions are contingent upon factors such as bed availability and the patient’s specific medical needs.
Balhan expresses a profound sense that the U.S. healthcare system failed to treat her father with basic human dignity.
“It didn’t feel to me like he was being treated with any dignity as a person,” she lamented. “If anything could change, that would be the change that I would want to see,” underscoring the need for a more compassionate and patient-centered healthcare approach.