Home Healthcare Agencies Provide Temporary Solution to Aging Problem in the U.S.


Luke Rosiak's article in the Washington Times describes the fear most developed countries face: the imbalance between the graying of a nation to its workforce. If it weren't for immigration and higher birthrates among minorities, the lower fertility rates in America would have already seen a more disastrous effect.

In locations where seniors clients dominate businesses and hospitals, young people find themselves relocating to "hip" areas with night life and other entities that seniors tend to not frequent, thus separating young and old geographically. Suburbs were once considered ideal for retirement but now the solitude and need for younger workers to provide labor for them such as in hospitals has made living in relative isolation from the cities risky. Although a younger workforce is ideal in areas like Palm Beach County, South Florida, the jobs they would get would most focus on aging services. 

In the meantime, home healthcare agencies are common place throughout South Florida (Palm Beach County, Broward County) for elders to find quality home care  and other services for the disabled. Perhaps the following generations of booming minorities in the US could help offset this issue but that's a different story. If you have thoughts on that, please feel free to comment for us. A Family Member HomeCare agency has been on top with bridging the gap between quality home care and seniors who want to age in place in South Florida.

For more on this article: As Florida goes, so goes nation of aging communities.

Portable High-Tech Cottage for Elder Care


 
With the help of Virginia Tech, the MedCottage was developed as a solution for the growing number of older Americans that need to find living arrangements. After installation, a MedCottage (12 foot by 24 foot- about the size of a master bedroom) can cost about $125,000. Compared to the assisted living costs of $40,000 a year, a MedCottage could be a bargain. Of course, one would need the space or the land to install such an addition. It was interesting to me, coming from New York City, that the family described in the article would have such land to implant a cottage but they didn't already have the extra space in the actual house. Perhaps moving forward, architectures and landscapers would take the aging issue into consideration when constructing small family homes in Virginia.

Although what really interests me about the MedCottage is the innovative floor material that would allow an egg dropped from seven feet above to simply "bounce" off, I'll just continue with the general importance: that the savings acquired from installed a MedCottage onto a family's property along with the achievement of the elder's acceptance to live in one can have amazingly beneficial effects for all involved. A couple could still retain the comfort of their family size inside the house, the elder could benefit from the small grant of privacy, costs would be kept low, the family is still kept close together, etc.

For more information about MedCottages, you can follow the original article here:The "Granny Pod:" High-tech dwelling could change elder care.

Family caregivers and senior home helpers would actually find themselves relocated to these situations more often in the future as our elders are moved into MedCottages. Having family so close to the senior could actually help monitor a caregiver's need for respite as well as the senior's moods in the case he or she feels homesick of lonely.

Still, not enough criticism was granted in this article. What downfalls can you see about MedCottages, especially if this were granted in South Florida? Or is there not many? 

Webinar Recording on Dementia Care

It is a great thing to have such material available for everyone. Anyone who cares for a person with dementia related disorders can benefit from this. 

Alzheimer's Disease and Related Dementia Disorders - October 19, 2012, Webinar Recording



On October 19, the Florida Department of Elder Affairs hosted a national public webinar to educate all interested parties on the strategies for communicating with patients who have Alzheimer’s Disease or Related Dementias (ADRD). The webinar served as an opportunity to better understand the disease and its signs and symptoms. Another goal of the webinar was to teach how a diagnosis of ADRD may enhance an elder’s vulnerability for abuse, neglect, or exploitation, and how to protect the individual who may be taken advantage of. More than 400 people from across the country participated.

Alzheimer's Disease and Related Dementia Disorders - Supplemental Materials

Caregivers Can Limit the Over-Medication of Seniors



In the following article, the AARP reports that it is not uncommon for older adults to be over-medicated and to experience adverse reactions to the ever-lengthening list of medications they take. 

Although it is sad to say this this problem is a way that institutions have dealt with patients on a general basis due (especially where staff is limited), this problem also suggests why having home care can really help to offset unneccessary medication intake. Having a good caregiver can help your senior become monitored regularly and correctly where each sign of over medicating or improper medication can be observed. A good caregiver's job is to help a senior feel naturally better, physically and mentally, with as little dependency on medication as possible. 

Click on the link below to access a full list of both prescription and over-the-counter pharmaceuticals to which seniors should pay especially close attention.  

Too Many Pills: Are We Overmedicated As We Age? 

Have you considered this a problem with your own loved one that needs care? What do you think could be done to keep them from being over-medicated in insitutions? 

Getting Older Drivers Off the Roads for Safety

This article focuses on the realities of restrictions desired to control age-correlated driving accidents. Although states have been doing their part to increase driving restrictions for the elderly, I'd like to see a forward-thinking movement to increase public transportation in areas where seniors depend on driving. If having knowledge that maintaining good health was the answer to driving better in old age, then a lot of our world's problems would be solved. Unfortunately, I believe what this article is missing is an ultimate solution to getting the elderly off the road: by providing them an alternative way to get around.

For now, senior caregivers and personal assistants could be the alternative answer to seniors giving up their keys.


senior_driver_20120917165535_JPG

For the article, go to: Exactly when is it time to give up the car keys?

Florida is Slowly "Opting In" to join the Health Information Exchange


Floridas Electronic Medical Health Information

TALLAHASSEE – Five more organizations have been selected to join Florida’s Health Information Exchange (HIE), which brings the total number of participants to 17. The technology framework provided by the HIE will enable participating health care providers to timely and securely access patient health information...

For more on this article, please go to : ~Floridians can benefit from use of electronic health records~ 

This is a great step! When I took a Health Care Delivery Models class at USC last spring, it seemed plain and simply that having a comprehensive electronic health and medical exchange between all health care providers could help to cut down the costs of unnecessary medical expenditures. Why this hasn't been done yet: $$$$

Tsk tsk. But it's not just the guilt or the ignorance of providers that have been at fault, patients with serious illnesses have been hesitant to release medical records in fear of losing a job opportunity, etc. Now, having the option to "opt in" a health information exchange systems seems to be the most proactive, encouraging way to get the nation towards accepting these conditions. 

Delaying Social Security Benefits Can Significantly Increase Monthly Benefits: Senate Aging Committee Holds Hearing on Women's Social Security Disproportionate Dependence


Wednesday, July 25, 2012
WASHINGTON – Senate Special Committee on Aging Chairman Herb Kohl, D-Wis., held a hearing today to examine the unique issues women face in achieving retirement security.
The hearing, entitled “Enhancing Women’s Retirement Security,” included testimony from the Government Accountability Office (GAO) on the findings of a new report requested by Kohl and from the Social Security Administration (SSA) and other policy experts.  The hearing largely focused on Social Security, which women disproportionately depend on for their retirement income.
During the hearing, Kohl pressed SSA to do more to help people understand their benefits.
“SSA has a responsibility to inform and educate  people about their benefits, and it needs to make sure people understand just how much money they are losing when they take their benefits sooner rather than later,” Kohl said.
Currently, the majority of women claim benefits at 62 - the earliest age possible. Only 18 percent wait until their normal retirement age of 66 or later. A woman expecting to get $1,000 a month at 66 gives up $250 every month for the rest of her life if she files to take her benefit at 62. On the other hand, if she waits until 70, she is looking at a monthly benefit of $1,320. A person claiming at 70 can get 76% more in benefits than if she claimed at 62. A recent study from the Center for Retirement Research called this strategy to delay benefits “the best deal in town.”
The GAO report, entitled “Retirement Security: Women Still Face Challenges,” included a range of policy proposals, including a stronger push to help people understand the benefits of delaying the receipt of Social Security benefits. 
“According to experts, many people do not realize that waiting to claim Social Security benefits can significantly increase monthly benefit amounts for the rest of their lives,” according to the report. “Better educational outreach could increase awareness. If workers delay claiming Social Security benefits, income and payroll tax revenues would be increased and solvency would be improved.”
Kohl also spoke in favor of the bipartisan proposal  to increase Social Security’s Special Minimum Benefit, which is the floor benefit level for career low-wage earners.


A FAMILY MEMBER HOMECARE — Approved by the Joint Commission on Accreditation of Healthcare Organizations. A Broward, Miami-Dade and Palm Beach County Home Health Care Agency Serving Coconut Creek, Cooper City, Coral Springs, Dania, Davie, Deerfield, Ft. Lauderdale, Hallandale, Hillsboro, Hollywood, Lauderdale Lakes, Lauderdale-by-the-Sea, Lauderhill, Lighthouse Point, Margate, Miramar, North Lauderdale, Oakland Park, Parkland, Pembroke Park, Pembroke Pines, Plantation, Pompano, Sea Ranch Lakes, Southwest Ranches, Sunrise, Tamarac, Weston, Wilton Manors, Aventura, Hialeah, North Miami, Miami Lakes, Sunny Isles, Bal Harbour, Surfside, Boynton, Boca Raton, Lake Worth & Delray Beach With Comprehensive Home Health Care Services, In-Home Caregivers, Nursing & Home Health Aides for Seniors, Elderly, Disabled, Dementia & Alzheimer’s Patients. Licensed, Bonded, Insured

Ever Wonder About Those "Short Wait Time" Emergency Room Billboards? The Sun-Sentinel Reports On Ads That Can Be Misleading


September 2, 2012|By Nicole Brochu, Sun Sentinel
The highly visible billboards dotting major South Florida road sides are peddling an unusual product: short wait times at hospital ERs.
But would you base your emergency room visit on a sign? Not so fast, skeptics say.
Hospitals are banking up to $10,000 a month per billboard on the signs raising brand awareness in the battle to attract the educated consumer, but critics say some of the ads can be misleading.
In the divide is a clear message: Your time is a hot commodity, but buyer beware.
"Would you make the decision on going to an ER based on a sign that says, 'Wait time: 3 minutes, 42 seconds'?" said Dr. Nabil El Sanadi, chief of emergency medicine for Broward Health, which doesn't advertise its ER. "More often than not, no. You'll go wherever your doctor tells you to go."
South Florida hospitals are not alone, though, in appealing to the time-pressed consumer. Medical facilities across the country are jumping on the ER billboard bandwagon, and they're getting noticed.
"Emergencies don't wait for appointments," says one sign, on Interstate 95 at Atlantic Avenue in Delray Beach. Advertising the ER at JFK Medical Center near Lake Worth, the digital readout on a recent weekday morning said, "Average Wait Time: 6 minutes."
"Faster emergency care saves more than time," says another for Northwest Medical Center in Margate.
Both billboards allow patients to text "ER" to 23000 for the latest wait times at JFK, Northwest and other area Hospital Corporation of America-owned facilities.
"I think they're an effective way to get people in the door, but I don't think they're accurate," said Dr. Evan Goldstein, an emergency physician at Boca Raton Regional Hospital. "Often, they don't equate to faster care, or better care."
Officials at HCA, the only hospital company in South Florida marketing digital wait times on billboards, did not return calls for comment on how their system works. But a 2009 Ad Age magazine story quoting company officials said it uses satellite feeds, drawing data from electronic records tracking patients' times in the ER, to regularly update the signs. A company spokesman told Ad Age that after putting up the billboards, all 12 of its South Florida hospital ERs saw "significant increases in the number of patients."
Of course, there's another issue: Times estimated on billboards are typically based on how quickly an ER patient sees someone of consequence, like a doctor or charge nurse — not how soon treatment is administered. They are averages, which factor in all ER traffic, including patients brought in by ambulance who don't wait at all. They are subject to change quickly, too, and often have little to do with the amount of time you actually spend in the department, Goldstein said.
And there's no regulatory body verifying the time clocks' accuracy.
"Everyone who's in emergency medicine knows it's a gimmick," said Dr. David Soria, chief of emergency medicine at Wellington Regional Medical Center, calling the estimates "something that is very hard to put your arms around, very hard to police and very hard to validate."
That's why, in choosing Wellington Regional's ER billboard campaign, Soria specifically stayed away from the digital wait times. Instead, his billboards — like the one depicting him and his ER physicians bedecked in tuxedos next to the message, "Wellington Regional Medical Center ER, Where Everyone Receives First Class Care" — focus on quality of care and efficiency of service.
Fast-paced, drive-through world
Since they began popping up on South Florida's roadsides a couple years ago, the ER billboards — those with time clocks and without — have stood out as an unusual marketing strategy. After all, in true emergencies, most patients head to the nearest hospital, so why treat ERs as if patients have a choice?
Because in many cases they do, experts say.
As the demand for health services has grown, the ER has become an important gateway in introducing a patient to the hospital setting. One in 10 ER visits are for nonemergencies, according to the National Center for Health Statistics. And the Centers for Disease Control and Prevention estimates that one out of eight visits results in an admission.
"A lot of admissions come through the emergency room, and putting heads in beds is part of what sustains an institution," said Linda Quick, president of the South Florida Hospital and Healthcare Association. "So getting people to choose your emergency room is a good thing."
Especially in South Florida — and Palm Beach County in particular, where some patients have two or three hospitals of equal distance from their homes.
"So people do have choices," said Soria, from Wellington Regional. "And that competition, I think, is helpful to the patient population. Because the hospital is not the only shop in town, they have to have competitive services and market them."
Even if they don't use the digital clocks, many hospitals find that appealing to the time-pressed consumer resonates in today's fast-paced, drive-through world.
"I think our society today, no one wants to wait for anything," said Margaret Neddo, ER director at West Boca Medical Center. "Everything's instantaneous."
Even, in some cases, restaurant-like reservation systems for the ER.
West Boca Medical Center, like other Tenet-owned hospitals in Palm Beach County, uses the InQuickER service, an online tool that allows patients to make a reservation for an ER visit, as long as their injury or condition is not potentially life-threatening.
For the construction worker who needs stitches for a laceration, or the mom picking up a sick child from day care after hours, the program allows people to hold their place in line at the ER while waiting in the comfort of their homes.
In the year since the service has been in place, Neddo said, the number of patients using it has grown from 25 to more than 100 a month, helped in large part by the billboards that once advertised the convenience from the sides of I95.
The billboard campaigns are all about branding in a competitive climate, said Quick, of South Florida Hospital and Healthcare Association.
"More and more people are trying to make informed decisions about their health care, so brand is important," she said. "People tend to make their decisions that way."
But she cautions that ER billboards, which can attract both paying and nonpaying customers, can be a "doubled-edged sword."
"My member hospitals have mixed emotions about marketing emergency rooms," Quick said. "The good news is you can advertise and get more people in the door, and the bad news is you can get people you wish didn't come."


A FAMILY MEMBER HOMECARE — Approved by the Joint Commission on Accreditation of Healthcare Organizations. A Broward, Miami-Dade and Palm Beach County Home Health Care Agency Serving Coconut Creek, Cooper City, Coral Springs, Dania, Davie, Deerfield, Ft. Lauderdale, Hallandale, Hillsboro, Hollywood, Lauderdale Lakes, Lauderdale-by-the-Sea, Lauderhill, Lighthouse Point, Margate, Miramar, North Lauderdale, Oakland Park, Parkland, Pembroke Park, Pembroke Pines, Plantation, Pompano, Sea Ranch Lakes, Southwest Ranches, Sunrise, Tamarac, Weston, Wilton Manors, Aventura, Hialeah, North Miami, Miami Lakes, Sunny Isles, Bal Harbour, Surfside, Boynton, Boca Raton, Lake Worth & Delray Beach With Comprehensive Home Health Care Services, In-Home Caregivers, Nursing & Home Health Aides for Seniors, Elderly, Disabled, Dementia & Alzheimer’s Patients. Licensed, Bonded, Insured

Why It's Important to Know Your Home Health Care Agency: The San Francisco Chronicle Reports on California Felons Serving as Publicly Funded Home Health Caretakers


Felons still caretakers for vulnerable

San Francisco Chronicle
Published 9:26 p.m., Sunday, September 2, 2012


Three years after California barred felons from serving as publicly funded home health caretakers, people with criminal histories in theft, prostitution and drug possession are still caring for the state's most vulnerable and frail residents.

The situation has led to calls for tougher laws from some district attorneys and lawmakers, who worry the In-Home Supportive Services program is rife with loopholes.

This was not what the headlines heralded in 2009, when Gov. Arnold Schwarzenegger signed legislation to protect about 450,000 low-income elderly, blind and disabled people who rely on the program. But legal wrangling and lack of oversight got in the way.
Background checks were slow to start, then a judge blocked the law from taking effect, and no one tracked many of the felons who were acting as caretakers until another, watered-down law was passed 14 months later.
About 2 of every 3 felon caretakers detected by the state last year were granted waivers by their disabled and elderly clients.
And so far, efforts to shore up the law have failed.
"The system is flawed because it does not disqualify the majority of felons who commit theft offenses," said Patrick Sequeira, a Los Angeles County deputy district attorney. "Most businesses would not hire these felons to work in a position of trust. Why should the government hire these people to care for the disabled and blind?"

How it goes wrong

One such case exemplified how things can go wrong.
Phetsarath Chanthavong, a former home health aide in Fresno County, collected more than $3,000 for the better part of a year beginning in mid-2009, after the patient he was supposed to be caring for left the country, according to court records. Chanthavong had convictions for spousal and elder abuse and making criminal threats, and eventually pleaded guilty to welfare fraud in the In-Home Supportive Services case.
Critics say the weak points of the current law invite fraud from people whose felony convictions limit their job prospects. Caretakers in the home health program earn an average of $9.50 an hour, $1.50 above the state's minimum wage.
"Many people that are doing IHSS fraud have rap sheets," said Mike Elder, a former Fresno County prosecutor who handled the case against Chanthavong.
Chanthavong should have been disqualified from the state program by the 2009 law. But it took more than a year for the state to complete criminal background checks of 390,000 caretakers, more than 800 of whom were barred from continuing their jobs.

Following the law

How many similar cases present future danger is unknown, because the state and counties disqualified only people convicted of the most egregious felonies who sought to become home health aides, both before the 2009 law and during a 14-month stretch after a judge blocked the state from implementing it.
State officials say they simply were following requirements of the law.
"When the legislation was passed, we did not look back; we just looked forward," said Michael Weston, a spokesman for the state Department of Social Services.

Many got waivers

On Feb. 1, 2011, the state began flagging caretaker applicants who had been convicted of "tier two" felonies, such as violent felonies and sex offenses. In all, 747 people were disqualified from the program through mid-March, according to the most recent figures available from the Department of Social Services.
Of those, 516 - about 69 percent - later received a waiver from patients to become their caretaker, allowed under a 2011 law if the conviction did not involve welfare fraud or elder or child abuse - the major disqualifying felonies before 2009.
Schwarzenegger's reforms were supposed to exclude anyone who had committed a felony in the past decade. The law also was intended to help control the spiraling cost of the program by weeding out providers whose records signaled potential for fraud. In the previous eight years, the cost of the program, funded with federal, state and local tax revenue, had more than doubled to $5 billion.
But in November 2009, an Alameda County Superior Court judge found the state did not have the authority to prohibit all felons from working in the program.

Serious felonies

The Legislature responded in February 2011 with a law that barred those who had been convicted of violent or serious felonies, sex offender registrants and people convicted of a felony for fraud against a public social services program.
However, the law allowed people with convictions dating back more than a decade to become caretakers, even if their crime was murder. Those convicted of drug possession and grand theft - among the most common felonies - also can still become home health aides.
Fraud investigators say those are not the best credentials for in-home caretakers, citing the Los Angeles case of Joseph Herd Jr., who became a caregiver despite two felony convictions for drug sales. In 2009, Herd collected more than $1,600 while the person he claimed to be caring for at home was actually in the hospital.
Over the past three years, Sequeira, the Los Angeles County deputy district attorney, has participated in a statewide task force that helped the state develop policies to thwart fraud in the In-Home Supportive Services program. The state Department of Social Services is reviewing the recommendations and intends to have protocols in place this fall.
A bill that would have expanded the list of disqualifying felonies to include some financial crimes - including forgery, identity theft and embezzlement - failed in June in the Senate Human Services Committee.
The Bay Citizen is part of the independent, nonprofit Center for Investigative Reporting. For more, go to www.baycitizen.org. E-mail: jgollan@baycitizen.org


Read more: http://www.sfgate.com/news/article/Felons-still-caretakers-for-vulnerable-3835591.php#ixzz25XVafHts



A FAMILY MEMBER HOMECARE — Approved by the Joint Commission on Accreditation of Healthcare Organizations. A Broward, Miami-Dade and Palm Beach County Home Health Care Agency Serving Coconut Creek, Cooper City, Coral Springs, Dania, Davie, Deerfield, Ft. Lauderdale, Hallandale, Hillsboro, Hollywood, Lauderdale Lakes, Lauderdale-by-the-Sea, Lauderhill, Lighthouse Point, Margate, Miramar, North Lauderdale, Oakland Park, Parkland, Pembroke Park, Pembroke Pines, Plantation, Pompano, Sea Ranch Lakes, Southwest Ranches, Sunrise, Tamarac, Weston, Wilton Manors, Aventura, Hialeah, North Miami, Miami Lakes, Sunny Isles, Bal Harbour, Surfside, Boynton, Boca Raton, Lake Worth & Delray Beach With Comprehensive Home Health Care Services, In-Home Caregivers, Nursing & Home Health Aides for Seniors, Elderly, Disabled, Dementia & Alzheimer’s Patients. Licensed, Bonded, Insured

Ft. Lauderdale, Florida Home Health Care Agency A Family Member HomeCare Notes: U.S. Center for Disease Control and Prevention Reports Wait Time at Hospital Emergency Departments Has Increased



From 1999 through 2009, the number of visits to emergency departments (EDs) increased 32%, from 102.8 million visits in 1999 to 136.1 million visits in 2009. In some hospitals, increased ED visit volume has resulted in ED crowding and increased wait times for minor and sometimes serious problems, such as myocardial infarction.  From 2003 through 2009, the mean wait time in U.S. emergency departments increased 25%, from 46.5 minutes to 58.1 minutes. Mean wait times were longer in EDs that went on ambulance diversion or boarded admitted patients in hallways and in other spaces. Longer wait times were associated with EDs in urban areas (62.4 minutes), compared with nonurban areas (40.0 minutes).

To view the report, click here.


On This Page

Key findings

  • From 2003 through 2009, the mean wait time in U.S. emergency departments (EDs) increased 25%, from 46.5 minutes to 58.1 minutes.
  • Mean wait times were longer in EDs that went on ambulance diversion or boarded admitted patients in hallways and in other spaces.
  • Longer wait times were associated with EDs in urban areas (62.4 minutes), compared with nonurban areas (40.0 minutes).
  • The mean wait time increased as annual ED visit volume increased; from 33.8 minutes in EDs with less than 20,000 annual visits, to 69.8 minutes in EDs with 50,000 or more annual visits.
  • There was no difference in mean wait time for patients needing immediate or emergent care by ambulance diversion status, or by whether the ED boarded admitted patients while waiting for an inpatient bed.
From 1999 through 2009, the number of visits to emergency departments (EDs) increased 32%, from 102.8 million visits in 1999 to 136.1 million visits in 2009 (1,2). In some hospitals, increased ED visit volume has resulted in ED crowding and increased wait times for minor and sometimes serious problems, such as myocardial infarction (3–7). This report describes the recent trend in wait times for treatment in EDs, and focuses on how wait times for treatment varied by two ED crowding measures: ambulance diversions and boarding of admitted patients.
Keywords: emergency department crowding, ambulance diversion, boarding

Has wait time for treatment in EDs increased?

  • Between 2003 and 2009, mean wait time to see a provider increased 25%, from 46.5 minutes to 58.1 minutes (Figure 1).
  • Because wait time is highly skewed, that is, a small percentage (5%) of visits have very long wait times (greater than 3 hours), median wait time is less affected by the skewed distribution and provides an alternative way of describing ED wait time.
Figure 1. Mean and median emergency department wait time to see a provider: United States, 2003–2009
Figure 1 is a line graph showing the mean and median emergency department wait time to see a provider from 2003 through 2009
NOTE: Dotted lines represent change in meaning of emergency department wait time. In 2009, emergency department wait time referred to wait time to see a physician, physician assistant, or nurse practitioner; prior to 2009, emergency department wait time referred to wait time to see a physician. See data source and methods for details.
SOURCE: CDC/NCHS, National Hospital Ambulatory Medical Care Survey.

  • Between 2003 and 2009, median time to see a provider increased 22%, from 27 minutes to 33 minutes.

Does ED crowding affect wait time?

  • In 2009, 33% of ED visits occurred in EDs that reported they went on ambulance diversion at some time during the previous year; 40% of visits occurred in EDs that reported they did not go on ambulance diversion; and 27% of visits occurred in EDs that reported it was unknown whether the ED went on ambulance diversion (Figure 2).
  • The average wait time to see an ED provider in EDs with ambulance diversions (64.3 minutes) was longer than in EDs with no diversions (48.7 minutes), but was similar to EDs for which diversions were unknown (65.2 minutes).
  • In 2009, 78% of visits occurred in EDs that reported boarding admitted patients in hallways and in other spaces while waiting for an inpatient bed to become available.
  • Wait time in EDs with any boarding was longer (61.3 minutes) than wait time in EDs with no boarding (44.1 minutes).

Figure 2. Mean wait time for treatment, by emergency department crowding measure: United States, 2009
Figure 2 is bar chart showing the mean wait time for treatment by emergency department crowding measure for 2009
1Significantly different from no diversion.
2Significantly different from no boarding.
SOURCE: CDC/NCHS, National Hospital Ambulatory Medical Care Survey.

How does hospital location and ED crowding affect wait time?

  • Wait time in urban EDs (62.4 minutes) was significantly longer than in EDs outside of metropolitan areas (40.0 minutes) (Figure 3).
  • The mean wait time among EDs reporting ambulance diversions was not significantly different in urban and nonurban hospitals (64.1 minutes compared with 68.4 minutes). The mean wait time in EDs with no ambulance diversions was longer among urban EDs (55.9 minutes) than among nonurban EDs (38.1 minutes).
  • Among EDs that boarded admitted patients, the mean wait time was longer in urban EDs (64.3 minutes) than in nonurban EDs (42.9 minutes). The difference in mean wait time by hospital location among EDs that did not board was not statistically significant.

Figure 3. Mean wait time for treatment, by emergency department crowding measure and hospital location: United States, 2009
Figure 3 is a bar chart showing the mean wait time for treatment by emergency department crowding measure and hospital location for 2009
1Difference by hospital location is statistically significant (p < 0.05).
NOTE: MSA is metropolitan statistical area.
SOURCE: CDC/NCHS, National Hospital Ambulatory Medical Care Survey.

How does ED visit volume and ED crowding affect wait time?

  • Mean wait time increased as the volume of annual ED visits increased; from 33.8 minutes in EDs with less than 20,000 annual visits, to 69.8 minutes in EDs with 50,000 or more annual visits (Figure 4).
  • Mean wait time to see a health care provider increased as annual ED visit volume increased in each ambulance diversion category.
  • The mean wait time in EDs that boarded patients increased as annual ED visit volume increased. Among EDs that did not board patients, EDs with less than 20,000 annual visits had shorter wait times than those with more than 20,000 annual visits; but there was no difference in wait times for EDs with 20,000–49,999 visits and those with 50,000 or more visits.

Figure 4. Mean wait time for treatment, by emergency department crowding measure and volume of annual emergency department visits: United States, 2009
Figure 4 is a bar chart showing the mean wait time for treatment by emergency department crowding measure and the volume of annual emergency department visits for 2009
1Trend by annual emergency department visit volume is statistically significant. 
2Mean wait time in emergency departments with fewer than 20,000 annual visits is significantly lower than wait times in emergency departments in other volume categories.
SOURCE: CDC/NCHS, National Hospital Ambulatory Medical Care Survey.

Does patient acuity affect wait time for treatment in EDs?

  • Two percent of ED patients were triaged as needing to be seen in less than 1 minute (immediate); 10% were triaged as needing to be seen within 1–14 minutes (emergent); 41% were triaged as needing to be seen within 15–60 minutes (urgent); 35% were triaged as needing to be seen within 1–2 hours (semiurgent); and 7% of patients were triaged as needing to be seen between 2 and 24 hours (nonurgent). No triage system was used for the remaining 4% of patients (Figure 5).
  • Mean wait times for patients triaged as immediate (28.9 minutes) and those with no triage system (38.2 minutes) were shorter than mean wait times for patients triaged as emergent (51.2 minutes), urgent (63.3 minutes), semiurgent (58.7 minutes), and nonurgent (53.5 minutes).

Figure 5. Mean emergency department wait time for treatment, by urgency of patient care: United States, 2009
Figure 5 is a bar chart showing the mean emergency department wait time for treatment by urgency of patient care for 2009
1Difference with immediate care is statistically significant (p < 0.05).
2Difference with no triage is statistically significant (p < 0.05).
SOURCE: CDC/NCHS, National Hospital Ambulatory Medical Care Survey.

Does ED crowding affect wait time for treatment when patient acuity is controlled for?

  • There were no differences in mean wait times for ED patients triaged as immediate or emergent between EDs that went on diversion and EDs that did not go on diversion (Figure 6). Similarly, there were no differences in wait times for ED patients triaged as immediate or emergent by whether the ED boarded any admitted patients.
  • Patients triaged as urgent, semiurgent, or nonurgent, and patients that had no triage, had longer wait times in EDs that went on diversion compared with EDs that did not go on diversion.
  • Patients triaged as urgent, semiurgent, or nonurgent, and patients that had no triage, had longer wait times in EDs that boarded any admitted patients compared with EDs that did not board any admitted patients.

Figure 6. Mean wait time for treatment, by urgency of patient care and whether emergency department experienced ambulance diversions or boarding: United States, 2009
Figure 6 is a bar chart showing the mean wait time for treatment by urgency of patient care and whether the emergency department experienced ambulance diversions or boarding for 2009
1Difference between ambulance diversion and no diversions is statistically significant (p < 0.05).
2Difference between boarding and no boarding is statistically significant (p < 0.05). 
SOURCE: CDC/NCHS, National Hospital Ambulatory Medical Care Survey.

Summary

Mean wait time to see a health care provider in EDs increased from 2003 through 2009. Consistent with previous research, longer wait time for treatment was associated with urban ED locations (inside metropolitan statistical areas) and with increased annual ED visit volume (6).
In 2009, EDs with any ambulance diversion during the previous year were associated with longer wait times, compared with EDs without ambulance diversions. EDs that boarded admitted patients inside the ED, in observation units, or outside the ED (in hallways) were also associated with longer wait times compared with EDs that did not board. In this analysis, mean wait times for treatment did not differ among urban EDs that went on ambulance diversion during the previous year, but mean wait times were longer among urban EDs and nonurban EDs with no ambulance diversions and with unknown ambulance diversion status. Among EDs that boarded admitted patients (either inside or outside ED spaces), mean wait times were longer in EDs with annual visit volumes of 20,000 or more.
The mean wait time in EDs with unknown ambulance diversion status was similar to the wait time in EDs that went on ambulance diversion. The mean wait time in EDs for which boarding was unknown was also similar to the mean wait time in EDs that boarded patients inside or outside the ED. Figures 3 and 4 further indicate that ED visits missing information on ambulance diversions were all located in urban EDs and in EDs with annual visit volumes of 20,000 or more. The long mean wait times for visits in EDs missing information on ambulance diversions, as well as the high percentage (71%) that also reported boarding admitted patients, suggest that these EDs may have been on ambulance diversion.
There was no difference in mean wait time for patients triaged as immediate or emergent between EDs that went on diversion compared with EDs that did not go on diversion. There was also no difference in wait time for patients triaged as immediate or emergent by whether the ED boarded patients.
This analysis indicates that EDs are continuing to experience pressure to treat more patients with fewer EDs and with fewer hospital beds. Patients not requiring immediate care have longer wait times in EDs experiencing crowding (i.e., went on ambulance diversion or boarded admitted patients while waiting for an inpatient bed).

Definitions

Emergency department crowding: An ED is considered crowded when inadequate resources to meet patient care demands lead to a reduction in the quality of care (8).
Ambulance diversion: An ambulance is diverted when hospitals request that ambulances bypass their ED and transport patients to other medical facilities (4).
Boarding: A patient remains in the ED after the decision to admit or transfer the patient has been made (e.g., because an inpatient bed elsewhere in the hospital is not yet available) (4).

Data source and methods

All estimates are from the National Hospital Ambulatory Medical Care Survey (NHAMCS), an annual nationally representative survey of visits to nonfederal, general, and short-stay hospital emergency and outpatient departments. ED visit response rate was 83% in 2009. More details about NHAMCS methodology are available (9).
In 2009, ED wait time data were reported for visits seen by a physician, physician assistant, or nurse practitioner (n = 30,904). Prior to 2009, only wait time to see a physician was reported. The trend in mean wait times was minimally affected by the wording change; the 2009 mean wait time to see a physician (57.2 minutes) was not statistically different from mean wait time to see a physician, physician assistant, or nurse practitioner (58.1 minutes). The median wait time to see a physician (33 minutes) was also not affected by the wording change in NHAMCS. In this report, wait times were not presented for visits not seen by a physician, physician assistant, or nurse practitioner (4.1%).
Data analyses were performed using the statistical packages SAS version 9.2 (SAS Institute, Cary, N.C.) and SUDAAN version 9.0 RTI International, Research Triangle Park, N.C.). Differences in average wait times for treatment by ED and patient visit characteristics were examined using t tests for differences at the 0.05 level.

About the authors

Esther Hing and Farida Bhuiya are with the Centers for Disease Control and Prevention's National Center for Health Statistics, Division of Health Care Statistics.

References

  1. McCaig LF, Burt CW. National Hospital Ambulatory Medical Care Survey: 1999 emergency department summary. Advance data from vital and health statistics; no 320. Hyattsville, MD: National Center for Health Statistics. 2001.
  2. National Center for Health Statistics. National Hospital Ambulatory Medical Care Survey: 2009 emergency department summary tables.
  3. Institute of Medicine, Committee on the Future of Emergency Care in the United States Health System. Hospital-based emergency care: At the breaking point. Washington, DC: National Academies Press. 2007.
  4. U.S. Government Accountability Office. Hospital emergency departments: Crowding continues to occur, and some patients wait longer than recommended time frames. A report to the Chairman, Committee on Finance, U.S. Senate. Washington, DC: Publication No. GAO–09–347 2009.
  5. McCaig LF, Burt CW. National Hospital Ambulatory Medical Care Survey: 2003 emergency department summary. Advance data from vital and health statistics; no 358. Hyattsville, MD: National Center for Health Statistics. 2005.
  6. Burt CW, McCaig LF, Valverde RH. Analysis of ambulance diversions in U.S. emergency departments. Ann Emerg Med 47(4):317–26. 2006.
  7. Wilper AP, Woolhandler S, Lasser KE, McCormick D, Cutrona SL, Bor DH, Himmelstein DU. Waits to see an emergency department physician: U.S. trends and predictors, 1997–2004. Health Aff 27(2):W84–95. 2008.
  8. American College of Emergency Physicians Crowding Resources Task Force. Responding to emergency department crowding: A guidebook for chapters. Dallas, TX. 2002.
  9. National Center for Health Statistics. NHAMCS Micro-data File Documentation. 2009. Adobe PDF file [PDF - 1.4 MB].

Suggested citation

Hing E, Bhuiya F. Wait time for treatment in hospital emergency departments: 2009. NCHS data brief, no 102. Hyattsville, MD: National Center for Health Statistics. 2012.

Copyright information

All material appearing in this report is in the public domain and may be reproduced or copied without permission; citation as to source, however, is appreciated.

National Center for Health Statistics

Edward J. Sondik, Ph.D., Director
Jennifer H. Madans, Ph.D., Associate Director for Science
Division of Health Care Statistics
Clarice Brown, M.S., Director

A FAMILY MEMBER HOMECARE — Approved by the Joint Commission on Accreditation of Healthcare Organizations. A Broward, Miami-Dade and Palm Beach County Home Health Care Agency Serving Coconut Creek, Cooper City, Coral Springs, Dania, Davie, Deerfield, Ft. Lauderdale, Hallandale, Hillsboro, Hollywood, Lauderdale Lakes, Lauderdale-by-the-Sea, Lauderhill, Lighthouse Point, Margate, Miramar, North Lauderdale, Oakland Park, Parkland, Pembroke Park, Pembroke Pines, Plantation, Pompano, Sea Ranch Lakes, Southwest Ranches, Sunrise, Tamarac, Weston, Wilton Manors, Aventura, Hialeah, North Miami, Miami Lakes, Sunny Isles, Bal Harbour, Surfside, Boynton, Boca Raton, Lake Worth & Delray Beach With Comprehensive Home Health Care Services, In-Home Caregivers, Nursing & Home Health Aides for Seniors, Elderly, Disabled, Dementia & Alzheimer’s Patients. Licensed, Bonded, Insured