A warm, friendly smile in a hospital emergency department is comforting at any age; especially if you’re confused and not sure how you arrived there – often the case for many senior citizens. And no one knows that better than the Westover family who found a special kind of comfort for their elderly mother at Toronto’s Humber River Regional Hospital (HRRH) in September.
“From the minute we met Lynn Demchuk, the Geriatric Emergency Management (GEM) nurse, she was kind, gentle and took the time to get to know our mother and her situation,” says Ken Westover, whose 85-year-old mother Muriel suffers from mild dementia. “Most importantly, Lynn reassured our family that she would be able to help us find a solution. She was wonderful and coordinated all of the details for my mother to move into the retirement residence that day – earlier than we had anticipated,” he adds.
The GEM nurse position, which began in 2004, is funded by Ontario’s Ministry of Health and Long-term care and functions at several hospitals across the province. It has proven to be a very valuable role. “Our GEM nurses understand the needs of seniors and the community services available to this group of people,” says Dr. Rakesh Kumar, Humber River’s Chief of Emergency Services. “Senior citizens over the age of 65 have the highest emergency department visit rate and that isn’t going to change anytime soon. Our GEM nurses make our emergency department and hospital very ‘senior friendly’ and we are really proud of that,” he notes.
Stella Cruz is another one of those ‘gems’ working hard to make that happen. In fact, Cruz is proud to be one of the original GEM nurses, who, along with other colleagues was instrumental in developing the GEM position in the emergency departments across the Humber River organization. Since the inception of the position, Cruz said she’s seen the job develop into a highly specialized role that is truly remarkable.
“Humber River’s GEM nurse role is unique because it provides both patients and their family members with an opportunity to receive assistance from an advanced practice nurse with a specialized focus in geriatric care while in the emergency department,” says Cruz. “The GEM nurse utilizes his/her education, expertise, leadership, effective communication skills and knowledge regarding geriatric syndromes and common diagnosis to help address patients and families’ questions or concerns. It’s very valuable for our elderly patient population,” she adds.
The most common concerns from elderly patients include confusion over medications and mobility problems. Falls and other patient safety-related issues are also regularly discussed. In order to quickly address and resolve these issues, Humber River’s GEM nurses work in collaboration with the HRRH emergency department, physicians, social workers and nurses to ensure the patient is safe at all times. The GEM nurse works together with community organizations to arrange placements in nursing or retirement residences for those patients who are unable to return to their homes.
“These placements are often done in the emergency department in a quick and efficient manner to help expedite a timely discharge from the ER and eliminate the need for a hospital admission,” says Cruz. Regardless of the circumstances, a plan of care is developed by the GEM nurse. Referrals are often made to specialty clinics (geriatric clinic, palliative care unit, fracture clinic) or to outside organizations including the Community Care Access Centre (CCAC), Mental Health Outreach Team or Meals on Wheels, to name a few.
“There have been so many positive outcomes – hospital-wide – as a result of this program,” says Dr. Kumar. “Seniors are receiving the specialized care they require and are then, in collaboration with HRRH, receiving community support so they can remain in their homes as long as possible. Another positive aspect of the program is that our GEM nurses are very passionate about what they do, and that’s important,” he adds.
“Some of my most memorable cases are those in which patients and family members were able to sit together and develop a plan of care that was suited to meet their needs upon discharge,” explains Cruz. “Patient advocacy is incredibly important as is the promotion of independence of the elderly. The GEM nurse helps patients and their families find that inner voice and assists them as they navigate through the emergency department and hospital back home. It’s really rewarding,” adds Cruz.
Ken Westover couldn’t agree more. “The GEM nurse was extremely helpful to us,” he says with a big smile. “We are quite pleased that our mother isn’t going home – where she might cause danger to herself. Lynn made the transition easier for us and I feel a hundred times better.”