“I’m not staying in the hospital tonight”: How Emergency Departments can leverage health and social services at home to support care transitions for older patients

The COVID-19 crisis has exposed deep problems in the way we care for medically complex older adults. However, it has also accelerated opportunities to support and keep these individuals safely in their homes both during the pandemic and in the future. Mrs. C’s situation represents the common ED dilemma of an independently living, medically complex older person with declining health who doesn’t necessarily require hospitalization. Many ED providers would admit Mrs. C to the hospital, potentially increasing her risk for COVID-19 or other nosocomial infection and filling a bed potentially needed by a sicker patient. Alternatively, she might be sent home alone, but risk returning to the ED quickly. However, there is a third option, where providers could ensure Mrs. C’s safe transition back home by discussing her goals and preferences, assessing her medical and social needs, identifying gaps, and arranging in-home services right from the ED. We propose that by investing in transitional care coordination encompassing comprehensive assessments, onsite case management and referrals to health and social services at home, EDs can meet the medical and social needs and the preferences of patients like Mrs. C.