How Family Caregivers Can Navigate the Emergency Department With an Older Adult

When you prepare and know what to do, your loved one may get better care

Kim Painter,

AARP

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En español

Published November 20, 2023

Close up of sign for emergency department in hospital

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No one loves going to a hospital emergency department. It’s often noisy, chaotic and crowded. Long waits are common; information about what’s going on may not be forthcoming or clear.

And yet older adults and their caregivers sometimes have to make that trip. It’s best to plan for it, doctors and patient advocates say. Caregivers who learn to navigate the emergency department (ED) can make a big difference in their loved one’s care, they say.

Too often, “people are unprepared,” says Carol Levine, a senior fellow at the United Hospital Fund, a nonprofit organization that focuses on improving health care for New Yorkers, and former director of its Families and Health Care Project. “You just don't want to think about what would happen if we had to go to the emergency room.”

Once there, “the emergency department can be a scary place for anyone,” but especially for older adults with any problems seeing, hearing, walking or thinking, says Martine Sanon, M.D., an associate professor of geriatrics and palliative medicine at the Icahn School of Medicine at Mount Sinai, New York. Those with effective caregivers are fortunate, she says: They have a “an extra set of eyes and ears [and an] advocate to keep things moving in the right direction.”

So how do you become that advocate? Here are some tips for each step of the way.

Before an emergency

Next Step in Care, a website Levine helped create, says that every caregiver should set up a hospital emergency kit, with health histories, doctors’ names, medication records, copies of insurance cards and essential legal documents, such as those that name health care proxies.

Registered nurse and patient advocate Barbara Abruzzo, of New York City, says she did exactly that when she was a caregiver for her mother many years ago. When she showed up with all that information in the emergency department, she says, doctors and nurses were often pleasantly surprised: “It was so helpful to them and to the patient.”

Abruzzo and Levine also urge caregivers to research nearby emergency departments. You may learn, they say, that some are better than others for certain emergencies, such as stroke response or trauma care. Also, some facilities offer enough special supports for older adults to be certified as geriatric emergency departments by the American College of Emergency Physicians. Some emergency departments haven’t gone through the certification process but do have age-friendly features, such as geriatric social workers and nurse practitioners on duty, says Todd James, M.D., a geriatrician and professor of medicine at the University of California San Francisco. It's wise to check ahead to see whether the facility accepts Medicare to avoid paying any unnecessary costs.

When an emergency happens

Sometimes, it’s OK to drive someone to the ED (a sick or injured person should never drive themselves). In life-threatening situations or if you are in doubt, call 911, says the emergency physicians’ group. If you do, the emergency medical workers who respond will make the final call on which hospital to go to, Abruzzo and Levine say. But “I would always make the request” about a preferred ED, Abruzzo says. A good reason — such as having records at one hospital but not another — could be persuasive, Levine says.

If possible, bring items your loved one might need, such as a cane, walker or wheelchair, reading glasses or hearing aids, says Megann Young, M.D., a patient advocate who is also a part-time emergency department doctor in California. Also think of small comforts, she says, such as blankets and pillows for cold rooms with plastic furniture.

Depending on what’s wrong and what tests they need, your loved one might not be able to eat and drink. But bring a snack for yourself, she says: “You might be sitting there for hours. … Be prepared to wait for twice as long as you think is reasonable.”

When to head to the ED

Not sure whether the person you are caring for really needs to go to the emergency department? You might call their doctor or an insurance company help line for advice. But you should head to the ED or call 911 if you can’t reach an adviser or if the person has any of these symptoms:

Trouble breathing
Pain or pressure in the chest or upper abdomen
Fainting, dizziness or weakness
Sudden vision changes
Slurred speech or trouble speaking
Sudden confusion or delirium
Sudden or severe pain
Uncontrollable bleeding
Diarrhea or vomiting that is severe or doesn’t stop
Coughing or vomiting blood
Suicidal feelings
Worsening or new problems moving arms or legs
A serious fall or other accident
Other problems a doctor has said are emergencies

Source: Next Step in Care (nextstepincare.org)

Bring your phone charger, James advises. And use the phone as soon as you can to let the patient’s primary doctor or relevant specialist know what’s happening.

While it’s smart to bring a medication list, it’s even better to bring a bag with all the patient’s medications, James says. That will give the staff extra information, he says. But don’t assume your loved one will be able to take their regular doses during the emergency visit, Young says. There may be medical reasons to wait, so always ask the staff, she advises: “Probably half the time we say, ‘Oh yeah, go ahead.’ And about half the time we say, ‘Heck no.’ ”

While you’re in the emergency department

“First of all, stay with them, if that’s allowable by hospital policy,” Young says. “Just the presence of a familiar person can be so helpful.”

Be ready to explain, clearly and briefly, why you are there. You’ll probably talk first to a triage nurse, who decides how quickly someone gets treated, Abruzzo says. “We want the caregiver to focus on the main event” — the accident, symptom or other change that brought you there.

What caregivers share can be extremely helpful, the professionals say.

“We’re going to certainly talk to our patient and try to get the history, but we recognize that the caregivers know this individual the best,” Sanon says. The caregiver can point to “subtle changes we may miss,” she says. “It goes a long way when you say, ‘Well, this is not how Mom would normally behave.’”

When you talk about your loved one, ask for their permission, James urges. That “sets the tone that this encounter is about the patient,” he says. The staff can share medical information with you if they have the patient’s permission, he adds.

It’s especially important for caregivers to speak up, the doctors say, if they see new signs of trouble — like someone becoming agitated or confused in a noisy, bright environment where sleep may be impossible. Older people who spend many hours in the emergency department — sometimes after they’ve been admitted, in a hospital with too few beds — are at increased risk for delirium, James says.

One of the toughest things to do is to stay calm and polite, Levine says. She knows that from experience. As a caregiver for her late husband, who lived 17 years with paralyzed arms and legs and brain damage after a car crash, she encountered emergency room staffers who seemed maddeningly insensitive to his disabilities, she says. “They would say things like, ‘Oh, can you hop up on this table?’ They were not really seeing the man in front of them.” But Levine says she tried to stay calm and helpful, for her husband’s sake, saying, “Oh, I’m sorry, you know, because of his condition, he can’t do that.”

In the emergency department, “everybody gets a little cranky,” Young says. But “if I give you the benefit of the doubt and you give me the benefit of the doubt, we can all work together.”

After the emergency

If your loved one isn’t admitted to the hospital or another facility, you’ll be sent home with discharge instructions that should tell you next steps — like calling your loved one’s primary doctor for a follow-up appointment.

If anything is unclear, Young says, ask this question: “Who do I need to see and when do I need to see them?”

If you’ve been told that someone else, like a social worker, will set up follow-up appointments for you, make sure you have that person’s contact information, Levine says.

Sometimes, James says, caregivers are asked to do things they don’t feel able to do — anything from dressing wounds to making room in their homes for the discharged person. Speak up before you leave the emergency department, he urges. “I want caregivers to be empowered to state their concerns, their limitations and their willingness,” he says. “They’re asked to do sometimes impossible things.”

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Kim Painter is a contributing writer who specializes in health and psychology. She frequently writes for AARP's Staying Sharp and previously worked as a health reporter and columnist at USA Today.