Female Nurse Assisting Senior Woman

It may be possible to give older people better care during emergency room (ER) visits while keeping costs down for insurers and hospitals. A recent study revealed that geriatric nurse specialist (GENIE) consults have a particularly positive impact in this area. 

GENIE consults were linked with a 13% reduction in admissions, modestly higher emergency department revisits, and a lower cost of inpatient and emergency department care, the study found. Older people who need emergency care often have complex medical needs and perhaps multiple conditions or diseases. Therefore, there is a need for improved care that pulls in additional resources long after the hospital visit.  

The team looked at people who were ill and needed testing, but weren’t critically ill. This subset of people often have abnormal vital signs and may need laboratory testing or imaging done. 

The GENIE screens for delirium, depression, fall risk, pain, elder abuse, dementia and palliative care needs. Then that GENIE nurse coordinates care including social workers, pharmacy resources and other services. (The study didn’t include physical therapy, but that is a service often coordinated in geriatric emergency departments.)

While there is a need for GENIEs, they are not being used on a widespread basis. That’s due to a lack of funding for the staff, and the absence of reimbursements for the program, authors wrote in an editorial that accompanied the study.

“Payment and reimbursement incentives to hospitals could drive dissemination of this care model,” wrote the authors, who urged the Centers for Medicare and Medicaid to heavily consider this model. 

“Currently, the inpatient hospitalization is the only option for most emergency physicians caring for a patient in need of comprehensive geriatric care,” they wrote.