AURORA, Ill. (AP) 鈥� , especially for older patients. Some wait for many hours or even days before they get a hospital bed.
In collaboration with The Associated Press, Side Effects Public Media鈥檚 Ben Thorp reports that experts say things will only get worse as the U.S. prepares for a 鈥渟ilver tsunami鈥� 鈥� that is, an aging population, which may come with complex diseases and more dementia cases.
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Ben Thorpe, Side Effects Public Media reporter: Tracy Balhan flips through old photos of her dad, Bill Speer, at their vacation home in Indiana. In one photo, her father wears a t-shirt in front of a sweaty bucket of beer bottles.
BALHAN: 鈥淗e does have my shirt on: Pops. The man. The myth. The legend.鈥�
THORPE: Balhan misses her dad. She even keeps some of his old voicemails.
SPEER VOICEMAIL: 鈥淚鈥檓 going to go to the place tomorrow so I want to know what I want to complain about. If you get a minute, give me a call." (Balhan laughing, fades under).
THORPE: Speer passed away last year after a long struggle with dementia. They routinely ended up in the emergency room.
During one stay, he spent 12 hours in the ER of Endeavor Health in Naperville, Illinois waiting for a psych evaluation.
BALHAN: 鈥淗e was strapped down. There was nothing he could do. So he was fighting, like banging his head, you know, like, doing the things.鈥�
THORPE: The hospital said they wouldn鈥檛 comment on Speer鈥檚 experience, citing patient privacy.
Balhan didn鈥檛 know it then, but her dad鈥檚 ER experience is so common it has a name: ER boarding.
In 2022, the most recent year we have data for, 3 million visits to an ER that led to a hospital admission had a wait of four hours or longer before getting a regular hospital bed. That鈥檚 according to an analysis by The Associated Press and Side Effects Public Media.
Data suggests that half of the patients who were boarded were 65 or older. Experts say at this rate, it鈥檚 unlikely things will get better.
Arjun Venkatesh, Yale researcher: 鈥淧eople have way more complicated illnesses. Some people are living longer and longer with the complexities of diseases like cancer, lung disease 鈥︹��
THORPE: That鈥檚 Arjun Venkatesh, who studies emergency medicine at Yale.
Other experts warn of a 鈥渟ilver tsunami鈥� of patients that will hit ERs. That鈥檚 because the rates of dementia in the U.S. are expected to grow over the next few decades.
Venkatesh says part of the problem is a lack of staffed hospital beds.
VENKATESH: 鈥淲e have about just as many hospital beds in America today as we did 20 years ago. The reason that鈥檚 a problem is that emergency department visits are up 30-40% over that time.鈥�
THORPE: And he says hospitals tend to prioritize scheduled care patients, whose insurance companies will reimburse them better for things like cancer care and orthopedic surgeries.
That means there aren鈥檛 incentives to bring patients from backed-up ERs into a hospital bed on another floor.
That leaves patient caregivers in a tough spot. They say when they鈥檙e in crisis, they don鈥檛 know where else to go 鈥� besides the ER.
Nancy Fregeau, Illinois resident: 鈥淚t鈥檚 where you end up. Because it鈥檚 like, what do I do? It鈥檚 an acute behavior. I need to do something."
THORPE: This is Nancy Fregeau. In 2024, she took her husband, Michael Reeman, to the emergency room in Kankakee, Illinois, three separate times. One of those times led to an emergency room stay longer than 10 hours waiting for specialized care.
FREGEAU: 鈥淚t鈥檚 hard enough for anyone to be in the ER, but I cannot imagine someone with dementia being in there. That was so hard for him. He just kept saying, 鈥榃hen am I going? What鈥檚 happening?鈥� Because he just didn鈥檛 understand.鈥�
THORPE: Fregeau 鈥� and most of the families we spoke to 鈥� do not blame the nurses and doctors for the long stays. They say the problem appears to be much deeper.
Several national organizations, including the American College of Emergency Physicians, have been advocating for systemic changes on the policy and hospital levels to tackle ER boarding.
But those groups say the effort hasn鈥檛 moved the needle far enough.
Tracy Balhan says the emergency room experience has stuck with her.
BALHAN: 鈥淧eople didn鈥檛 look at my dad as a man when we were going through the worst of it. It didn鈥檛 feel to me like he was being treated with any dignity.鈥�
More than that, caregivers like Balhan say their experiences leave them worried that the U.S. health system isn鈥檛 prepared to handle a population of dementia patients that is only expected to grow.
I鈥檓 Ben Thorp, Side Effects Public Media.
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This story comes from a collaboration between The Associated Press and Side Effects Public Media. Learn more at apnews.com. Side Effects is a health reporting partnership among NPR member stations across the Midwest.
Devna Bose/associated Press And Benjamin Thorp/side Effects Public Media, The Associated Press
