When an 82-year-old woman with multiple chronic conditions arrived at the Kaiser Permanente Santa Clara Emergency Department after a fall at home, she was quickly triaged by a nurse trained in geriatric screening and assessment protocols.
When evaluating the woman, the nurse used what is called the “5Ms framework.” That framework guides staff to address all aspects of an older adult’s health and well-being. The 5Ms stand for mobility, mind (cognition and mental health), medications, multicomplexity, (complex medical conditions), and what matters most. The nurse discovered that the Santa Clara patient lives alone and didn’t eat or drink enough, which contributed to her fall.
“The tailored assessment helped staff to identify not only her physical fall injuries but contributing health challenges common among older adults, including dehydration and medication mismanagement,” said Hazel Aspiras, MSN, RN, Emergency Department manager at the Santa Clara Medical Center.
Care focused on older patients
A multidisciplinary team — including a nurse, physician, social worker, and patient care coordinator — collaborated to build a comprehensive care plan, ensuring the 82-year-old patient received appropriate treatment, medication review, and fall prevention support.
These age-specific tools are central to the department’s commitment to provide top-notch care for the growing population of patients 65 and older. By 2050, the number of Americans in that age group is likely to increase from about 58 million to 82 million, a 47% jump, the US Census Bureau projected in 2023.
These tools also reflect why the department received an accreditation for geriatric care. To receive accreditation, the department met a higher quality of care. Examples of that higher level of care include educating staff, making physical environments geriatric friendly, and establishing quality measures.
“This holistic approach exemplifies the value of Geriatric Emergency Department Accreditation,” said Aspiras. “This accreditation ensures older adults receive tailored, high-quality care that meets their unique needs.”
Expanding accreditation
In May, Santa Clara became the latest Kaiser Permanente Northern California emergency department to earn Level 2 Geriatric Emergency Department Accreditation, a national recognition for emergency care specifically designed for older adults.
With Santa Clara’s recent accreditation, 10 Northern California emergency departments have now earned the prestigious designation, including Antioch, Fremont, San Francisco, San Leandro, Santa Rosa, South San Francisco, Redwood City, Vacaville, and Walnut Creek.
“The accreditation highlights practices and interventions that support Kaiser Permanente’s model of care for older adults,” said The Permanente Medical Group Regional Director Tracy Broce, DNP, RN. “The ultimate goal is to have all emergency departments across the region apply for and receive the designation.”
Nurses played a pivotal role in achieving the accreditation. A nursing work group led self-assessment, identified opportunities for improvement, and helped champion new workflows and training focused on older adult care.
Work group champions audited charts to verify geriatric protocols were being followed and shared best practices and care coordination among nurses, physicians, and social workers — ensuring the protocols were embedded into daily practice.
“By addressing both the immediate needs and the underlying health risks facing older adults, we’re improving outcomes and reducing the risk of readmissions,” Aspiras noted. “Our patients and families can be assured that they are receiving care from a team that meets national standards and understands the complex needs of older adults.”
