HealthBiz: ACE units fill growing niche


WASHINGTON, Jan. 25 (UPI) -- There are 76 million baby boomers heading toward retirement and U.S. healthcare is trying to find ways to handle what figures to be a huge increase in medical services for the elderly, who tend to have multiple conditions and chronic illness. Acute Care for the Elderly or ACE units in hospitals are becoming an important resource.

"We need to really master how best to take care of that population in anticipation of the growth in that population with the baby boomers," Wendy Osgood, administrative director of geriatric services at the Maine Medical Center in Portland, told UPI's HealthBiz. "It's a big issue that I think has gone unrecognized."


ACE units are not new -- they have been around since the 1990s and are well-studied by the gerontology sector -- but they are under-the-radar in terms of publicity and more general public awareness. In 2001, there only were 15 or so such units, but now more facilities are including them, including Warminster Hospital near Philadelphia, which opened an ACE unit this week.


Lauren Ellis, the hospital's nursing director for the unit, told HealthBiz the 20-bed operation will "extend a more specialized service level to our community of geriatric patients."

Warminster's ACE unit includes two private hospice rooms to accommodate patients and families and a ward of four beds with specialized lighting and music, staffed around-the-clock, to allow disoriented or combative patients a restraint-free environment.

"What you want to do is take the geriatric population -- and keep in mind, of course, all the problems they can encounter that tend to draw out length of stay or make them sicker -- and minimize the use of invasive procedures and diagnostics," Ellis said. "You want to get them out of bed, so they aren't deconditioned, minimize confusion and disruption ... decrease length of stay and get them home sooner."

Typical ACE units begin with 10 to 20 beds and provide physical therapy, art therapy, pet therapy and other activities for social stimulation. At the same time, however, they also provide all of the medical services a general acute care hospital unit offers -- just targeted for the specific needs of elderly patients. Unit rooms may be more senior-friendly, allowing for more bathroom space and comfortable furniture.


ACE units draw patients from the emergency department or other hospital units. Some target patients going home or to assisted living, and may not accept nursing home patients, while other units take all types of patients. The make-up of the unit varies with the demographics of the community and is targeted to meet those needs and complement existing services.

"We do our best to keep people at the greatest level of independence," said Dr. Hal Atkinson, assistant professor in the Department of Internal Medicine's section on gerontology and geriatric medicine at Wake Forest University Baptist Medical Center in Winston-Salem, N.C.

"We know that older people who have an acute illness are at risk for losing a lot of functional ground," he told HealthBiz.

What makes these units work and makes them unique -- and Atkinson said other hospital departments would benefit from a similar approach -- is interdisciplinary teamwork and communication. Physicians, nurses, nutritionists, therapists, pharmacists, pastoral care providers -- the entire spectrum of professionals involved in caring for patients on the unit -- meet every day and discuss each patient.

"It's not easy to get six or seven different disciplines to sit in a room together," Dr. Joseph Flaherty, associate professor of geriatrics at St. Louis University School of Medicine, told HealthBiz. "We can discuss 20 patients in one hour. You have to have a facilitator to run the meeting ... all they have to know is to stay on time and keep the order."


Dr. Heidi Wierman, of the Maine Medical Center's ACE unit, which opened last September, said the operation stems from "a general recognition that we can provide better care to our geriatric population, and the communication among team members is really important. This patient population has the most to lose for lack of having this process involved."

Patient and family satisfaction with ACE units runs high. The American Hospital Association said it is not tracking the facilities, but their popularity is growing nationwide.

"As baby boomers become more demanding, they're going to choose hospitals with ACE units if there is a choice within the city," Flaherty said.

In-house studies at St. Louis and at Wake Forest, which began ACE units in 1997 -- show a reduction in the average length of stay of about one day. Flaherty said it takes at least a year -- maybe longer -- "to figure out how you are doing" in terms of outcomes, including LOS.

ACE units make sense for hospitals planning for 2030, when 20 percent of the population will be 65 or older and the number of seniors 85 and older is expected to double.



Social Security is top dog, but on Monday the Republicans and Democrats in the Senate placed healthcare in the top tier of issues for this session. In outlining legislation for reporters, neither party proposed anything really new, but there appears to be bipartisan concern over headlines being generated by the Food and Drug Administration -- which could receive closer scrutiny in light of drug importation, the COX-2 debate, and the larger issue of the FDA's handing of a pharmaceutical industry from which it receives financial support.

"Rising healthcare costs and access to affordable health insurance are two of the biggest worries that Americans face today. Last year Majority Leader (Bill) Frist (R-Tenn.) appointed a task force to take a look at the problem of accessibility, affordability and quality in health care, and we came up with a package of some 15 bills that would solve that," said Sen. Mike Enzi, R-Wyo.

"We've got the doctors, we've got the lawyers, we've got the insurance companies, and yes, we have the patients, too," Enzi added, "and each of them have ideas for how the other groups can solve their problems. What I want to know is how those people themselves can solve their problems. And we'll combine all of those and come up with a future version of the bill."


Enzi, chairman of the Senate Health, Education, Labor and Pensions Committee, said "critical features" of the GOP's Healthy America proposal include expanding health savings accounts, medical malpractice reform, tax credits for the purchase of health insurance, pushing along electronic medical records and expanding community health centers, all items proposed by President Bush, some several times. The malpractice issue, which along with tax credits and association health plans have failed to gain a footing in the Senate in past attempts. Republicans, though, picked up three seats in November's election -- a point Democrats keep central in their planning.

"The first responsibility of anyone in the legislative scene is to know how to count, and we can count -- it's 55-45," said Sen. Dick Durbin, D-Ill. "But the agenda that we lay out today is a suggestion of our vision, not only of where America should go but where this Senate should go. The vision of the Republicans is very clear. It's called the 'ownership society.' What is the ownership society? I think you can boil it down to just one basic statement: Just remember, we're all in this alone."

Democrats are pushing for legalizing importation of FDA-approved prescription drugs, reaffirming support for Medicaid and expansion of health coverage for pregnant women and children, as well as tax credits for small employers who offer health insurance to employees. It was pointed out the Democratic agenda is very similar to that proposed by Sen. John Kerry, D-Mass., during his failed presidential campaign.


"These are important issues, important to the American people," responded Minority Leader Harry Reid, D-Nev.

Sen. Mark Dayton, D-Minn., also introduced legislation to amend the Medicare Modernization Act of 2003. It would allow the government to negotiate lower prescription drug prices for Medicare beneficiaries, a hot topic since the law specifically prohibits such activity. The Dayton bill also would eliminate new federal subsidies for managed care plans, deal with the coverage gap in the prescription drug benefit and ensure retirees with employer-provided coverage do not lose it because of the MMA.

Enzi said the issue of drug safety is of concern to both parties and added, "We will be holding probably several hearings that will deal with drug safety legislation, including a closer look at the FDA, some reforms that might be needed there, and also flu vaccines. We'll have to see how cooperative we can be on the issues, but so far there's a lot of cooperation expressed."


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