Cynthia Hamada was horrified when her 92-year-old father, Wallace, fell at a skilled-nursing facility this month.
Her father, who is on blood thinners, was rushed to San Francisco General Hospital, the only Level 1 trauma center in The City, amid fears that he may have hit his head. Wallace Hamada is also hard of hearing, making communication difficult.
But Cynthia Hamada said her nightmare eased in the early-morning hours of Feb. 5 upon her father's admittance to San Francisco General's Acute Care for Elders unit, a component of the trauma center that focuses on maintaining and improving the physical function of older adult patients and returning them to a community setting.
The unit, the first of its kind in California, marked eight years of service Friday.
“They have to have sensitivity to not only some of the dementia issues that occur with some of the elderly, but also they have to be sensitive to their social needs as well,” Hamada said of health care workers who treat her father and other elderly patients, as she ate lunch with her father in the ACE unit's communal eating space where patients are encouraged to dine together.
That personal care, hospital officials say, is exactly what the ACE unit seeks to accomplish.
“The geriatrics approach is to look at the whole person, and ask, 'What can I best do to maintain independence and quality of life for this person, who may be hard of hearing, may have dementia and not understand the medications that they're taking, may be very frail?'” said Dr. Edgar Pierluissi, the unit's medical director.
The approach taken by Pierluissi and his team of doctors and nurses is, essentially, to promote the best quality of life for a patient with the least amount of risk.
Pierluissi has led the unit since its inception in 2007, and on Thursday, received a Heroes & Hearts award from the San Francisco General Hospital Foundation, which honors community leaders.
The doctor is also leading the unit into its next home, the new 453,000-square-foot complex at San Francisco General that is slated to open in December.
The unit today includes 12 beds and is embedded in a medical surgical ward on the fifth floor. The new facility will feature 32 beds and is being designed specifically to meet the needs of the elderly patients, with ubiquitous handrails to promote walking and a larger community room to accommodate more social activities.
All of the hospital rooms will also have windows, and the ACE unit will even have its own private rooftop garden space. While the entire hospital will have access to the rooftop garden, the ACE unit's space will be separated to prevent patients from getting lost.
When the local unit first opened eight years ago, there were about 30 or 40 ACE units nationwide, and none in California, although the concept was born in the early 1990s. The unit was designed to assist elderly patients with the transition from hospital to home.
“There is a lot of research that's been done over the last 30 years that makes the case that in older adults, despite the fact that we understand and then treat appropriately the reason why they came to the hospital, despite the fact that we do that well, people leave the hospital with worse function than they started out,” Pierluissi explained.
For example, a third of all patients over 65 who come to a hospital reportedly will leave worse than when they arrived, he noted.
<p> "It makes you question what's happening in the hospital, that maybe because we're not really paying attention to it, it may promote disability," said Pierluissi, referring to some areas a hospital may need to improve to address the issue.
Today, there are some 300 ACE units in the U.S., and at least 15 in California.
Promoting mobility is a key focus of the unit, Pierluissi said.
“Some of this went against the existing culture … that if somebody is confused, you don't want them to hurt themselves, so you tie them down,” he said of when the unit opened. “Ours is the absolute opposite approach. If somebody's confused, you untie them, you get rid of barriers to their movement, you just support them to move around safely.”
San Francisco's unit, however, is poised to begin offering patients even more mobility when the hospital becomes the first in The City and possibly California to equip patients in the ACE unit with accelerometers that will track their physical activity, including sleep, Pierluissi said.
Patient movement is currently noted by nurses, who enter the data on their shift reports, such as if a patient walks or gets out of bed and into a chair. The accelerometers will better follow such progress and allow the hospital to better understand whether patients are moving enough or encourage families to take a more active role because the data is more available.
The 20 accelerometers, which are slated to be implemented June 1, will be clipped to a belt worn by the patient around their waste. Pierluissi acknowledges this may take some getting used to.
“Patients might not understand it and take it off, it may be bothersome to some people,” Pierluissi said. “And so we just want to learn: 1) Will patients wear them for a period of time? 2) Can we understand how to interpret the signals from the accelerometer and have it categorize the signals into actual activities like walking, sitting, sleeping?”