According to the U.S. Census Bureau, Americans over 65 will number more than 77 million by 2034. Seventeen percent of these older adults are twice as likely as middle-aged adults to require hospitalization at least once a year (Covinsky & Palmer, 2021). They’re also more susceptible to complex medical conditions, cognitive and psychosocial decline and complications during hospitalization.
Acute Care for the Elderly (ACE) units in hospitals address these realities by focusing on the unique clinical and psychosocial needs of elderly patients. Tricia Dela Paz, nurse manager of the 34-bed ACE Unit at California Pacific Medical Center (CPMC) Mission Bernal Campus, explains.
What is an ACE unit?
TDP: A hospital ACE unit provides specialized, comprehensive and coordinated care for older adults. It’s designed to enable elderly patients to maintain their independence, psychosocial well-being and cognitive abilities without succumbing to their critical illness.
What compelled CPMC to open an ACE unit?
TDP: According to research, length of stay and readmission rates for patients age 70 and older are much higher than for the rest of the population. A three-year study with Hospital Elder Life Program (HELP) showed that ACE interventions not only lower these metrics but save the hospital over a million dollars a year. It made sense to translate this work into a specialized geriatric unit.
The study showed 2146 HELP patients with an average age of 82.1 showed improvement in 30-day readmission rates, with a readmission rate of 11.3% in the HELP group and 13.5% in the control group. Detailed age data noted statistical significance only in the 70-85 population for readmission. ALOS was 5.6 and 6.2 days respectively in the HELP and non-HELP population. ALOS was also statistically significant across 70-85 and 85 +.
What are ACE unit best practices and goals?
TDP:
ACE approaches that serve older adults include early and frequent mobilization; sleep hygiene protocols, such as encouraging daytime wakefulness and sleep at night; judicious medication use with emphasis on nonpharmacologic means of achieving medical goals when possible; robust gerontologic nurse training; an interdisciplinary, collaborative care model; and a physical environment that’s safe and uncluttered, with good lighting and support railings.
Beyond the ACE Unit, we share these best practices with other CPMC and Sutter Health entities, including medical-surgical and telehealth, through routine leadership communication, daily safety huddles and the Geriatric Council.
It’s our goal to promote and maintain all older adults’ functional independence with activities of daily living. We strive to deliver the care and planning needed to ensure a safe and successful transition from hospital to home or other care setting.
Who’s on the ACE interdisciplinary team?
TDP: An Elder Life Nurse Specialist leads the ACE Unit team, which includes a geriatrician, nurse, social worker, case manager, physical therapist, occupational therapist, registered dietitian, pharmacist, music therapist, and volunteers specially trained to assist in activities of daily living.
What training does the ACE staff receive?
TDP: Staffing and training are essential to ensure that everyone has the expertise and skills to provide specialized care for older adults. Every team member receives geriatric training through the Nurses Improving Care for Healthsystem Elders (NICHE) program. We also highly recommend ANCC Gerontological Nurse Certification. Sutter Health supports training and education through the RN Certification Recognition Program, which offers bonuses for RNs who pursue and maintain a certification.
What therapies or treatment protocols do staff provide?
TDP: Numerous therapies support ACE Unit clinical care. We use group or individual activities, including music therapy, guided imagery, pet therapy, spiritual care, pain management, talk therapy and more, to encourage socialization and mobility. Rehabilitation focuses on exercise, socialization and better sleep. The Hospital Elder Life Program (HELP) develops a personalized care plan for each patient to stay mobile and social and to prevent delirium and functional decline. CPMC is one of only six U.S. organizations designated as a HELP Center of Excellence by the American Geriatrics Society and the Institute of Healthcare Improvement’s Age Friendly Health System designation.
What community partnerships exist with the ACE Unit?
We initially had two community partners who focus on social supports for discharged ACE patients to help reduce readmissions. Our contract ended with one of them recently. Our current partner is San Francisco Village, a membership organization designed in collaboration with older San Franciscans and the broader community. As part of supporting our ACE Unit, SF Village offers three months of free membership and peer-volunteer-based social support to every patient. Members can partake in seminars on aging, fall prevention and other relevant topics. SF Village also offers activities that help older adults foster connections with young volunteers, who may offer support with meal preparation, grocery shopping and other social needs.
What do patients and families say about their stay on the ACE floor?
TDP: Older adults and their families commonly compliment the team for their patient, compassionate and gentle care. They recognize the value of the heightened focus on mobility, adequate sleep and increased interaction to help prevent delirium and deconditioning. They know this specialized attention sets ACE care apart from other units.
Comments from our Patient Experience Survey include:
- “It was all excellent. The view of the sky and East Bay from the window was spectacular and helped to keep me feeling positive. The staff were all nice, PT & OT very helpful for my return home. If one has to be hospitalized, this is the place to be! Thank you.”
- “I was very pleased with the quality of care I received. The nursing staff was excellent.”
- “I am very grateful for the care I received at CPMC. This care helped me to move and be able now to live a healthier and better life. Thank you, California Pacific Medical Center.”
To learn more or to refer a patient, call 415-641-6482 or visit sutterhealth.org/aceunit.
Tricia Grace Dela Paz, MSN, RN, is Nurse Manager of the ACE Unit at California Pacific Medical Center (CPMC) Mission Bernal Campus.
Author Rabiha Ahmed-Sheikh, MHA, is Pharmacy Care Reimagined Strategy and Innovation Program Manager at Blue Shield of California.