A modern-day purgatory: older adults in the emergency department with nonoperative injuries

Older adults frequently present to the emergency department (ED) with injuries that do not require operative treatment but are sufficiently severe to make it unsafe for them to return home. These individuals typically do not meet criteria for hospital admission, but because of limited reimbursement for observation, admitting physicians are often reluctant to accept these individuals for observation. Admission to a skilled nursing or assisted living facility from the ED or rapid access to additional in-home care is also often difficult or impossible. As a result, older adults with nonoperative injuries often spend a long time in the ED waiting for an appropriate disposition. The challenges of identifying an appropriate disposition for these individuals, the consequences for patients, and some potential solutions to this commonly encountered problem are described.