Public-private partnership aids VA in becoming the largest integrated health network with specialized geriatric emergency care

The Department of Veterans Affairs (VA) has launched a nationwide movement to improve emergency department (ED) care for older Veterans treated in VA Medical Centers and become the nation’s largest integrated health network with specialized geriatric emergency care. 

The VA Geriatric Emergency Department Initiative is a public-private collaboration between the VA, the American College of Emergency Physicians (ACEP), The John A. Hartford Foundation, and the West Health Institute to establish 70 of the VA’s EDs as accredited geriatric emergency departments (GEDs). GEDs are better equipped to treat older adults with complex conditions, catch unmet care needs, and develop teamwork strategies to better coordinate emergency and follow-up care. Recent studies have found GEDs can decrease hospital admissions and lower total healthcare costs.

According to leadership at the VA, the initiative promotes Veteran goals of care, home safety, community emergency risk mitigation and preservation of Veteran independence.  

“Nearly half of the nation’s 19.5 million Veterans are over 65 years old and account for more than 45% of ED visits at VA hospitals, more than double the ED visit rate for seniors nationwide,” said Steven L. Lieberman, MD, VA Acting Under Secretary for Health. “With COVID-19 highlighting the importance of geriatric emergency care around the world, through this initiative, VA continues to rise to the occasion by infusing age-friendly emergency care practices and improving care coordination in communities across the nation.”

Accreditation of VA Medical Centers is underway. Over the past year, an initial set of 20 EDs across 15 states applied for GED accreditation (full list below). To date, 16 have received accreditation, and the remaining four submissions are pending review.

“Geriatric-specific emergency care aligns with VA’s priority to provide age-friendly care to all older Veterans in all settings,” said Dr. Chad Kessler, National VA Emergency Medicine Director. “Partnering with the leading experts of geriatric emergency medicine, our emergency department teams are empowered to effectively meet the unique needs of our older Veterans and their caregivers and address what matters most to them. Geriatric emergency care programming identifies our most vulnerable Veterans, enhances their emergency care, and coordinates transitions of care through an interdisciplinary team approach from various services throughout their facilities."

“Older adults visit emergency departments more frequently than other age groups and often manage multiple chronic conditions,” said Mark Rosenberg, DO, MBA, FACEP, FAAHPM, President of ACEP. “When you add the physical, mental or social challenges frequently faced by our Veterans to that equation it is easy to see that one size does not fit all—a specialized approach to emergency care for older Veterans can improve treatment and help our heroes lead healthier lives.”

“Emergency departments are a vital source of frontline care to older adults, including our older Veterans,” said Terry Fulmer, PhD, RN, FAAN, President of The John A. Hartford Foundation. “Our goal is to take what we learn in VA emergency departments and scale it nationally, so all older adults get high-quality, age-friendly emergency care.”

“Our nation’s Veterans deserve the best care possible and to that end, we are proud to be partnering with the VA in a first-of-its-kind public-private initiative to establish accredited geriatric emergency departments across the VA system,” said Shelley Lyford, President and CEO of the West Health Institute. “It’s our hope that the 70 VA GED sites will serve as a role model for further system-wide adoption across the nation.”

Similar to trauma designations, voluntary accreditation is awarded across three levels. ACEP’s Geriatric ED Accreditation Program promotes more than two dozen best practices for geriatric emergency care. Since the program's inception in 2018, ACEP has accredited more than 260 EDs.

ACEP, The John A. Hartford Foundation, and the West Health Institute announced a 2-year extension of support in honor of the nation’s older Veterans. This extension will support a designated team to facilitate the accreditation of the remaining 50 VA EDs and upgrade 10 already accredited VA Medical Centers. Once accredited, all 70 EDs will deliver care in line with the Geriatric ED Accreditation Program and the Age-Friendly Health Systems framework, an evidence-based approach to care for older adults developed by The John A. Hartford Foundation and the Institute for Healthcare Improvement. The VA anticipates that all 70 sites will apply for accreditation by December 31, 2022.

The Geriatric Emergency Department Collaborative (GEDC), a national network of leading experts, hospitals, and professional organizations is also providing specialized training and assistance to the VA’s GED Initiative. The GEDC is a project supported by The John A. Hartford Foundation and the West Health Institute. Best practices and lessons learned from this collaboration will be shared with emergency departments across the country.

List of Program Participants

California
Palo Alto VA Medical Center^
VA Greater Los Angeles Healthcare^
VA Long Beach Health Care System^
VA San Diego Healthcare System^

Colorado
Denver Rocky Mountain Regional VA Medical Center*
VA Western Colorado Health Care System Grand Junction^

Connecticut
VA Connecticut Healthcare System in New Haven^

Georgia
Atlanta VA Medical Center^

Indiana
Richard L. Roudebush VA Medical Center Indianapolis*

Iowa
VA Central Iowa Health Care System*

Kentucky
Robley Rex VA Medical Center in Louisville^

Louisiana
Southeast Louisiana Veterans Health Care System in New Orleans^

New York
VA Western New York Healthcare System^
Syracuse VA Medical Center^

North Carolina
Durham VA Health Care System^

Ohio
Louis Stokes Cleveland VA Medical Center^

South Carolina
Ralph H. Johnson VA Medical Center in Charleston^

Texas
Dallas VA Medical Center*

Utah
VA Salt Lake City Health Care System^

Wisconsin
William S. Middleton Memorial Veterans Hospital in Madison^

^ACEP Geriatric Emergency Department Accreditation
*ACEP Geriatric Emergency Department Accreditation Submission in Process/Review

About the U.S. Department of Veterans Affairs/Veterans Health Administration

The VA’s mission is to fulfill President Lincoln's promise, “To care for him who shall have borne the battle, and for his widow, and his orphan,” by serving and honoring the men and women who are America’s Veterans. We strive to provide Veterans the world-class benefits and services they have earned - and to do so by adhering to the highest standards of compassion, commitment, excellence, professionalism, integrity, accountability, and stewardship. The Veterans Health Administration is America’s largest integrated health care system, providing care at 1,293 health care facilities, including 171 medical centers and 1,112 outpatient sites of care of varying complexity (VHA outpatient clinics), serving 9 million enrolled Veterans each year.

About the American College of Emergency Physicians (ACEP)

The American College of Emergency Physicians (ACEP) is the national medical society representing emergency medicine. Through continuing education, research, public education and advocacy, ACEP advances emergency care on behalf of its 40,000 emergency physician members, and the more than 150 million people they treat on an annual basis. For more information, visit www.acep.org and www.emergencyphysicians.org.

About The John A. Hartford Foundation

The John A. Hartford Foundation, based in New York City, is a private, nonpartisan, national philanthropy dedicated to improving the care of older adults. The leader in the field of aging and health, the Foundation has three priority areas: creating age-friendly health systems, supporting family caregivers, and improving serious illness and end-of-life care. For more information, visit johnahartford.org and follow @johnahartford.

About West Health Institute

Solely funded by philanthropists Gary and Mary West, West Health is a family of nonprofit and nonpartisan organizations including the Gary and Mary West Foundation and Gary and Mary West Health Institute in San Diego, and the Gary and Mary West Health Policy Center in Washington, D.C. West Health is dedicated to lowering healthcare costs to enable seniors to successfully age in place with access to high-quality, affordable health and support services that preserve and protect their dignity, quality of life and independence. Learn more at westhealth.org and follow @WestHealth.