Rural-dwelling older adults experience unique issues related to accessing medical and social services. We describe the development, implementation, and experience of a novel, community-based program to identify rural-dwelling older adults with unmet medical and social needs. The program leveraged the existing emergency medical services (EMS) system. The program specifically included: 1) geriatrics training for EMS providers; 2) screening of older adult EMS patients for falls, depression, and medication management strategies by EMS providers; 3) communication of EMS findings to community-based case managers; 4) in-home evaluation by case managers; 5) referral to community resources for medical and social interventions. Measures used to evaluate the program included patient needs identified by EMS or the in-home assessment, referrals provided to patients, and patient satisfaction. 1231 of 1444 visits to older patients (85%) were screened by EMS. Of those receiving specific screens, 45% had fall-related, 69% had medication management-related, and 20% had depression-related needs identified. 171 of eligible EMS patients who could be contacted accepted the in-home assessment. For the 153 individuals completing the assessment, 91% of patients had identified needs and received referrals or interventions. This project demonstrated that screening by EMS during emergency care for common geriatric syndromes and linkage to case managers is feasible in this rural community, although many will refuse the services. Further patient evaluations by case managers, with subsequent interventions by existing service providers as required, can facilitate the needed linkages between vulnerable rural-dwelling older adults and needed community-based social and medical services.

Background: Long-stay nursing home (NH) residents are at high risk of having emergency department (ED) visits, but current knowledge regarding risk-adjusted ED rates is limited. Objectives: To construct and validate 3 quarterly risk-adjusted rates of long-stay residents’ ED use: any ED visit, ED visits without hospitalization or observation stay (outpatient ED), and potentially avoidable ED visits (PAED). Research Design: The authors calculated quarterly NH risk-adjusted ED rates from 2011 Q2 to 2013 Q3 national Medicare claims and Minimum Data Set data. Using random-effect linear regressions, the authors validated these rates against Nursing Home Compare overall 5-star quality ratings and examined their associations with hospitalization rates to provide a quality context. Subjects: Resident-quarter observations (7.3 million) from 15,235 unique NHs. Results: Risk-adjusted rates of any ED, outpatient ED, and PAED averaged 9.7%, 3.4%, and 3.2%, respectively. Compared with NHs with 1 or 2 stars overall rating, NHs with ≥3 stars were significantly associated with lower rates of any ED visit, outpatient ED, and PAED (β, −0.23%, −0.16%, and −0.11%, respectively; all P<0.01). Pearson Correlation coefficients between hospitalization rates and rates of any ED visit, outpatient ED, and PAED were 0.74, 0.31, and 0.46, respectively. Conclusions: The moderately negative associations of 5-star ratings with ED rates provide supportive evidence to their validity. Outpatient ED and PAED were moderately correlated to hospitalizations suggesting they provided more information about quality than any ED.