In This Section      

Johns Hopkins Medicine Suburban - Seeing Hospitals Through Seniors’ Eyes

New Directions Spring 2012

Seeing Hospitals Through Seniors’ Eyes

Date: May 1, 2012

New Program Improves Time in the Hospital
Find the nine differences between the top photo and the bottom photo that highlight the Suburban Hospital NICHE Way!

New Program Improves Time in the Hospital

Improving care for seniors is a real and growing need. About 50 percent of America’s hospitalized patients are age 65 or older, with numbers rising each year. At Suburban Hospital the majority of patients are also age 65 and older. Many hospitalized elders struggle not only to overcome illness, but also the hospital environment itself.

In response, Suburban and Sibley Hospitals, both part of the Johns Hopkins Health System, participate in the NICHE program (Nurses Improving Care for Healthsystem Elders). “NICHE is transforming the way we take care of older patients,” says Barbara Jacobs, chief nursing officer. “The training and new tools we have in place to care for our elders is significantly improving their hospital experience, with the express goal of getting them back home better and stronger than they were when they came in.”

NICHE has made a dramatic difference in how our staff views older patients,” says Denise Carlson, MBA, RN, who directs the adult medical unit at Suburban, where 70 percent of patients are age 65 and older. “We are learning about the aging process so that we have a better understanding of why someone may be confused or why they are not eating, for example.”

Physicians who admit their patients to Suburban Hospital also see the benefits to NICHE. “Besides providing quality care to older patients, empathy, patience and an understanding of the aging process by hospital staff are critical to the recovery of the older hospitalized patient,” says Merlyn Vemury, M.D., an internist and president-elect of the Maryland Medical Directors Association, a group that primarily works in senior health care. “One of the most important benefits of this training and focus on the older patient is to create a smooth transition of care from hospital to home, rehabilitation or whatever the case may be for the patient.”

Q:  What practical changes are being made?

A: Red straws replace difficult-to-see white ones; contrasting paint color in rooms, bathrooms and hallways makes it easier to see where a wall begins and the floor ends; low beds help to prevent falls by enabling patients to plant their feet firmly on the floor before getting up; smaller IV poles can be wheeled into the bathroom with ease; white boards clearly identify the day and date, the patient’s nurse, physician and goals for the day.

Q: Who’s on the team?

A: Nurses, social workers, physical and occupational therapists, physicians, dieticians and pharmacists collaborate to create individualized treatment plans that support each patient’s physical, emotional and psychological well-being. Therapists advise nurses on the safest way to get patients up and moving without risk of falling, while pharmacists recognize that older adults metabolize medications differently and nutritionists consider food choices and presentation, keeping elders’ decreased sense of taste and smell in mind.

Q: What special training does Suburban’s staff receive?

A: To teach nurses on her unit what it is like to be older, Carlson uses role play and props, such as having staff wear eyeglasses that simulate cataracts, loss of visual fields and depth perception, while using a walker or wheelchair. To feel the limitations of arthritis and decreased sensation, staff wear gloves and then try to pour pills from medicine containers. 

Read more about NICHE at:

Download a Geriatric Resource Guide

Find the nine differences between the top photo and the bottom photo that highlight the Suburban Hospital NICHE Way!

Check your answers below:

Answers: 1. Call bell is on pillow within reach.  2. Bed is low and patient can plant feet squarely on the ground.  3. Cup has red straw vs. difficult-to-see white straw.  4. Nurse is clearly identified by her badge and her navy blue uniform.  5. Patient in yellow gown indicates this patient has already fallen and needs closer monitoring.  6. Yellow socks indicate the patient is at risk for falling.  7. IV pole has smaller base and can fit with patient into the bathroom.  8. White board clearly states date, nurse’s name, doctor’s name and daily goal.  9. Contrasting blanket color helps patients differentiate their bed covers.