A look at ER boarding in the US from the AP and Side Effects Public Media

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This article was published 15/04/2025 (530 days ago), so information in it may no longer be current.

AURORA, Ill. (AP) — Long ER waits in the U.S. are common, especially for older patients. Some wait for many hours or even days before they get a hospital bed.

In collaboration with The Associated Press, Side Effects Public Media’s Ben Thorp reports that experts say things will only get worse as the U.S. prepares for a “silver tsunami” — that is, an aging population, which may come with complex diseases and more dementia cases.

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Ben Thorpe, Side Effects Public Media reporter: Tracy Balhan flips through old photos of her dad, Bill Speer, at their vacation home in Indiana. In one photo, her father wears a t-shirt in front of a sweaty bucket of beer bottles.

BALHAN: “He does have my shirt on: Pops. The man. The myth. The legend.”

THORPE: Balhan misses her dad. She even keeps some of his old voicemails.

SPEER VOICEMAIL: “I’m going to go to the place tomorrow so I want to know what I want to complain about. If you get a minute, give me a call.” (Balhan laughing, fades under).

THORPE: Speer passed away last year after a long struggle with dementia. They routinely ended up in the emergency room.

During one stay, he spent 12 hours in the ER of Endeavor Health in Naperville, Illinois waiting for a psych evaluation.

BALHAN: “He was strapped down. There was nothing he could do. So he was fighting, like banging his head, you know, like, doing the things.”

THORPE: The hospital said they wouldn’t comment on Speer’s experience, citing patient privacy.

Balhan didn’t know it then, but her dad’s ER experience is so common it has a name: ER boarding.

In 2022, the most recent year we have data for, 3 million visits to an ER that led to a hospital admission had a wait of four hours or longer before getting a regular hospital bed. That’s according to an analysis by The Associated Press and Side Effects Public Media.

Data suggests that half of the patients who were boarded were 65 or older. Experts say at this rate, it’s unlikely things will get better.

Arjun Venkatesh, Yale researcher: “People have way more complicated illnesses. Some people are living longer and longer with the complexities of diseases like cancer, lung disease …”

THORPE: That’s Arjun Venkatesh, who studies emergency medicine at Yale.

Other experts warn of a “silver tsunami” of patients that will hit ERs. That’s because the rates of dementia in the U.S. are expected to grow over the next few decades.

Venkatesh says part of the problem is a lack of staffed hospital beds.

VENKATESH: “We have about just as many hospital beds in America today as we did 20 years ago. The reason that’s a problem is that emergency department visits are up 30-40% over that time.”

THORPE: And he says hospitals tend to prioritize scheduled care patients, whose insurance companies will reimburse them better for things like cancer care and orthopedic surgeries.

That means there aren’t incentives to bring patients from backed-up ERs into a hospital bed on another floor.

That leaves patient caregivers in a tough spot. They say when they’re in crisis, they don’t know where else to go — besides the ER.

Nancy Fregeau, Illinois resident: “It’s where you end up. Because it’s like, what do I do? It’s an acute behavior. I need to do something.”

THORPE: This is Nancy Fregeau. In 2024, she took her husband, Michael Reeman, to the emergency room in Kankakee, Illinois, three separate times. One of those times led to an emergency room stay longer than 10 hours waiting for specialized care.

FREGEAU: “It’s hard enough for anyone to be in the ER, but I cannot imagine someone with dementia being in there. That was so hard for him. He just kept saying, ‘When am I going? What’s happening?’ Because he just didn’t understand.”

THORPE: Fregeau — and most of the families we spoke to — do not blame the nurses and doctors for the long stays. They say the problem appears to be much deeper.

Several national organizations, including the American College of Emergency Physicians, have been advocating for systemic changes on the policy and hospital levels to tackle ER boarding.

But those groups say the effort hasn’t moved the needle far enough.

Tracy Balhan says the emergency room experience has stuck with her.

BALHAN: “People didn’t look at my dad as a man when we were going through the worst of it. It didn’t feel to me like he was being treated with any dignity.”

More than that, caregivers like Balhan say their experiences leave them worried that the U.S. health system isn’t prepared to handle a population of dementia patients that is only expected to grow.

I’m Ben Thorp, Side Effects Public Media.

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This story comes from a collaboration between The Associated Press and Side Effects Public Media. Learn more at apnews.com. Side Effects is a health reporting partnership among NPR member stations across the Midwest.