Table 1.

Quotations Illustrating Theme 1: System Fragmentation Influences Emergency Care Use by Persons with Dementia

#	Quote
1	“[My mother-in-law] had multiple ER visits and then sub-acute care, but they were at different facilities. [My husband] thought they all transferred all the records amongst themselves. When she would go to a new place, I’d say we gotta take these records and take ‘em to the new place, and he would say “Why? Don’t they all work together?”… I think a layperson thinks that healthcare providers, community-based providers, nursing homes—we all communicate. We don’t.” (aging service provider, ID 23)
2	“…I can’t say I have any particularly close community partners with the AD community. …So I assume that they feel like this is the healthcare system doesn’t reach out to them very often. So maybe we all sort of live in our own little bubbles. I’m sure that there’s a lost opportunity because of that lack of contact.” (PCP, ID 4)
3	“Communication and coordination with the community agencies is a big one. Just knowing what the resources are and having them readily available to refer to from our electronic health record system would be helpful… in the moment when things are happening, we don’t necessarily have that available. There’s a fair amount of resources… But I also feel like they’re not coordinated as well…Or at least if they are coordinated, it’s hard for us (clinicians) to know how to coordinate best with them.” (PCP, ID 10)
4	“I think again it goes to…the systems level communication, between professionals. Especially when it comes to discharge services, who’s doing what, what’s needed in the home, is there enough planning time? I know I frequently got calls from hospitals …saying ‘Your client’s getting discharged today’. I didn’t even know they were in the hospital! And trying to piece that together is a lot of work.” (aging service provider, ID 8)
5	I mean there’s more than just me involved with somebody. It’s helpful for me to know the other professional, whatever their profession is, because if I’m doing something with a client, and then I find out they’re doing the same thing, well that’s a lot of time wasted… I think collaboration, especially with people with dementia, is really important. Whether it’s doctors, or family, or whoever. (aging service provider, ID 20)
6	“Communication between geriatrician and the PCP is so vital and important… having like all the different docs be on the same page, and be communicating with the patient. And for the geriatrician to be able to send a report to the PCP to say ‘Hey here’s where your patient’s at’, so they’re educated when they come in for other aches and pains (and know) what they might be experiencing could be related to the dementia. (caregiver, ID 15)
7	“It always helps to understand the kind of motivations that get people sent to the emergency room. I think if I could understand why this PCP is sending half of his patients to the Emergency Department without seeing them, or if he’s seeing them, how often, or whether he seeing them for follow-up when I recommended it.” (ED Physician, ID 1)
8	“I think a particular problem is when we see patients, especially with early-stage dementia, we don’t realize that they have any Alzheimer’s-type dementia, and we just kind of assume that people can carry out this complex series of (discharge) tasks that if you think about it is almost designed to be the type of thing that someone with early type Alzheimer’s is going to struggle with.” (ED Physician, ID 3)
9	“There are times when I think that there hasn’t been an understanding, and the doctor is seeing one thing, and might not have the information on the whole picture. I fill that gap.” (caregiver, ID 14)