Table 3.

Quotations Illustrating Theme 3: EDs are not designed to Optimally Address Patients with Dementia and Caregiver Needs

#	Quote
20	“…when something is going poorly, having nothing in place to get help in the home is why the ER has become such as common last refuge for these patients. I think they feel like there’s nowhere else they can go. And they end up in the ER, and then they’re on the conveyor belt of healthcare and all of a sudden they’re in the in the hospital. Nobody wants that but I don’t think there’s alternatives to care where we can respond to some of these issues at home. I think needs are not being met for these community patients.” (geriatric healthcare provider, ID 16)
21	“….I do think there’s definitely an association with healthcare utilization, both in terms of ED visits and admissions, based on the living circumstance. I think… people with increased social isolation are at higher risk for readmission and things like that.” (ED physician, ID 21)
22	“…we’re very focused on identifying and removing life-threatening diseases and we use a lot of diagnostic testing and other resources to do that. And we tend to do fairly aggressive work-ups in the Emergency Department. [We] could perform a more focused work-up, or a work-up that doesn’t include so many resources…saving patients from harm to themselves by undergoing testing that they don’t need.” (ED physician, ID 3)
23	“They need to have someone who recognizes that they’re different from their baseline… The challenge [is that] it’s difficult to get a good history, and even the exam can be somewhat unreliable. It ends up being bigger work-ups…so they’ll get CAT scans of their heads, and they’ll get X rays and blood tests that they may or may not need. But a lot of that’s secondary to the fact that they’re difficult historians. (ED physician, ID 2).
24	“I’m not a geriatrician I’m not an internist in a clinic or anything like that. Those are the kind of needs that those people see every day. Is their hypertension being addressed, I don’t know? I see them as an endpoint when they get to the emergency room. Right? And so (I don’t know) what their actual medical needs are. It’s hard for me to say…I see them as their problem when they get into the emergency room, rather than before they get to the emergency room.” (ED physician, ID 1)
25	“There was a time when my dad ended up having a fever on a weekend, and he was just burning up. So I took him to urgent care and they tried to take blood, and all of his veins collapsed… So they rushed him in the ambulance to the hospital… it was a really traumatic experience for my dad in the ER because they (were) checking his chest, and they started to do a lumbar puncture…and my poor dad, who couldn’t communicate is staring at me like ‘What the hell are you letting people do to me’.” (caregiver, ID 15)
26	“The biggest complaint about the ER for any patient is how many times I [they] had to tell the same thing… Especially when you’re older and you’re not feeling good. I’m telling and who is this person, and who is this person, I mean whenever I do the interview after a discharge that’s the number one complaint. And feeling kind of a less intimate (relationship). They just want the one doctor. They want it the way it was. (community paramedic, ID 5)