When Tracy Balhan brought her father, Bill Speer, to the emergency room at Edward Hospital in Naperville, Illinois, she hoped he would receive urgent help for a serious dementia-related episode. Instead, the 78-year-old spent 12 hours waiting for a psychiatric evaluation — restrained at one point — before being transferred to another facility.
Balhan’s experience is far from rare. It’s part of a widespread and worsening crisis known as ER boarding, where patients wait hours — sometimes even days — in emergency rooms for a hospital bed.
New data analysis by the Associated Press and Side Effects Public Media reveals that in 2022, one in six ER patients admitted to the hospital waited more than four hours. Half of those patients were age 65 or older. And for some not facing immediate life-threatening emergencies, the wait can stretch for days or even weeks, experts say.
A Health System Under Strain
ER boarding isn’t just an inconvenience — it’s a warning sign of deeper problems in the U.S. health care system.
“We are facing a system that’s overwhelmed and broken,” said Dr. Alison Haddock, president of the American College of Emergency Physicians. “ER boarding isn’t caused by the emergency department. It’s a system failure that becomes visible in the ER.”
A key problem: hospitals are prioritizing scheduled surgeries and treatments — like cancer care or joint replacements — over emergency cases because insurance companies reimburse more for planned procedures. That leaves fewer available beds for ER patients.
Compounding the issue is the lack of growth in hospital bed numbers. From 2003 to 2023, the number of staffed hospital beds in the U.S. decreased from 965,000 to 913,000, according to the American Hospital Association. Meanwhile, ER visits rose by 30% to 40% in the same period.
“It’s a math problem,” said Dr. Arjun Venkatesh, an emergency medicine expert at Yale University. “More patients, fewer beds.”
A Dangerous Delay for Dementia Patients
Older patients with dementia are especially at risk during long ER waits. A study published in the Journal of the American Medical Association in June 2024 found a link between long emergency room stays and increased risk of delirium — a temporary but severe state of confusion — among dementia patients.
“It’s not just uncomfortable. It’s dangerous,” said Dr. Shafi Siddiqui, a geriatric psychiatrist in Chicago. “The ER is the worst place for someone with dementia to be stuck for hours.”
Balhan’s father, who once wore a shirt proudly declaring him “The man. The myth. The legend,” became increasingly agitated during his 24-hour ER stay. In the end, a facility outside the hospital system had to take him in.
The hospital said its behavioral unit does admit dementia patients, depending on bed availability and medical needs. But Balhan says her dad wasn’t treated with the dignity he deserved.
“It didn’t feel to me like he was being treated as a human being,” she said. “That’s what hurts the most.”
The Problem Is Only Getting Worse
Experts warn that the situation could reach a breaking point. The U.S. population is aging, and dementia rates are expected to rise sharply in the coming years. But the number of specialized care facilities is shrinking.
From 2015 to 2022, over 1,000 nursing homes shut down across the country. At least 15 behavioral health centers closed in 2023 alone, further limiting options for patients like Bill Speer.
That means hospital beds are occupied longer, worsening the backlog in ERs.
In Illinois, Nancy Fregeau has seen the effects firsthand. Her husband, Michael Reeman, who has dementia, spent hours — sometimes more than 10 — in the ER before finally being admitted to a behavioral unit.
“I didn’t know what to say to him,” Fregeau said. “He just kept asking, ‘When am I going? What’s happening?’”
Fregeau eventually found a local senior day center for her husband, which he now attends regularly. But such centers are in short supply. In Illinois, there are fewer adult day centers than counties, meaning many families are left without support.
Where Are the Solutions?
National emergency physician groups have pushed for reforms to reduce ER boarding for years. Some minor progress has been made, but nothing on a large scale.
One big hurdle is data. The Centers for Medicare and Medicaid Services (CMS) recently stopped requiring hospitals to report median ER wait times, making it harder to track the full extent of the problem. A new proposal is under review that could bring back more accurate tracking.
Until larger changes are made, families like Balhan’s will continue to suffer.
“This is a nationwide problem,” said Dr. Vicki Norton, president-elect of the American Academy of Emergency Medicine. “And people need to be enraged about it.”
Key Facts:
- 1 in 6 ER patients admitted to U.S. hospitals in 2022 waited 4+ hours.
- Half of all ER-boarded patients were 65 and older.
- Dementia patients are at higher risk of developing delirium during long ER stays.
- U.S. hospital beds declined by 5% between 2003 and 2023.
- Over 1,000 nursing homes and 15 mental health centers have closed in recent years.
Conclusion
As America’s aging population grows, experts warn that the problem of long ER wait times and hospital bed shortages will only worsen. Without major changes to hospital policies and federal health care planning, the health system may struggle to keep up — especially for those who are most vulnerable.
Balhan hopes her father’s painful experience sparks change.
“If we can’t treat our elderly with care and dignity,” she said, “what does that say about us as a society?”
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