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Sick children deserve optimal medical care. So why were my colleagues and I saddened by a California midterm ballot initiative aimed at doing just that?

Like the majority of Californians, I voted for the initiative to authorize $1.5 billion in bonds in grants for the “construction, expansion, renovation, and equipping of qualifying children’s hospitals.” Voting “yes” was the socially responsible, compassionate choice. My chagrin came not from what the measure will do for our state but from what is missing in health care funding — not just in California, but across the nation.

Given the vast number of children who have died throughout most of human history (in 1900, 30 percent of all deaths in the United States occurred in children less than 5 years of age), we are fortunate to live at a time when most children are healthy and live into adulthood and beyond. While children and adolescents make up 23 percent of the U.S. population, they account for only 16 percent of hospitalizations, mostly in the first year of life. If you exclude infants, individuals under age 18 make up just 4 percent of hospitalizations.


Thanks to 20th-century advances in public health and medicine, a majority of Americans now live into elderhood. More children today benefit from education bonds than health care bonds. Yet our policies and priorities are still directed at century-old needs and demographics.

In the 21st century, health care is to elderhood as education is to childhood. But we don’t see bond measures for the “construction, expansion, renovation, and equipping” of hospitals to optimize care of old people, an investment that would surely benefit Americans of all ages.


People age 65 and older make up just 16 percent of the U.S. population but nearly 40 percent of hospitalized adults. In 2014, Americans over age 74 had the highest rate of hospital stays, followed by those in their late 60s and early 70s.

Remarkably, hospitals aren’t designed with elders in mind. Walk through one and you’ll almost invariably find cheerful decor for children, services and facilities aimed at adults, and a gauntlet of obstacles and insults to elders.

At most hospitals and medical centers, the newest buildings focus on cancer, neuroscience, children, and research. Old people end up in old buildings. That usually means long walks down halls without railings or chairs with arms for rest stops. It means signs that are hard to read until you are right under them. It means a one-size-fits-all approach to both facilities and care that doesn’t acknowledge that the needs, preferences, and realities of a 75- or 95-year-old with a medical condition might differ from those of a 35- or 55-year-old with the same thing.

It’s the rare industry that doesn’t target and cater to its best customers. Health care not only fails to cater to elders, it fosters system-wide injustice by failing to apply the same standards to elderhood that it applies to childhood and adulthood. Just as children’s hospitals have been shown to save and better the lives of children, hospital wards, services, and emergency departments aimed at elders improve their care and lives when compared to adult-centric facilities.

The good news is that we already know what to do to make hospitals safer and more welcoming to older patients and family visitors.

A collaboration of industry leaders, including the American Hospital Association, the John A. Hartford Foundation, and the Institute for Healthcare Improvement, has launched an age-friendly health system initiative. While its purview is limited to a few geriatric conditions, it’s a step in the right direction. (And the field of geriatrics is finally beginning to model itself after pediatrics, taking a more whole health, life stage approach to elderhood.)

Some of the best ideas for hospital design come from outside health care. Innovations developed for aging-in-place homes or continuing care communities offer prototypes of “silver architecture.” Businesses like Microsoft are investing in structural and people-flow design that meets needs across the lifespan. They are adopting the position that if you design for the mythical “average human” you create barriers, whereas if you design for those with disabilities you create systems that benefit everyone.

Hospitals will find that many features that would benefit their older patients already exist in their newest facilities. Useful tech-based design elements include communication options that don’t require finding and pressing a call button, as well smart monitors that identify staff members on a large TV as they come into the room. While such technology helps all patients, it’s particularly beneficial for people with impaired vision, hearing, dexterity, or thinking.

Rooms in many new children’s hospitals are equipped with a pullout couch bed and privacy screens. Such accommodations are just as important for the children of old patients as they are for the parents of young ones. Any adult child of a sick elder parent can tell you bad things happen when they aren’t present to watch over their loved one. My father was cared for at my top 10 medical center, and my mother is being care for there now. I wouldn’t have them go anywhere else and yet, after 20 years as a geriatrician, I would never leave them there without one of us staying with them for protection.

Arguments for spending billions of dollars on children’s hospitals often emphasize that saving a child offers the best return on our societal investment. In terms of potential years gained, that may be true. But valuing some lives over others teeters on a logic disturbingly reminiscent of past measures that ensured the marginalization, institutionalization, and deficient care of people because they were disabled, poor, brown-skinned, black-skinned, or female. Hospital design and health care should not penalize us in elderhood for having benefited from medical care in childhood and adulthood.

There is also this immutable fact: Although some of us will develop cancer or AIDS or other diseases, most of us will become old. Denying that basic truth ensures that we will have the elderhood we fear, the one our society and medical system too often dismiss and deride.

Anyone not planning on dying prematurely should consider doing the following: When supporting an adult or children’s hospital, ask what it is doing for elders, the “third age” of life. When voting for a ballot measure aimed at the “construction, expansion, renovation, and equipping” of hospitals, make sure that it covers the people most likely to require hospital care.

Youth, absolute or relative, should not be a prerequisite for modern facilities, compassion, and good health care.

Louise Aronson, M.D., is professor of geriatrics at the University of California, San Francisco, and director of the UCSF Health Humanities and Social Advocacy Initiative.

  • I barely knew that elders are this much badly treated in modern healthcare. Whether it’s an old guy or a new born baby, our system should try to treat both the lives equally. A life is nothing to play with. Elderly are the ones who are more subject to hospitalizations, required to stay there much longer and also needs to utilize more hospital resources too. Then why our healthcare system is reluctant to spend more on geriatric care? Are they purposefully ignoring the seniors?

    I do agree with some points the article raised up as a reason for this practice. I have heard that elderly are more likely to feel uncomfortable with a hospital atmosphere. It may be because, they might not be provided with enough facilities which offers them a comfortable stay there. It’s the responsibility of the healthcare organizations to keep expectations of each patient who approaches them for better medical aid. In case of a hospitalization, they should try to minimize wait times, help in paperwork, give focused individual care & attention, and should also make them comfortable with the staff and hospital environments too. These simple things will greatly improve geriatric care.

    It’s overtime that US should design new models for better elderly care, especially for those with various chronic conditions, improve professional human resources for elderly care, expand use of technology based geriatric care etc. I personally feel that technology could help healthcare organizations for delivering better geriatric care. Technology can reduce unwanted hospitalization, facilitates 24×7 remote patient monitoring & treatments, improve patient engagement & thus helps provide more patient centric care.

    Many healthcare organizations are using senior care technologies for offering best service possible. You may read these case studies of an IoT based health monitoring system and another solution with a mobile application to monitor healthcare plan of the elderly. These kinds of technologies can tremendously improve elderly patient care without much investment in infrastructure and other facilities which the government seems hard to approve.

  • This article is amazing! I didn’t know this. I am trying to remain independent at 64. I don’t have the best situation but I feared not being able to care for myself , to the extent I do now in a nursing home. I am glad to have seen this. I hope that others will help further this for you. I fear that gov agencies may resist, as it upsets the apple cart, where they are snug as a bug in the rug. Good luck. Your parents are lucky to have you! I hope they do well, too.

  • This is much worse than this article implies. Elders are the bread and butter for these hospitals. They frequently cash in on expensive unnecessary procedures, and repeated hospitalization of people over 65. the hospital industry bean counters have figured out how to scrape every last dollar from their insurance or Medicare. If people had all of the facts they would be disgusted and horrified, dying in agony is the more profitable healthcare model.

    • I agree, Mavis. That is why I refuse all testing and medication. I have seen too many tortured and ill people who would have been better if “untreated.” As you stated, elders are looked at as cash cows. Just today I read that a senior woman wrongfully had both kidneys removed at University of Colorado Health Sciences Center Hospital. Her life is ruined and she is on dialysis. They need to get her a kidney. Quacks.

    • Oh, Mavis, thanks for writing the truth. People are used and abused and the marketing to go to the big institutions – factories – never ends. People believe the marketing!
      Die in hospice, die at home, do whatever you must, but do not die in a hospital. Get the paperwork in order do they cannot do whatever they want to you and justify it.

    • Mr. Johnston,

      Peddling your wares on this site is morally reprehensible. It is highly unlikely your quack cure is useful for anything. I am hoping that people are catching on to these deceptive marketing practices. The FTC needs to step in and regulate this kind of creepy and illegal internet marketing. Your Medical Device is probably useless and dangerous. Shame on You!

  • Nurses’ contributions are overlooked in the article. I urge readers (and the author) to search for ACES (Advancing Care Excellence for Seniors) and NICHE (Nurses Improving Care for Healthsystem Elders.) Nurses have led efforts to improve hospital care for older adults for some time, but our efforts are often unacknowledged.

  • Thank you Dr. Anderson for superbly represented view on proper care for those in the “third phase” of life. This group (the Boomers) will grow exponentially in just a mere few years. As birthrates are actually in decline, there must be a priority switch to Elder Care. This better come sooner than too late for a very large group of people who actually assisted in the improved care and facilities for the very young. The Elder sure paid it forward.

  • Thank you, Dr. Aronson. Your points are so correct. Also, exam room tables that are up in the aur are dangerous. I have a friend who fell backwards off one. She suffered a briken nexk but would not sue her doctor. As a senior, I really have a hard time finding suite numbers as well as filling out history form and prefer that they be mailed to me. Younger people have no idea of how to deal with seniors.

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