AGEING AND MANAGING HEALTH



Ageing and Managing Health



Ageing and Managing Health

Introduction

Part 1 - A Discharge Plan

Discharge planning has been defined as a systematic, organized and centralized approach to providing continuity of care from the time a patient is admitted to a health care facility through return to the community. In the United Kingdom, the majority of older adults live in community settings and receive support, and care if needed, from their family members. Wolff and Kasper (2006) found that care giving for older adults was done by children (41.3%), spouses (38.4%), or other relatives or friends (20.4%). When asked whether there would be someone to care for them in the event of serious illness or disability, 80% of older adults indicated they would have an available caregiver (Roth, Haley, Wadley, Clay, & Howard, 2007). The cost of informal care giving not included in reports of U.K. national health care spending, but it would be equivalent to 18% of the total health care spending amount. In many respects, the informal network of care giving is the backbone of the health care system in the United Kingdom.

Although informal care forms the backbone of the U.K. community based health care system, the importance of institutional services should not be underestimated. In the last two decades from 1994 to 2004, the number of older adults living in U.K. nursing homes declined from 1.21 million to just above 1 million. The reasons for this decline are numerous and include reductions in disability, improved management of disability, and more options for care in both institutional and community settings. Nonetheless, long-term institutional care continues to serve a core function to support older adults who require a nursing home level of care for multiple co morbid conditions and disability. In the United Kingdom, home health care services also remain a very important source of support for older adults, even though the intensity and duration of the services decreased after prospective payment for home health care was introduced. There is little doubt that patients desire to be involved in decision-making as it relates to discharge planning. It is essential that HCTMs include and actively work with older adults and their caregivers at the time of hospital discharge to reasonably assure that information and care needs met. However, there is some doubt that patients and families form the core of health care decision-making. Brook, Thompson, and Tierney (2007) in their study about older adults' participation in decision-making noted that patients' perspectives about discharge decisions become fragmented and invisible and that care routines interfered with communication about hospital discharge. Complex health care systems result in lack of knowledge about patient issues, poor communication between HCTMs, and indecisiveness on the part of patients and family (Bull, 1996, 486-500). In research about treatment decision-making patients have consistently favored collaborative decision-making with HCTMs. When it comes to decisions about hospital discharge, there are a myriad of small decisions that must be made to support the overall discharge plan, and many of the decisions ...