Older adults and their family caregivers face numerous decisions about hospital discharge, including where they will go and how they will receive care. Older adults who account for nearly 37% of all hospital discharges often need care and support of family members at the time of hospital discharge. This study examines decisions made by hospitalized older adults, families, and health care team members (HCTMs) about hospital discharge. The sample included older adults (n = 13, average age 84), family members (n = 12, average age 71), and HCTMs (n = 7, average age 47). Findings revealed the complexity of hospital discharge planning for older adults through five themes as follows: (a) home, (b) staying independent, (c) “advocating for them,” (d) deciding what to tell, and (e) changing the plan.
Anthony, M.K., & Hudson-Barr, D. (2004). A patient-centered model of care for hospital discharge. Clinical Nursing Research , 13, 117-136.
2.
Arno, P.S., Levine, C., & Memmott, M.M. ( 1999). The economic value of informal caregiving. Health Affairs, 18, 182-188.
3.
Baron, J. ( 2000). Thinking and deciding. New York, NY : Cambridge University Press.
4.
Bowles, K.H., Naylor, M.D., & Foust, J.B. ( 2002). Patient characteristics at hospital discharge and a comparison of home care referral decisions. Journal of the American Geriatrics Society, 50, 336-342.
5.
Bull, M.J., Hansen, H.E., & Gross, C.R. ( 2000). A professional-patient partnership model of discharge planning with elders hospitalized with heart failure. Applied Nursing Research, 13, 19-28.
6.
Cahill, E., Lewis, L.M., Barg, F.K., & Bogner, H.R. ( 2009). "You don’t want to be burden them": Older adults’ views on family involvement in care. Journal of Family Nursing , 15, 295-317. doi: 10.1177/1074840709337247
7.
Callahan, C.M., Unverzagt, F.W., Hui, S.L., Perkins, A.J., & Hendrie, H.C. ( 2002). Six-item screener to identify cognitive impairment among potential subjects for clinical research. Medical Care, 40, 771-781.
8.
Coleman, E.A., Parry, C., Chalmers, S., & Min, S.J. ( 2006). The care transitions intervention: Results of a randomized control trial. Archives of Internal Medicine, 166, 1822-1828.
9.
Coleman, E.A., Smith, J.D., Frank, J.C., Min, S.J., Parry, C., & Kramer, A.K. ( 2004). Preparing patients and caregivers to participate in care delivered across settings: The care transitions intervention. Journal of the American Geriatrics Society, 52, 1817-1825.
10.
Davis, K. ( 2007). Paying for care episodes and care coordination. New England Journal of Medicine, 356, 1166-1167.
11.
Davison, B.J., Gleave, M.E., Goldenberg, S.L., Degner, L.F., Hoffart, D., & Berkowitz, J. ( 2002). Assessing information and decision preferences of men with prostate cancer and their partners. Cancer Nursing, 25, 42-49.
Degner, L.E., Sloan, J.A., & Venkatesh, P. ( 1997). The Control Preferences Scale. Canadian Journal of Nursing Research, 23(3), 21-43.
14.
Dellasega, C.A., & Fisher, K.M. ( 2001). Posthospital home care for frail older adults in rural locations. Journal of Community Health Nursing, 18, 247-260.
15.
DeSantis, L., & Ugarriza, D.N. (2000). The concept of theme as used in qualitative research. Western Journal of Nursing Research , 22, 351-372.
16.
FitzGerald, J.D., Mangione, C.M., Boscardin, J., Kominski, G., Hahn, B., & Ettner, S.L. ( 2006). Impact of changes in Medicare HHC reimbursement on month to month home health utilization between 1996 and 2001 for a national sample of patients undergoing orthopedic procedures. Medical Care , 44, 870-878.
17.
Fried, L.P., Tangen, C.M., Walston, J., Newman, A.B., Hirsch, C., Gottdiener, J., . . . McBurnie, M.A. (2001). Frailty in older adults: Evidence for a phenotype. Journal of Gerontology: Medical Sciences, 56A, M146-M156.
18.
Goins, R.T., Williams, K.A., Carter, M.W., Spencer, S.M., & Solovieva, T. ( 2005). Perceived barriers to healthcare access among rural older adults: A qualitative study. Journal of Rural Health, 21, 206-213.
19.
Grimmer, K., Moss, J., & Falco, J. ( 2004). Experiences of elderly patients regarding independent community living after discharge from hospital: A longitudinal study. International Journal for Quality in Healthcare, 16, 465-472.
20.
Hall, M.J., DeFrances, C.J., Williams, S.M., Golosinskiy, A., & Schwartzman, A. (2010). National Hospital Discharge Survey: 2007 summary (National Health Statistics Reports Number29). Hyattsville, MD: National Center for Health Statistics.
21.
Huber, D.L., & McClelland, E. (2003). Patient preferences and discharge planning transitions. Journal of Professional Nursing , 19, 204-210.
22.
Huby, G., Brook, J.H., Thompson, A., & Tierney, A. ( 2007). Capturing the concealed: Interprofessional practice and older patients’ participation in decision-making about discharge after acute hospitalization. Journal of Interprofessional Care, 21, 55-67.
23.
Jacelon, C. ( 2006). Directive and supportive behaviors used by families of hospitalized older adults to affect the process of hospitalization. Journal of Family Nursing, 12, 234-250.
24.
Jacob, L., & Poletick, E.B. (2008). Systematic review: Predictors of successful transitions to community based care for adults with chronic needs. Care Management Journals, 9, 164.
25.
Kasper, J., & O’Malley, M. (2007). Kaiser commission on Medicaid and the uninsured. Retrieved on September 22, 2010 from http://www.kff.org/medicaid/upload/7663.pdf .
26.
Kincheloe, J.L., & McLaren, P.L. ( 1998). Rethinking critical theory and qualitative research. In N. K. Denzin & Y. S. Lincoln (Eds.), The landscape of qualitative research: Theories and issues (pp. 260-299). Thousand Oaks, CA: Sage.
27.
Komisar, H.L., Feder, J., & Kasper, J. ( 2005). Unmet long term care needs: An analysis of Medicare-Medicaid dual eligibles. Inquiry, 42, 171-182.
28.
Kulesher, R.B., & Wilder, M.G. ( 2008). The impact of PPS on hospital sponsored post-acute services: A case study of Delaware medical recipients. Journal of Healthcare Management, 53, 54-69.
29.
Kuzel, A. ( 1999). Sampling in qualitative inquiry. In B. F. Crabtree & W. L. Miller (Eds.), Doing qualitative research (2nd ed., pp. 33-45). Thousand Oaks, CA: Sage.
30.
Leininger, M. ( 1994). Evaluation criteria and critique of qualitative research studies. In J. M. Morse (Ed.), Critical issues in qualitative research methods (pp. 95-133). Thousand Oaks, CA: Sage.
31.
Magilvy, J.K., & Congdon, J.G. ( 2000). The crisis nature of healthcare transitions for rural older adults. Public Health Nursing, 17, 336-345.
32.
Mansall, D., Poses, R., Kazis, L., & Duefield, C. ( 2000). Clinical factors that influence patient’s desire for participation in decisions about illness. Archives of Internal Medicine, 160, 2991-2996.
33.
Marek, K.D., Adams, S.J., Stetzer, F., Popejoy, L., & Rantz, M. ( 2010). The relationship of community-based nurse care coordination to costs in the Medicare and Medicaid programs. Research in Nursing & Health, 33, 235-242.
34.
Marek, K.D., Popejoy, L., Petroski, G., Mehr, D., Rantz, M., & Lin, W.C. ( 2005). Clinical outcomes of aging in place. Nursing Research, 54, 202-211.
35.
Marek, K.D., Popejoy, L., Petroski, G., & Rantz, M. ( 2006). Nurse care coordination in community-based long term care. Journal of Nursing Scholarship, 38, 80-86.
36.
Metlife Foundation, National Alliance of Caregivers, American Association of Retired Persons. (2009). Executive summary: Caregiving in the U.S Retrieved from http://www.caregiving.org/data/CaregivingUSAllAgesExecSum.pdf
37.
Mukotekwa, C., & Carson, E. ( 2007). Improving discharge planning process: A systems study . Journal of Research in Nursing, 12, 667-686.
38.
National Academies Press. (2008). Retooling for an aging America: Building the healthcare workforce. Washington, DC: Author. Retrieved from http://www.nap.edu/catalog.php?record_id=12089
39.
Naylor, M.D. ( 2000). A decade of transitional care research with vulnerable elders. Journal of Cardiovascular Nursing, 14(3), 1-14.
40.
Popejoy, L.L. ( 2008). Adult protective services use for older adults at the time of hospital discharge. Journal of Nursing Scholarship , 40, 326-332.
41.
Popejoy, L.L. (in press). Participation of older adults, families, and health care team in hospital discharge destination decisions. Applied Nursing Research. doi: 10.1016/j.apnr.2009.11.001
42.
QRS-N6 Reference Guide. (2002, March). Using N6 in qualitative research. Sydney, Australia: QRS International.
43.
Roth, D.L., Haley, W.E., Wadley, V.G., Clay, O.J., & Howard, G. ( 2007). Race and gender differences in perceived caregiver availability for community-dwelling middle-aged and older adults. Gerontologist , 47, 721-729.
44.
Shea, D.A., Davey, E.F., Femia, S.H., Zarit, G., Sundstrom, S.G., & Smyer, M.A. ( 2003). Exploring assistance in Sweden and the United States . Gerontologist, 43, 712-721.
45.
Sutton, J.P. ( 2005). Utilization of home health services among rural Medicare beneficiaries before and after PPS (Final Report). Bethesda , MD: NORC Walsh Center for Rural Health Analysis.
46.
Taylor, P., Morin, R., Parker, K., Cohn, D., & Wang, W. ( 2009). Growing old in America: expectations vs. reality. Retrieved from http://pewsocialtrends.org/2009/06/29/growing-old-in-america-expectations-vs-reality/
47.
Tversky, A., & Kahneman, D. ( 1981). The framing of decisions and the psychology of choice . Science, 211, 453-458.
48.
Weiss, M.E., Piacentine, L.B., Ancona, J., Gresser, S., Toman, S., & Vega-Stromberg, T. (2007). Perceived readiness for hospital discharge in adult medical-surgical patients. Clinical Nurse Specialist, 21, 31-42.
49.
Wolff, J.L., & Kasper, J.D. ( 2006). Caregivers of frail elders: Updating a national profile . Gerontologist, 46, 344-356.
