Report examines hospital-to-home transition for seniors

Andrew Robinson
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Recommends navigating model to follow care from diagnosis to end of life

A report documenting the experiences of seniors transitioning from hospitals to their home environment documents numerous unsatisfactory experiences, but it also offers a suggestion for how to prevent certain problems from occurring.

Gail Wideman, an assistant professor of sociology at Memorial University, assisted with the design, implementation and analysis of a report examining the experiences of seniors transitioning from hospital to home. She presented its findings at the annual general meeting of the Seniors Resource Centre of Newfoundland and Labrador, held Tuesday at Corpus Christi Parish Hall in St. John’s.

Prepared by the Seniors Resource Centre of Newfoundland and Labrador’s advocacy committee, the report’s findings were discussed at Tuesday’s annual general meeting in St. John’s for the non-profit organization.

“The fact that older adults and the people who support them are having difficulty with this transition is not new information,” said Gail Wideman, an assistant professor of the school of social work at Memorial University who helped design, implement and analyze work that went into the report.

“But what we hoped to contribute to that story with this project was the experiences, the words, of people who were actually living it. Adding some personal context, but also some urgency to the fact that we need to do this a little better.”

The report’s findings were informed by three focus groups that involved a total of 32 participants ranging in age from 58 to 97. Ageist attitudes, limited resources, a lack of understanding about the needs of seniors and improper treatment of patients with dementia were among the frustrations expressed by patients and caregivers who took part in the focus groups.

The report also heard from people who found that assumptions were made about what patients already knew and who haphazardly learned details concerning their health or treatment. Some were ultimately fearful about going home.

“We recognized that more can be done, that there’s a lack of practical support and care, as well as a lack of emotional and social support, and an overall lack of trust in the system,” said Wideman. “Ageist practices and attitudes are pervasive, and change is required at many levels.”

She also noted that such issues are not limited to Newfoundland and Labrador. Literature reviewed for the report identified similar problems in other parts of Canada and the world.

While those who chose to have their voices heard for the purpose of the report largely dwelled on the negative aspects of their care, Wideman said, there were examples of good experiences. Nurses and social workers were singled out in some cases, and at least two people spoke well of their long-term-care experience.

The report recommends an integrated continuum of discharge and post-discharge care that’s called a navigating model.

According to Wideman, that model starts with providing assistance at the diagnosis stage and continuing on through to the acute and long-term care stages, eventually moving on to end-of-life care. Wideman said the navigating model can help create efficiencies in health care and save governments money.

“It’s a single access point to health and social services,” she said. “It contributes to a more effective and sustainable allocation of resources, and there are models out there … where both volunteers and professionals are used as the navigators. It really connects the dots between the separate functions of the health-care system. It’s meant to be flexible and seamless to meet the diverse needs of individuals. The key is navigation and communication.”

Twitter: @TeleAndrew

This is a corrected version.

Organizations: Seniors Resource Centre

Geographic location: Newfoundland and Labrador, Canada

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