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Mediators of marginalisation in discharge planning with older adults

Published online by Cambridge University Press:  20 June 2016

EVELYNE DUROCHER ,
BARBARA E. GIBSON  and
SUSAN RAPPOLT
EVELYNE DUROCHER*
Affiliation:
School of Occupational Therapy Occupational Science Field, Faculty of Health Sciences, Western University, London, Ontario, Canada.
BARBARA E. GIBSON
Affiliation:
School of Physical Therapy, University of Toronto, Canada. Bloorview Research Institute, Holland Bloorview Kids Rehab Hospital, Toronto, Canada.
SUSAN RAPPOLT
Affiliation:
Department of Occupational Science and Occupational Therapy, University of Toronto, Canada.
*
Address for correspondence: Evelyne Durocher, School of Occupational Therapy Occupational Science Field, Faculty of Health Sciences, Western University, 1201 Western Road, London, ON, N6 G 1H1, Canada E-mail: evelyne.durocher@utoronto.ca or edurocher@gmail.com
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Abstract

Returning home or moving to a more supportive setting upon discharge from inpatient health-care services can have a tremendous impact on the lives of older adults and their families. Institutional concerns with patient safety and expedience can overshadow health-care professionals' commitments to collaborative discharge planning. In light of many competing demands and agendas, it can be unclear what is driving discharge-planning processes and outcomes. This paper presents the results of a study examining discharge planning in an older adult rehabilitation unit in a Canadian urban setting. Using microethnographic case studies, we explored the perspectives of older adults, family members and health-care professionals. Drawing on concepts of relational autonomy to guide the analysis, we found that discourses of ageing-as-decline, beliefs privileging health-care professionals' expertise and conventions guiding discharge planning intersected to marginalise older adult patients in discharge-planning decision making. Discharge planning in the research setting was driven by norms of ‘protecting physical safety’ at the expense of older adults’ self-declared interests and values. Such practices resulted in frequent recommendations of 24-hour care, which have significant personal, social and financial implications for older adults and their families, and ultimately might undermine clients' or health-care systems' aims. The analysis revealed social, political and institutional biases that diminish the rights and autonomy of older adults.

Keywords

discharge planningolder peoplerehabilitationsafetycase studiesdecision makingethnography
Type
Articles
Information
Ageing & Society , Volume 37 , Issue 9 , October 2017 , pp. 1747 - 1769
Copyright
Copyright © Cambridge University Press 2016 

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