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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

Information

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

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