Older patient participation in multi-disciplinary decision-making: discharge planning in scotland and british columbia, canada

An increasing proportion of older people today are returning to their own homes following discharge from hospital. The aim of community care policies in both Britain and Canada has been to provide these older people with the services necessary to continue living independently in the community. The maintenance of this independence is dependent upon effective discharge planning. There are four stages of discharge planning: assessment of the patient's needs; planning which services will be required by the patient after release from hospital; implementation of these services; and follow-up to determine whether the patient's needs are being met by the implemented discharge plan. Discharge planning is therefore a multi-disciplinary decision-making process involving negotiation between a variety of hospital based health and social care practitioners, the patient and his or her carers, and community service agencies. The older patient's involvement in this decision-making process serves as the focus for this research. The aim of this comparative study was to determine what role older patients play in discharge planning, to what extent they are permitted to be involved and to what extent they wish to be involved. The research setting for this qualitative study was two geriatric assessment and rehabilitation units, one in Scotland, the other in British Columbia, Canada. Older patients and health and social care practitioners were interviewed in each unit. Following release from hospital, these older patients were also interviewed in their own homes. Findings from these interviews, combined with observation and document analysis, demonstrate how each ward attempted to facilitate patient input in planning and what patients' and professionals' views of participation were. Findings also reveal a relationship between patient participation and discharge outcomes in each country, and suggest ways in which greater patient involvement can be introduced into the discharge planning process in order to attain continuity of care between the hospital and the community.