Delayed transfer from hospital to community settings: the older person's perspective

Abstract

Prevention and management of delayed transfer of older people from hospital to community settings is an enduring issue in industrialised societies and is the subject of many recent policies in the United Kingdom. A deeper, evidence-based understanding of the complex organizational and interprofessional issues which contribute to delays in transfer has emerged in recent years. Despite this, and the relative success of recent policies, two recent reviews of the area highlight the lack of studies on patients' perspectives. We sought to address this deficit by using conversational interviews and a phenomenological approach to explore and interpret participants' perceptions of delayed transfer from hospital into the community. A purposive sampling strategy was employed to incorporate participants from different categories of delay identified on weekly Situation Reports. Participants aged 65 years and over (mean age 82 +/- 5.4 years) and with a mean delay of 32 days (+/- 26) were recruited from three hospitals based in two NHS Trusts in the South of England. This paper focuses on their perceptions of the effects of delayed transfer into the community, their involvement in discharge planning and future community care needs. Our findings show that participants actively or passively relinquished their involvement in the processes of discharge planning because of the perceived expertise of others and also feelings of disempowerment secondary to poor health, low mood, dependency, lack of information and the intricacies of discharge planning processes for complex community care needs. Participants expressed a longing for continuity, emphasised the importance of social contact and sometimes appeared unrealistic about their future care needs. While current policies may have helped reduce overall numbers of delayed patients in the UK, our study suggests that there is scope for improvement in the involvement of delayed patients in planning their discharge into the community.

A review of the literature on patient participation in transitions of the elderly

“…Lack of information concerning the discharge process was apparent in several of the studies exploring the patients' perspective on discharge planning (Benten and Spalding 2008;Ellis-Hill et al 2009;Foss and Hofoss 2011;McKain et al 2005;Perry et al 2011;Swinkels and Mitchell 2008). Information was provided orally.…”

“…Information was provided orally. In one study by Benten and Spalding (2008) (Perry et al 2011;Swinkels and Mitchell 2008) documented that some patients were not aware of their own formal discharge plan. One study (Foss and Hofoss 2011) revealed sparsely information to patients about discharge.…”

“…Swinkels and Mitchell (2008) focused on elderly patients' perceptions of effects of delayed transfer into the community, involvement in discharge planning and future community care needs. Decision about transfer to a residential or nursing care was, according to the patients, taken by healthcare professionals.…”

“…Swinkels and Mitchell (2008) reported patients' experiences of depression, change in functional ability, dependence on others, hopelessness, apathy, grief and loss of personal autonomy. Patients felt imprisoned in hospital and disempowered, but despite this several speculated about self-discharge.…”

Transitions at the end of life for older adults – patient, carer and professional perspectives: a mixed-methods study

“…Aside from the additional costs of delayed hospital discharge, qualitative interviews indicate that uncertainty in having their hospital discharge delayed and guilt about being identified as a 'bed blocker' can cause considerable anxiety and stress to patients at the end of life. 53,54 When provision for support outside hospital is in place, arranging timely and appropriate transport can cause further delays. 55 …”