Long-Term Care Health Care Aides’ Perceptions of Decision-Making Processes in Transferring Residents to Acute Care Services

Abstract

<jats:p> Most transfers of long-term care (LTC) facility residents to the emergency department (ED) via 911 calls are necessary. Avoidable transfers can have adverse effects including increased confusion and dehydration. Around 20% of transfers are perceived to be avoidable or unnecessary, yet decision making around transfers is complex and poorly understood. Using a qualitative-focused ethnographic approach, we examined 20 health care aides’ (HCAs) perceptions of decision processes leading to transfer using experiential interview data. Inductive analysis throughout iterative data collection and analysis illuminated how HCAs’ familiarity with residents make them vital in initiating care processes. Hierarchical reporting structures influenced HCAs’ perceptions of nurse responsiveness to their concerns about resident condition, which influenced communications related to transfers. Communication processes in LTC facilities and the value placed on HCA concerns are inconsistent. There is an urgent need to improve conceptualization of HCA roles and communication structures in LTCs. </jats:p>

Resident loneliness, social isolation and unplanned emergency department visits from supportive living facilities: a population-based study in Alberta, Canada

“…It is worth noting that most studies of loneliness and social isolation and ED visits have focused on community-dwelling older adults and therefore they do not consider the organizational and staffing factors in institutional settings—like SL— that add yet another layer of complexity when considering factors related to ED visits and other health service use [ 41 ]. For example, studies in institutional settings like NH have found that the decision to transfer a resident to ED is influenced by hierarchical reporting structures, perception of staff roles and expertise, and communication processes [ 42 ]. Using information available in administrative health data, we were unable to meaningfully assess how specific organizational factors in SL might influence loneliness, social isolation, and health service use.…”

Who Doesn’t Come Home? Factors Influencing Mortality Among Long-Term Care Residents Transitioning to and From Emergency Departments in Two Canadian Cities

“…Despite family involvement not directly influencing death, family involvement was included in this model because research supports that families are often not effectively prepared for end-of-life processes, and family involvement in decisions to transfer have been linked to avoidable transitions (Tate et al, 2020;Trahan et al, 2016). Other studies show resident ED utilization may be more likely upon family request, or when older persons perceive they have low levels of social support (Barken et al, 2016;Dermody et al, 2017;Tate et al, 2020;Trahan et al, 2016). Including this variable in the model provides a preliminary framework for adding other factors related to the interactions between families and health care professionals involved in transition decisions, and advance care planning.…”

“…Given the conflicting reports related to the effect of ownership model and resident death (Anic et al, 2014;Menec et al, 2009), research should explore how ownership model related to staffing levels and staff-mix can influence family involvement in resident care to reduce transitions in instances when quality end-of-life care could be provided on site. Research should determine the influence of regional context in future modeling work (e.g., availability and access to diagnostic services, LTC site proximity to hospital, access to or awareness of alternative health services, resident case-mix in facilities (Avdic, 2014;Cornillon et al, 2016;Tate et al, 2020). Further work is needed to include factors related to advance care planning, such as training or availability of specialized clinicians for this purpose and the number and quality of formal conversations with care teams regarding end-of-life care (Wilson et al, 2020;Bollig et al, 2016).…”

“…Although family involvement was not expected to directly influence death during transition in our model, we expected it to be correlated with higher resident acuity, which did predict resident death. Despite family involvement not directly influencing death, family involvement was included in this model because research supports that families are often not effectively prepared for end-of-life processes, and family involvement in decisions to transfer have been linked to avoidable transitions (Tate et al, 2020;Trahan et al, 2016). Other studies show resident ED utilization may be more likely upon family request, or when older persons perceive they have low levels of social support (Barken et al, 2016;Dermody et al, 2017;Tate et al, 2020;Trahan et al, 2016).…”

“Nurses caught in the middle”: A qualitative study of nurses’ perspectives on the decision to transfer deteriorating nursing home residents to emergency departments in Singapore

“…Unlike primary and acute care settings, NHs are not required to engage a resident physician for round-the-clock medical coverage. Hence, most NHs outsource their medical care services for residents to private general practitioners on a contract basis, and registered nurses (RNs), enrolled nurses (ENs), and nursing aides remain the primary healthcare providers Tate et al, 2018 ). Given that physicians are often off-site, NH nurses often play a major role in deciding residents' transfer to the ED during an acute situation or medical emergency .…”