Discharge planning with older adults in Minnesota hospitals.

Abstract

This mixed methods study utilizes data collected through telephone interviews with hospital administrators and health care professionals who assist elders with planning for post-acute care and secondary data from the Minnesota Department of Health and the Minnesota Hospital Association website to examine the discharge planning process in all hospitals serving older adults in Minnesota. It addresses two research questions: 1) How, if at all, decision-making help for hospitalized seniors is structured and what predicts that structure? and 2) To what extent, do professionals who help with decisions deliberately engage in processes that help elders and their families explore alternatives and reach decisions consistent with their own values, and what predicts whether that process takes place? Quantitative analyses determined that the majority of hospitals in Minnesota serving that serve older adults are small, rural hospitals with critical access designations, are private nonprofit, and are affiliated with a health care system. Social workers are primarily responsible for discharge planning in half of the hospitals, nurses in a quarter and either a nurse/social worker team or both nurse and social workers separately in a quarter. Multinomial logistic regression determined that in critical access hospitals nurses are more likely than social workers to be the profession primarily responsible for discharge planning. The majority of professionals who assist elders in making decisions about post-acute care, decision counselors, were female, in their 40s, and social workers who have received a bachelor's degree. The majority of decision counselors reported typically using a deliberate approach to their work. Multivariate analysis suggests that social workers score higher than nurses on the deliberate decision counseling scale based on Janis and Mann's (1977) framework. The qualitative method, conventional content analysis, was used to analyze open ended responses by decision counselors when asked to describe a recent case of an elder who presented the most decision challenges related to discharge planning. Decision counselors do not use a consistent process in assisting elders make decisions about post-acute care. Instead, decision counselors vary in their practice due to influences from the medical model and ethical dilemmas concerning the values of safety and self-determination.