SCIE Research briefing 12: Involving individual older patients and their carers in the discharge process from acute to community care: implications for intermediate care
Published February 2005
Introduction - What is the issue?
A SCIE Research briefing provides up-to-date information on a particular topic. It is a concise document summarising the knowledge base in a particular area and is intended as a 'launch pad’ or signpost to more in-depth investigation or enquiry. It is not a definitive statement of all evidence on a particular issue. The briefing is divided into the different types of knowledge relevant to health and social care research and practice, as defined by the Social Care Institute for Excellence (SCIE). It is intended to help health and social care practitioners and policy-makers in their decision-making and practice.
The topic of this briefing is the involvement of individual patients and carers in the process of assessment and discharge to community care, especially intermediate care. Intermediate care essentially acts as a bridge between social, primary and secondary care services. It aims "to provide an integrated service to promote faster recovery from illness, prevent unnecessary acute hospital admissions, support timely discharge and maximize independent living". It is "a short term intervention to preserve the independence of people who might otherwise face unnecessarily prolonged hospital stays or inappropriate admission to hospital or residential care. The care is person-centred, focused on rehabilitation and delivered by a combination of professional groups". It is not expected to last more than six weeks. The nature of intermediate care can be extremely broad-ranging and extensive, however. It may encompass everything from step-up and step-down beds or care, to low-level social rehabilitation. The majority of this care is provided by a combination of health and social care professionals, and therefore requires an integrated and collaborative approach from these services. The client group considered by this briefing is older people only (aged 65 and over).
This briefing does not consider the general strengths or weaknesses of current or proposed intermediate care programmes, or the effectiveness or cost-effectiveness of this type of care as a service. Nor does it consider the benefits or limitations of intermediate care as a concept, the roles of the various professionals involved in providing this care, or the appropriateness of criteria for discharge or admission. This is all discussed in great depth elsewhere. This briefing is concerned with the participation of individual patients and carers, rather than groups, in the planning of discharge to intermediate care. For the purpose of this briefing, user participation or involvement is defined as health and social care professionals seeking the views of individual older patients and their carers about their discharge and care. The briefing therefore aims to examine the findings of the research and policy literature into the means, benefits and difficulties of involving patients in the planning of discharge to community or intermediate care. It will also consider the role of carers in this process, as well as what happens when an older person’s ability to communicate their preferences in these matters is affected by dementia, language difficulties, or an unwillingness or reluctance to express preferences about the provision of care. There is limited research on the involvement of individual older patients and carers on discharge to intermediate care itself. This briefing therefore also examines policy and research findings on older people’s involvement in discharge planning more generally. This obviously has implications for the participation or involvement of older users in discharge planning to intermediate care.
- Guidance and standards outlined by the Department of Health call for more patient-centred care for older people, including their individual involvement in decisions relating to their own care.
- Patient and public involvement in the provision of health and social services is a key element of government policy, but older people are not usually consulted about the planning of their discharge or care.
- There is almost no research on individual patient or carer involvement in intermediate care, either on assessment and discharge to intermediate care, or on the care itself. However, research does address the involvement of individual older users in the provision of more general health and social services.
- Some older people voluntarily express opinions about their discharge and care, while many others are happy to do so when prompted. However, some older people can be reluctant to express any views, and others do not want to play any role at all in the decision-making process.
- Communication is recognised to be an essential part of user involvement, but older patients who wish to be involved in decisions regarding their care may be prevented from doing so by cognitive impairments, frailty, very poor health, language difficulties, or a lack of confidence when faced with health and social care staff.
- Carers of older people experience the same lack of involvement in discharge planning as the patients. The system often fails to consult with them about their own needs and concerns.