An examination of discharge planning with older adults in light of the social and political dimensions of healthcare contexts

Background: Discharge planning is a complex process in which intersections of competing demands and agendas often beget ethical challenges. Returning home or moving to a more supportive setting can have tremendous personal,... [ view full abstract ]

Background: Discharge planning is a complex process in which intersections of competing demands and agendas often beget ethical challenges. Returning home or moving to a more supportive setting can have tremendous personal, social and financial implications for older adults. Institutional concerns with patient safety and experience can overshadow healthcare professionals’ commitments to client-centred approaches.
Methods: The purposes of this research were to 1) explore perspectives of older adults, family members, and healthcare professionals engaged in discharge planning from inpatient rehabilitation; 2) examine how social and political contexts shaped discharge-planning processes, practices and outcomes in one older adult rehabilitation setting. Using microethnographic case study methods, observations and interview data were generated from five case studies, each consisting of an older adult, involved family members and healthcare professionals.
Results: Taking a critical bioethics perspective in the analysis revealed that discourses of aging-as-decline, beliefs privileging healthcare professionals’ expertise and conventions guiding discharge planning marginalized older adults in the study setting. The prioritization of safety and focus on discharge superseded approaches to maximize function: the stated aim of rehabilitation. A profession-centric approach and the focus on safety and discharge from the time of admission intersected to promote 24-hour care recommendations in all cases.
Conclusions: Occupational therapists are heavily involved in discharge planning, yet social and political influences intersect to marginalize older adults and impede intended client-centered practice.
Implications for Practice: A relational approach to discharge planning could promote practices that align professional responsibilities with client needs and preferences, thereby upholding older adults’ agency.