Gaps in health care limit options for older adults, expert says

March 22, 2011, University of Missouri-Columbia

There are 50 million family members providing care to older adults in the United States, according to the MetLife Foundation and national caregiving associations. When older adults are hospitalized and discharged, their families face numerous choices about where they will go and how they will receive care. A University of Missouri nursing expert says the complexity of this process will intensify with increasing demands for health care and workforce shortages.

"Coordination among families, patients and is essential to providing effective care for the in the next few years," said Lori Popejoy, assistant professor in the MU Sinclair School of Nursing. "Stress, fear and lack of understanding often complicate the decision-making process for families and patients. Open communication is needed to support end-of-life care and decision making."

Hospital visits and discharge processes are often complicated; family members have to communicate with each other and health care team members (HCTMs), which include physicians, nurses and , about treatments and make decisions with limited resources. Popejoy identified common concerns about the process: going home, advocating for independence, making decisions and changing plans.

"A new approach to the process should further consider the rights of patients and families – to be fully and accurately informed of older adults' conditions and realistic care options, including home care, personal care and nursing homes," Popejoy said.

Popejoy says decision making should be an interactive and incremental process that occurs among patients, families and HCTMs. A HCTM can be designated to communicate information among care providers, patients and their families. In previous research, Popejoy found that families and patients who worked with a nurse communicator reported less stress and better overall care.

More information: The study, "Complexity of Family Caregiving and Discharge Planning," was published in the recent issue of the Journal of Family Nursing.

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