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Gaps In Health Care Limit Options For Older Adults

March 28, 2011

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. Lori Popejoy, 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 health care providers is essential to providing effective care for the aging population in the next few years," said Popejoy, assistant professor and John A. Hartford Foundation Claire M. Fagin Fellow 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 hospital staff, 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 hospital discharge 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.

The study, "Complexity of Family Caregiving and Discharge Planning," was published in the recent issue of the Journal of Family Nursing. Popejoy earned a master's degree and doctorate in nursing from MU. Her work experience in hospitals, nursing homes and home health care has inspired her to understand more about the problems and issues faced by nurses as they work with older adults and their families. Currently, she is studying the challenges faced by health care providers as they discharge older adults from the hospital, and the health care transitions faced by elderly people and their families following hospitalizations.