Nursing Studies

One Chance to get it right: exploring care home discharge decision making

This case study research project explores the different perspectives of patients, staff and family members on the decisions made to discharge someone from acute hospital to care home.

Discharge from acute hospital directly to care home is not recommended in policy documents but is the reality in many care settings. The decision making which shapes the discharge to a care home is not well understood. Many people – patients, family members, nurses, doctors, allied health professionals, and social workers may contribute to the decision making yet, the process remains unclear. The motivations and interests which shape the decision are not well understood.

Following a successful exploratory retrospective case note review, this project has developed in order to explore a range of perspectives. Case notes suggested that stakeholders brought different priorities, motivations and interests to the decision making process. This study set out to explore those priorities and interests.

Preliminary findings:

  • The decision to move to a care home is hugely significant for the individual and their family members. This significance may not always be fully recognised by staff or family members
  • The decision-making process is fragmented which does not enhance the experience for stakeholders
  • The hospital setting is important and has potential both to (1) facilitate decision making and (2) limit some elements of choice within the decision-making process
  • Professional expectations of family roles in care and support influence the decision-making process
  • Relationships between older adults and their adult children highlight significant complexity around individual roles
  • The portrayal of care homes by stakeholders is influential in decision making.

This study is currently being written up and findings are being disseminated. Further work is now planned to explore specific groups of patients, experiences after care home admission and the discharge home from hospital of those patients who considered care home but opted for discharge home instead.

Project team

Dr Sarah Rhynas, University of Edinburgh

Ms Gemma Logan, NHS Lothian

Dr Jennifer Burton, University of Glasgow