133A Life Changing Decision: Exploring Different Perspectives Of Risk In Care Home Discharge Decision Making

Abstract

Introduction: Discharge from acute hospital to care home is a life-changing experience which shapes the remaining years of a person's life. Despite the importance of this event, the processes which underlie such decisions are often not clearly articulated and the differing perspectives of individual patient, family and multidisciplinary team (MDT) members are not well understood. Methods: A retrospective case note study (n = 100) was undertaken to improve understanding of this increasingly important aspect of healthcare practice. From the 100 case notes, 10 examples were selected for further, in-depth reflexive sociological analysis. Narrative accounts were developed and were subsequently thematically analysed. Results: Data demonstrate that risk narratives pervade decision making about discharge to care home. Voices of patients struggle to be heard in the face of challenging dialogue between patient, family and MDT. Perceived societal expectations of the role of adult children in caring for elderly parents were found to interact with individual fears for that parent's safety and a desire to uphold parental wishes regarding discharge destination. Multidisciplinary professionals and family members were noted to articulate different risks and safety concerns. These narratives reflect debates and expectations from the wider social world. The concept of a 'last chance' to be discharged home rather than to care home was found to be an important way of bridging gaps between different conceptualisations of risk and alleviating both familial and professional anxiety. Risks associated with loss of independence and the life-changing nature of care home discharge often form a tacit backdrop to the explicit articulation of more obvious challenges to personal safety and health. Conclusions: Risk is a dominant discourse in the discharge of older people directly from acute hospital to care home. The language of risk pervades the narrative of both families and professionals, shaping discharge decision making. Societal expectations of family and professionals are influential in shaping understandings of risk in discharging older people from acute hospital. Explicit understanding of the ways in which risk, safety and personal integrity interact in care home discharge decision-making has the potential to improve care during this life-changing transition.