Abstract
This mixed-methods study addressed the problem that although waiting placement is considered a major hospital utilization issue, minimal evidence exists to highlight the extent of it and the personal impact of waiting placement. An analysis of two years of complete hospital data for the Canadian province of Alberta was undertaken to examine waiting placement rates and describe waiting placement patients. Qualitative interviews and observations of elderly patients waiting in hospital for nursing home placement were also undertaken to gain an understanding of the lived experience of waiting for placement in hospital. Only 1.8% of all inpatients were waiting placement with an ALC (Alternative Level of Care) designation, 80% of ALC waits were less than 41 days (mean=29.85, median=14), and 2.2% of total hospital bed days in these two years were used by ALC patients. Three qualitative themes emerged: (a) coming to a realization of this significant move, (b) waiting is boring and distressing, and (c) hospitals are not designed for waiting placement. The findings of this study should raise awareness that although relatively few people wait placement in hospital, there are some major possible negative effects of waiting for placement in hospital for those who wait; with remedies to address waiting placement care deficits needed.
Highlights
Hospitals are a common transition point for nursing home entry, as only around 40% of the people who move into nursing homes are admitted directly from the community (Canadian Institutes for Health Information [CIHI], 2009; Devroey, Van Casteren, & De Lepeleire, 2002; Goodwin, Howrey, Zhang, & Kuo, 2011)
1.8% of all inpatients were waiting placement with an alternative level of care (ALC) (Alternative Level of Care) designation, 80% of ALC waits were less than 41 days, and 2.2% of total hospital bed days in these two years were used by ALC patients
The ALC designation was made after hospital admission, as only 221 of the 13,043 patients who had an ALC designation were admitted from a nursing home with this designation
Summary
Hospitals are a common transition point for nursing home entry, as only around 40% of the people who move into nursing homes are admitted directly from the community (Canadian Institutes for Health Information [CIHI], 2009; Devroey, Van Casteren, & De Lepeleire, 2002; Goodwin, Howrey, Zhang, & Kuo, 2011). With population aging beginning to accelerate many more elderly people in the future could wait in hospital for a nursing home bed. These waits can be lengthy (CIHI; Epure, & Blanchette, 2002; Mayo, Wood-Dauphinee, Gayton, & Scott, 1997), and this use of expensive and scarce hospital beds has been of considerable concern for some time in Canada and many other developed countries (Beland et al, 2006; CIHI, Devroey et al.; Fjelltun, Henriksen, Norberg, Gilje, & Normann, 2009; Murtaugh & Litke, 2002). Long hospital stays have been linked with depression and cognitive deterioration for older patients, as well as physical www.ccsenet.org/gjhs
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