Abstract
Older adults are rarely consulted on health care restructuring. To address this gap, our study explored older adults' views on "repositioning", a restructuring initiative to support independent living for older adults with complex chronic disease (CCD). We collected and analysed data from 83 older adults living in one small city and nine rural small towns where "repositioning" of primary and community care was occurring. Average participant age was 75 years; 56 (67%) were women, 44 (53%) had CCD, and 20 (24%) identified as Indigenous or South Asian. The four themes were: unfamiliarity with repositioning; optimism versus skepticism; improving primary and community care (through better home care, improved transportation, and more doctors); and, playing an active role to effect change. For repositioning to be successful, diverse service users must be fully included; rural-dwelling older adults' priorities for primary and community care need to be addressed, rather than using a "cookie-cutter" approach.
Highlights
Older adults are rarely consulted on health care restructuring
P3: “By repositioning, what do you mean?” (FG, SR4). After participants displayed their unfamiliarity and/or asked for the meaning of repositioning, we provided the Ministry of Health (2015a) definition; this includes a focus on adults aged 75 and older with complex chronic disease (CCD) and refers to a shifting of resources within the health care system to reduce hospital and residential care admissions
Older adults living in Kamloops and surrounding rural towns were unfamiliar with repositioning
Summary
Demand is increasing for primary and community care services for older adults who have multiple and interconnected health needs. For Interior Health, this “repositioning” initiative meant a shift in resources from acute care to primary and community care to better support independent living at home or in the community and, at the same time, to reduce hospital and residential care admissions (Ministry of Health, 2015a). This initiative, which began in 2015, was driven by a projected increase in the senior population (defined as those aged 65 and older) of 20 per cent between 2014 and 2019 in Kamloops (one of two small cities in Interior Health’s catchment area) and was in the planning stages when we conducted the research reported . Research on rural aging treats seniors with health problems as “marginalized”, yet often overlooks poverty and gender (Keating, Swindle & Fletcher, 2011) despite these being key SDOH
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