Who Bears Responsibility for the Post-Acute Older Adult: Patient, Family or State?

Abstract

This study explores the perceptions of hospital discharge coordinators on the issues raised for the post-acute older adult and their family, using the lens of assisted decision-making and advance directives. New legislation has been developed in Ireland to support assisted decision-making and advance directives that is largely consistent with other countries around the world. The Assisted Decision-Making Act of 2015 was fully commeced in April 2023, following lengthy debate. However, there is a lot of professional uncertainty regarding how to support and integrate Advance Healthcare Directives and assisted decision-making into the care of adults and into the role of nurses working in the community. Utilising a qualitative approach, this study conducted a series of five focus groups, with 23 participants, across the South-East of Ireland. Thematic analysis was used to interpret results. The 32-item consolidated criteria for reporting qualitative research checklist was utilised. The central finding in this study concerned the locus of control, as well as findings on burden of care and the role of the nurse. A stark incongruence of beliefs among patient, family and State was identified. Nurses must learn to circumnavigate the complex terrain involved in supporting the older adult's advance decision-making and advance healthcare directives.