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

Abstract

Aim: 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.

Background: 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.

Methods: 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.

Findings: 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.

Conclusion: Nurses must learn to circumnavigate the complex terrain involved in supporting the older adult's advance decision-making and advance healthcare directives.

Keywords: Ireland; Older adults; community nursing; post-acute care.