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Heading home from the hospital? Caregivers can play an important role in the discharge process

The Bottom Line

  • Every year, millions of people in Canada are hospitalized, thereby requiring the need for hospital discharge plans. 
  • Caregivers play an integral role in the care of patients following discharge from the hospital but often feel unsatisfied with the discharge planning process. 
  • When caregivers are included in hospital-discharge planning for older adults, the risk of readmissions, the length of stay of rehospitalizations, and cost of care following discharge may be reduced. 
  • With the consent of their loved one, caregivers are encouraged to be proactive in advocating on behalf of the patient and themselves during conversations around hospital-discharge planning.

In Canada, millions of people are hospitalized each year. Between 2019 and 2020, over three million individuals were admitted to hospitals with an acute disease, illness, or medical condition—such as heart attack, heart failure, bronchitis, or pneumonia (1). During the admittance process, key information is collected and documented. This important step helps to ensure that patients receive the appropriate type and level of care while in hospital. Similar efforts are needed at discharge to ensure patients seamlessly receive the care they need at home or in the community to continue their recovery.


There is a lot to consider for effective discharge planning, including determining where the patient’s next stop is (e.g., home) after their stay at a hospital or other advanced health care facility, as well as what is needed for them to transition there safely and within a timely manner (2). Research has shown that providing quality transitions through tailored discharge planning and transitional care programs/interventions can: reduce the length of hospital stays, hospital readmissions, use of unnecessary home care services, and admissions to long-term care homes; increase the use of primary-care services; and enhance the patient’s health outcomes (5-10). On the other hand, when the transition process is mismanaged, there is a risk of the patient experiencing interruptions in care, harm due to mistakes, and worsening symptoms. Both patients and caregivers can also endure emotional distress (11-24).


Caregivers have reported that their needs are often not met and have expressed disappointment with the discharge planning process. This is concerning given that informal caregivers, especially those caring for older adults, are providing quite complex care—such as medication management, the use of medical equipment, and wound maintenance (2;25). In addition to these tasks, caregivers also assist patients with completing activities of daily living, and can provide vital knowledge into the patient and their medical condition to the health care team (26-28). Is it possible that greater engagement of caregivers in discharge planning could support improved care in the community and ultimately better outcomes for patients? One systematic review took a closer look at the effects of including caregivers of older adults in hospital-discharge planning (2).


What the research tells us

The review found three potential benefits to including caregivers in hospital-discharge planning. First, this strategy can help to reduce the risk of older adults being re-admitted to the hospital. More specifically, the risk may be reduced by 9% to 38% three months after discharge and by 10% to 36% at six months post-discharge. Generally, studies also reported that including caregivers in discharge planning may reduce the length of rehospitalizations, as well as cost of care following discharge. These results underscore the importance of caregivers having a “seat at the table” when it comes to decision-making related to the discharge of their loved one from the hospital (2).


If you are a caregiver to a hospitalized older adult, it is important to get involved in discharge planning. With the patient’s consent, you can play an integral role in the care team as an advocate for the values, needs, and preference of both the patient and yourself (26; 28). This may seem daunting, but resources exist to help you navigate conversations by increasing your awareness of what questions to ask and information to seek. Health Quality Ontario’s comprehensive Quality Standard on transitioning between the hospital and home is one resource, while their more targeted Patient Guide on the topic, which presents the most relevant information for patients and caregivers, is another.


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References

  1. Canadian Institute for Health Information. Hospital stays in Canada. [Internet] 2021. [cited August 2021]. Available from https://www.cihi.ca/en/hospital-stays-in-canada 
  2. Rodakowski J, Rocco PB, Ortiz M, et al. Caregiver integration during discharge planning for older adults to reduce resource use: A metaanalysis. J Am Geriatr Soc. 2017; 65(8):1748-1755. doi: 10.1111/jgs.14873.
  3. Naylor MD, Brooten D, Campbell R, et al. Comprehensive discharge planning and home follow-up of hospitalized elders: A randomized clinical trial. JAMA. 1999; 281:613-620. doi: 10.1161/01.CIR.0000151811.53450.B8.
  4. Koelling TM, Johnson ML, Cody RJ, et al. Discharge education improves clinical outcomes in patients with chronic heart failure. Circulation. 2005; 111:179-185. doi: 10.1161/01.CIR.0000151811.53450.B8.
  5. The McMaster Optimal Aging Portal. Going home: Plan your transition before being discharged. [Interne] 2019. [cited August 2021]. Available from https://www.mcmasteroptimalaging.org/blog/detail/blog/2019/11/06/going-home-plan-your-transition-before-being-discharged 
  6. Shepperd S, Lannin N, Clemson L, et al. Discharge planning from hospital to home. Cochrane Database Syst Rev. 2013; 1:CD000313. doi: 10.1002/14651858.CD000313.pub4. 
  7. Weeks LE, Macdonald M, Martin-Misener R, et al. The impact of transitional care programs on health services utilization in community-dwelling older adults: A systematic review. JBI Database System Rev Implement Rep. 2018; 16(2):345-384. doi: 10.11124/JBISRIR-2017-003486.
  8. Allen J, Hutchinson AM, Brown R, et al. Quality care outcomes following transitional care interventions for older people from hospital to home: A systematic review. BMC Health Serv Res. 2014; 14:346.
  9. Hyde CJ, Robert IE, Sinclair AJ. The effects of supporting discharge from hospital to home in older people. Age and Ageing. 2000; 29(3): 271-279. doi: 10.1093/ageing/29.3.271.
  10. Registered Nurses’ Association of Ontario. Care transitions. Toronto, Canada: Registered Nurses’ Association of Ontario; 2014.
  11. Naylor M, Keating SA. Transitional care: Moving patients from one care setting to another. Am J Nurs. 2008; 108(9 Suppl):58-63. doi: 10.1097/01.NAJ.0000336420.34946.3a
  12. Avoidable Hospitalization Advisory Panel. Enhancing the continuum of care: Report of the Avoidable Hospitalization Advisory Panel. Toronto (ON): Queen’s Printer for Ontario; 2011. 
  13. Forster AJ, Murff HJ, Peterson JF, et al. The incidence and severity of adverse events affecting patients after discharge from the hospital. Ann Intern Med. 2003; 138(3):161-167. doi: 10.7326/0003-4819-138-3-200302040-00007.
  14. Kiran T, Wells D, Okrainec K, et al. Patient and caregiver priorities in the transition from hospital to home: Results from province-wide group concept mapping. BMJ Qual Saf. 2020; 29(5):390-400. doi: 10.1136/bmjqs-2019-009993.
  15. Coleman EA, Boult C. Improving the quality of transitional care for persons with complex care needs. J Am Geriatr Soc. 2003; 51(4):556-557. doi: 10.1046/j.1532-5415.2003.51186.x.
  16. Jencks SF, Williams MV, Coleman EA. Rehospitalizations among patients in the Medicare fee-for-service program. N Engl J Med. 2009; 360(14):1418-1428. doi: 10.1056/NEJMsa0803563.
  17. Naylor MD, Aiken LH, Kurtzman ET, et al. The care span: The importance of transitional care in achieving health reform. Health Aff. 2011; 30(4):746-754. doi: 10.1377/hlthaff.2011.0041.
  18. Forster AJ, Clark HD, Menard A, et al. Adverse events among medical patients after discharge from hospital. CMAJ. 2004; 170(3):345-349.
  19. Moore C, McGinn T, Halm E. Tying up loose ends: Discharging patients with unresolved medical issues. Arch Intern Med. 2007; 167(12):1305-1311.
  20. Roy CL, Poon EG, Karson AS, et al. Patient safety concerns arising from test results that return after hospital discharge. Ann Intern Med. 2005; 143(2):121-128. doi: 10.7326/0003-4819-143-2-200507190-00011.
  21. Dhalla IA, O’Brien T, Ko F, et al. Toward safer transitions: How can we reduce post-discharge adverse events? Healthc Q. 2012; 15. doi: 10.12927/hcq.2012.22839.
  22. Kripalani S, LeFevre F, Phillips CO, et al. Deficits in communication and information transfer between hospital-based and primary care physicians: Implications for patient safety and continuity of care. J Am Med Assoc. 2007; 297(8):831-841.
  23. Jeffs L, Saragosa M, Law M, et al. Elucidating the information exchange during interfacility care transitions: insights from a qualitative study. BMJ Open. 2017; 7(7):e015400. doi: 10.1136/bmjopen-2016-015400. 
  24. The Change Foundation. Spotlight on Ontario’s caregivers. Toronto (ON): The Foundation; 2018.
  25. Gitlin L, Schulz R. Family caregiving of older adults. In: Porhaska TR, editor. Public Health for an Aging Society. Baltimore, MD: Johns Hopkins Universiy Press; 2015.
  26. Health Quality Ontario. Transitions between hospital and home: Care for people of all ages. [Internet] 2020. [cited August 2021]. Available from https://www.hqontario.ca/Portals/0/documents/evidence/quality-standards/qs-transitions-between-hospital-and-home-quality-standard-en.pdf 
  27. National Institute for Health and Care Excellence. Transition between inpatient hospital settings and community or care home settings for adults with social care needs. London: The Institute;  2015.
  28. Okrainec K, Lau D, Abrams HB, et al. Impact of patient-centered discharge tools: A systematic review. J Hosp Med. 2017; 12(2):110-117. doi: 10.12788/jhm.2692.

DISCLAIMER: Many of our Blog Posts were written before the COVID-19 pandemic and thus do not necessarily reflect the latest public health recommendations. While the content of these blogs identify activities that support optimal aging, it is important to defer to the most current public health recommendations such as social distancing and frequent hand washing. Some of the activities suggested within these blogs may need to be modified or avoided altogether to comply with current social distancing recommendations. To view the latest updates from the Public Health Agency of Canada, please visit their website.

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