From hospital to nursing home… eventually

For many elderly people, the transition from hospital ward to long-term-care facility can bring with it resignation, even depression — but what happens when this important life change is drawn out over multiple moves?
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For many elderly people, the transition from hospital ward to long-term-care facility can bring with it resignation, even depression — but what happens when this important life change is drawn out over multiple moves?

In early 2011, Tamara Sussman began a longitudinal study of elderly Quebec people as they transition from hospital care to long-term care. Sussman is an assistant professor in McGill’s School of Social Work. Her study was sparked by the implementation of Quebec’s Program 68, which dramatically revises the procedure for how older adults make this change. In the past, if elderly hospital patients were deemed in need of long-term care, they were moved to the hospital’s nursing home care evaluation wing, where they lived until there was an availability in the longterm facility of their choice. Under Program 68, which was piloted in two Montreal hospitals and is now being rolled out in the greater Montreal area, patients are subjected to many more moves. Within 72 hours of being deemed acutely stable, yet in need of long-term care, they’re moved to an evaluation bed at a nursing home, then into a transition bed at a different home, and only later into their final long-term-care home of choice.

Working with St. Mary’s Hospital Center, Sussman is following patients as they move through the new transition system. She wants to learn about their experiences, as well as those of their families. “What are the actual movements?” she wonders. “Are people following the new policy or circumventing the moves? And how do the moves impact people? Are more moves worse than fewer?” The study will run until everyone in the cohort completes the transition into their final long-term-care facility (approximately two years), but Sussman has already observed that the process seems hardest on the family members.

“The older people may be depressed about giving up their own homes, but they’ve given their day-to-day planning over to their family members,” she notes. “It’s the family members who are showing a lot of stress and anxiety. Some of this comes from having to make big decisions in very short time periods. And some of it actually seems to come from seeing their family member adjust and do well in their new transitional setting, while knowing that they won’t be staying there. The new policy seems to be interfering with their own adjustment.”

This research is funded by the Fonds de la recherche en santé du Québec.