Why older adults may decline offers of post-acute care services: A qualitative descriptive study.
Justine S Sefcik, Ashley Z Ritter, Emilia J Flores and 5 others
PMID 27964972WHAT IT FOUND
Older adults decline post-acute care due to previous negative experiences, a strong preference to remain at home, or fears about privacy and safety.
Many refuse facility-based care but would accept home services. Understanding these personal histories and preferences is key to effective discharge planning.
Key findings
01Participants cited previous negative experiences with post-acute care services, including poor quality of care or unmet expectations, as a primary reason for declining future offers.
02A strong preference to remain in their own home, driven by comfort and family support, led many participants to reject facility-based care, even if they were open to home-based services.
03Participants identified concerns about invasion of privacy, embarrassment over home conditions, and personal safety as specific reasons why others might decline home care services.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
The study relied on a single open-ended question, which may have limited the depth of understanding regarding specific decision-making processes. Participants were recruited from one academic medical center in the Northeast US, which may limit the generalizability of findings to other settings or populations. The sample was a convenience sample of hospitalized patients, potentially excluding those who had already declined care without being hospitalized or those with cognitive impairment. Four different research assistants conducted the interviews, which may have introduced variability in how questions were probed.
Declared interests
The study was supported by the National Institute of Nursing Research (NINR) and the University of Pennsylvania School of Nursing. The authors declare no conflicts of interest.
The easy way to misread this
Do not assume that patients who decline facility-based care are refusing all post-acute support. Many participants in this study rejected nursing homes but were open to home care services if their specific concerns about privacy and safety were addressed.