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Addressing issues of competency in older adults when discharge planning : a social work perspective Torontali, Sarah Ann

Abstract

An aging Canadian population suggests that social workers in hospital settings will increasingly encounter older adults whose capacity to make decisions regarding place of residence may be impaired. There is a lack of discussion in the social work literature around the issue of competency to make this decision, specifically, how competency is determined, and how the assessment process unfolds. Qualitative research was conducted in order to explore the process of discharge planning with elderly, hospitalized patients, when there are concerns about their competency to make decisions regarding place of residence. The results of this research highlight the key role social workers play in both informal and formal assessments of competency in elderly patients. The findings suggest that competency to decide place of residence was based on the patient's mental capacity, as well as his/her ability to function in the chosen environment. As a result, an assessment of risk was integral to the assessment of competency and discharge planning. The assessment of risk, and thus the assessment of competency, are highly subjective processes, influenced by the values of the assessor, the organizational context, and the societal and legislative context. The research also emphasized that formal competency assessments were used as a last resort, due in part to the gaps in the current legislative context. This research provides an emerging social work perspective which was previously untold, and establishes a basis from which to further develop knowledge in this intriguing and important area for social work practice.

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