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Discharge planning in homes for the aged : an analytical survey of a group of patients hospitalized for mental illness in the Homes for the Aged, Port Coquitlam, B.C., 1958 Elmore, Eugene

Abstract

There has been a growing conviction on the part of medical and nursing staff in the Homes for the Aged in British Columbia, which provide psychiatric care for the aged, that some of the residents have sufficient physical and mental health to be discharged. This study makes an analytical survey of some of the needs and resources of a group of patients considered to be ready to leave one of these institutions (the Port Coquitlam Unit). The purpose of the survey was to determine what kinds of resources these people would require to maintain an optimal level of adjustment in the community, as well as to describe the possible contribution social services could make in facilitating their discharge. The areas selected for assessment were grouped into two broad categories, (1) the patient's needs which resulted directly from his hospitalization and (2) the personal and social resources which he could employ upon discharge. There are two steps involved in selecting the group for study. First, through the use of a questionnaire submitted to the medical and nursing staff in order to determine which patients were judged to be mentally and physically ready for discharge, and second, from this larger number of patients, through the use of routine sampling procedure, a smaller group was selected for study. This final group was assessed by the clinical team in the institution primarily through the use of rating scales. An examination of the needs and resources of these patients revealed that all of these patients could benefit from the assistance of social work in one or more of the areas evaluated. Although the needs and resources of the group varied considerably, there were some indications that the patient's length of stay had a marked effect upon the type of social work service they could use. Those remaining in hospital for a period of less than two years had usually retained some resources in their former community which could be mobilized to assist them in discharge. On the other hand, the indications for these patients is that they would need an extension of hospital services after they were discharged. The patients who had remained in hospital for a longer period of time, had less need for out-patient hospital services, yet had little in the way of social resources or contacts in their former community to assist them once they had left the hospital. This group also evidenced less motivation for discharge and seemed to regard their hospitalization as a permanent living arrangement. In conclusion, the study points out the need for further definitive assessments of the areas of function of a social worker in an institution where the aged, psychiatrically ill are treated. Also pointed out is the need for social work programme planning in the light of these assessments, as well as the insurance of adequate provisions for further research to help develope it. Treatment programmes in other psychiatric institutions are mentioned, indicating that with the use of more advanced therapies, an increasing number of geriatric patients with mental illnesses are responding to treatment and are, therefore, eligible for discharge. Thus, there is a growing need for social work contributions in planning with the older person who is leaving hospital. Some indications of community concern in planning for these people are cited as evidence of awareness on the part of both the institutions for the geriatric patient and the community that the change from hospital life to community life must be an uninterrupted process.

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