Going home from hospital : the perceived post discharge needs and challenges of Maltese homebound elderly individuals and their informal carers

Abstract

Literature revealed that the transition from acute care back into the community may be accompanied with a myriad of needs and challenges influencing the bio-psycho-social spiritual aspects of life of both elderly individuals and their informal carers especially in the immediate weeks following discharge. This study explored how Maltese homebound elderly individuals and their informal carers describe the immediate needs and challenges of everyday life in the first two to three weeks following discharge. A qualitative case study approach was adopted and data were collected via face-to-face semi-structured interviews with homebound elders and their informal together with document analysis of the discharge letter and forms. The Multiple case method was adopted where three families were chosen as life cases. Each case was made up of a Maltese elder individual discharged from the local acute general hospital in the months of November or December 2010 following either a medical, surgical or orthopeadic admission diagnosis and his/ her nominated informal carer/s. Miles and Huberman's (1994) model of analysis together with the six phases of thematic analysis outlined by Braun and Clarke (2006) were merged and adopted as the framework guiding the data analysis. Participants felt that there was very little discharge planning. Moreover, the three elderly participants identified physical needs as a prominent concern in the immediate weeks, whilst informal carers remarked that they felt physically and emotionally exhausted with the new role of carer which had repercussions on their health and family relationships. Moreover, both elders and informal carers went through a period of frustration and psychological distress characterised by panic, uncertainty, sadness and fear. The impact and challenges of becoming homebound or an informal carer for the first time strongly emerged, accompanied with social and financial needs which were quite pertinent issues for the three families. The participants mentioned various coping strategies which they adopted. These included spirituality, adjustment in their life routines and environment, prioritizing, laying down the rules and delegating. This study raised in-depth issues around the perceived needs and challenges of these two vulnerable groups following hospitalisation providing the building blocks for different larger studies. Different recommendations for education and practice were presented including the introduction of structured discharge planning which prepares and caters for the holistic needs of both the patients and their informal carers for their return to the community.