Improving Decision Making On Location of Care With the Frail Elderly and Their Caregivers

Improving the Decision Making Process About Location of Care With the Frail Elderly and Their Caregivers

One of the toughest decisions faced by the frail elderly in Canada is whether to stay at home or move to a care facility. It is certainly difficult to make this decision alone, but can be even harder if someone else makes it for you. Shared decision making is when, instead of making decisions for the patient, healthcare professionals share information about what the evidence says, and they talk about what's important with the patient, and then make the decision together. In the case of the frail elderly in home care services, there are many health care professionals involved, e.g. the doctor, nurse and social worker. In this case decisions should be shared by all the professionals involved with the elderly person along with his or her caregivers. Unfortunately, in this context, shared decision making rarely occurs.

We have designed a training program that teaches interprofessional teams how to share decisions with their frail elderly patients, and tested it in one Quebec City and one Edmonton home care team. This project tests the training program on a broader scale with 16 home care teams attached to community health centres across the province of Quebec, and will compare the results with what happens when no one has completed the training (usual care). Home care is a rapidly growing sector and this study will lay the foundations for a national strategy to ensure that no one has to make this difficult decision alone.

Inclusion Criteria:

• Receiving care from the home care team
• Faced the decision about whether to stay at home or move to a care facility in the previous 3 to 6 months
• Able to read, understand and write french or english
• Able to give informed consent
• For the case of clients unable to provide informed consent, their caregivers who was involved into decision making process will be eligible

Exclusion Criteria:

• Clients who cannot provide informed consent (e. g. clients with cognitive impairment) without a caregiver
• Clients who require acute care hospitalization and whom the location of care decision is transferred to hospital-based social services