title: Factors influencing the decision of older people living in independent units to enter the acute care system.
abstract: OBJECTIVE
  This South Australian-based study explored and described the factors influencing the decision of older people living in the community in independent living units to enter the acute care system.
  
  
  BACKGROUND
  Community-based older Australians, an increasing population segment, make choices about support needed to optimize health and well-being. This includes when to enter the acute care system. Entering this system has potential risks as well as benefits. The current South Australian Department of Human Services policies of 'keeping older people out' of the acute care system has implications for prevention and early intervention measures and requires an understanding of how and why older people enter the acute care system.
  
  
  METHODS
  In-depth interviews were conducted with older people (N = 31) and their families (N = 10), drawn from three South Australian aged care organizations providing independent living unit accommodation, and focus groups (N = 14) were conducted with stakeholders to identify factors influencing the decision of older people living in independent living units to enter the acute care system.
  
  
  RESULTS
  Analysis of the data revealed eight facets influencing this group of older people's decision-making with respect to entering the acute care system; they were: expectations of support in the independent living unit not being met; the presence/absence of safety nets; lack of after-hours support; the desire to remain independent; the general practitioner as pivotal; the influence of others; perceptions of the emergency department; and having access to information.
  
  
  CONCLUSIONS
  These facets provide insights into entry processes, links and relationships that form an interface between primary care, community care, the aged care industry and the acute system. Analysis of these insights highlight prevention and early intervention responses that can promote the health and well-being of older people, potential ways to streamline services, as well as gaps in current services.
authors.affiliation: University of South Australia, Adelaide, SA, Australia. julianne.cheek@unisa.edu.au
authors.forename: Julianne
authors.initials: J
authors.lastname: Cheek
authors.forename: Alison
authors.initials: A
authors.lastname: Ballantyne
authors.forename: Gerda
authors.initials: G
authors.lastname: Roder-Allen
mesh_terms: D000203:Activities of Daily Living; D000368:Aged; D003657:Decision Making; D004636:Emergency Service, Hospital; D006761:Hospitals; D006801:Humans; D013021:South Australia