title: Why older adults may decline offers of post-acute care services: A qualitative descriptive study.
abstract: The most common post-acute care (PAC) services available to patients after hospital discharge include home care, skilled nursing facilities, nursing homes, inpatient rehabilitation, and hospice. Patients who need PAC and receive services have better outcomes, however almost one-third of those offered services decline. Little research exists on PAC decision-making and why patients may decline services. This qualitative descriptive study explored the responses of thirty older adults to the question: "Can you, from the patient point of view, tell me why someone would not want post hospital care?" Three themes emerged. Participants may decline due to 1) previous negative experiences with PAC, or 2) a preference to be home. Some participants stated, "I'd be there" and would not decline services. Participants also discussed 3) why other patients might decline PAC which included patients' past experiences, lack of understanding/preconceived ideas, and preferences. Clinical implications include assessing patients' knowledge and experience before providing recommendations.
authors.affiliation: University of Pennsylvania School of Nursing, 418 Curie Blvd., Philadelphia, PA 19104, USA.
authors.forename: Justine S
authors.initials: JS
authors.lastname: Sefcik
authors.affiliation: University of Pennsylvania School of Nursing, 418 Curie Blvd., Philadelphia, PA 19104, USA.
authors.forename: Ashley Z
authors.initials: AZ
authors.lastname: Ritter
authors.affiliation: University of Pennsylvania School of Nursing, 418 Curie Blvd., Philadelphia, PA 19104, USA.
authors.forename: Emilia J
authors.initials: EJ
authors.lastname: Flores
authors.affiliation: University of Pennsylvania School of Nursing, 418 Curie Blvd., Philadelphia, PA 19104, USA.
authors.forename: Rebecca H
authors.initials: RH
authors.lastname: Nock
authors.affiliation: University of Pennsylvania School of Nursing, 418 Curie Blvd., Philadelphia, PA 19104, USA; University of Missouri Sinclair School of Nursing, S343 Sinclair School of Nursing, Columbia, MO 65211, USA.
authors.forename: Jo-Ana D
authors.initials: JD
authors.lastname: Chase
authors.affiliation: University of Pennsylvania School of Nursing, 418 Curie Blvd., Philadelphia, PA 19104, USA.
authors.forename: Christine
authors.initials: C
authors.lastname: Bradway
authors.affiliation: University of Pennsylvania School of Nursing, 418 Curie Blvd., Philadelphia, PA 19104, USA.
authors.forename: Sheryl
authors.initials: S
authors.lastname: Potashnik
authors.affiliation: University of Pennsylvania School of Nursing, 418 Curie Blvd., Philadelphia, PA 19104, USA; Center for Home Care Policy and Research, Visiting Nurse Service of New York, USA. Electronic address: bowles@nursing.upenn.edu.
authors.forename: Kathryn H
authors.initials: KH
authors.lastname: Bowles
mesh_terms: D000359:Aftercare / Q000379:methods* / Q000523:psychology; D000368:Aged; D003657:Decision Making; D005260:Female; D006699:Home Care Services; D006738:Hospices; D006801:Humans; D008297:Male; D009735:Nursing Homes; D010342:Patient Acceptance of Health Care / Q000523:psychology*; D010351:Patient Discharge; D036301:Qualitative Research; D012866:Skilled Nursing Facilities
keywords: Discharge decision making; Discharge planning; Older adults; Post-acute care services; Qualitative research