Justine has been working as a health services researcher in both academic and applied settings for ten years. In her current role as Manager of Research Operations, Justine is responsible to ensure the effective execution and evaluation of the annual research plan of the Saint Elizabeth Research Centre. She also ensures that all Saint Elizabeth researchers are supported appropriately to plan, conduct, and translate innovative and collaborative research activities into action with integrity and strong ethics. Following her completion of an Honours B.Sc in Biology and Psychology, Justine completed her Masters of Science in Health Studies and Gerontology, and worked as a Research Assistant on the CIHR-funded InfoRehab program of research. She is currently a PhD candidate at the University of Waterloo in the School of Public Health and Health Systems. Her doctoral research is focused on the development of a more integrated geriatric care planning and delivery approach for home care service providers.
‘I am not blind, deaf or stupid’: Challenging ageist assumptions to improve geriatric home care planning
Background: Ageist assumptions about the cognitive, physical and social limitations of older persons often result in their exclusion from participating in the design, delivery and evaluation of health and social care services. This ageism is detrimental to both patient experience and health outcomes in geriatric care, as tools and services tend to represent a very narrow and mainly clinical view of the goals, needs and preferences of this population. Recognition and meaningful inclusion of older adults as experts in their own experience in geriatric care planning has the potential to prompt more integrated, person and family-centred care.
Objectives: This study aimed to meaningfully engage older adults, their family/friend caregivers and health care providers as experts in the development of a more integrated geriatric care planning approach in home care.
Methods: A sequential transformative mixed methods design was applied. A web-based survey of geriatric care assessment practices was developed with and completed by home care nurses, occupational therapists and physiotherapists (n=350) to explore their experiences planning home care for older adults. Solutions-focused interviews were completed with older adults and their family/friend caregivers (n=24) to leverage their expertise in developing ideas to improve person-centred goal setting in geriatric home care. Survey and interview results were applied in a workshop with older adults, their family/friend caregivers and health care providers (n=19) to co-design solutions for more integrated geriatric home care planning through collaborative brainstorming, empathy mapping, and role play.
Results: An implementation framework for integrated geriatric care planning in home care emerged. The framework includes the following specific actions to protect care plans from ageist assumptions:
- a) Inclusive assessment practices that equally address, support, and value the common clinical and non-clinical information needs of older adults, their family/friend caregivers and health care providers;
- b) Dialogue-based goal setting practices that begin with asking older adults about their understanding of their health and care needs followed by discussion about their personal interests, preferences and motivators; and
- c) Flexible communication strategies tailored to the preferences and abilities of older adults and family/friend caregivers and supported by existing and potentially new tools and technology.
Conclusion: Meaningful engagement of older adults, family/friend caregivers and health care providers in the development of a more integrated geriatric care panning approach challenges ageism in health care design and points to ways to reduce ageism in geriatric home care delivery through integrated planning.