Client-Centred Practice: Is it Compatible with Early Discharge Hospital-at-Home Policies?

Abstract

Current Government initiatives promote the provision of health care in the community rather than in medical institutions. Over the last decade there has been a growth in the number of early discharge hospital-at-home initiatives which provide a level of nursing and rehabilitation care in the home that previously would have been provided in an acute hospital. Simultaneously, there has been a move away from medical to client-centred models of health care delivery. These new client-centred models of health care emphasise collaboration between client and professional and encourage users of health care services to take greater control over and responsibility for their health care. Some occupational therapists may question whether the principles of client-centred care are compatible with the policy of discharging patients early from hospital while they remain in need of health care. This paper briefly reviews some of the principles of the Canadian Model of Occupational Performance; discusses some of the barriers to providing client-centred services in the early discharge hospital-at-home setting; and reflects upon whether the principles of client-centredness are consistent with early discharge from hospital policies.

Agency and Engagement: Older Adults' Experiences of Participation in Occupation during Home-Based Rehabilitation

“…This has implications for clinical practice and the striving in occupational therapy to be client centred (Lane, 2000;Townsend, 2002;Wressle & Samuelsson, 2004). Research indicates that occupational therapists do not manage fully to live up to the goal of being client centred in their practices (Sumsion, 2004;Wressle & Samuelsson).…”

Valuing narrative in the care of older people: a framework of narrative practice for older adult residential care settings

“…While narrative method is the overarching paradigm of this research, operationalising this approach also takes account of person-centred and practice development approaches. The concepts of person-centred practice currently expounded in the literature are derived from the Rogerian model of counselling, which is based on the assumption that each person is responsible for their own choices and decisions (Lane 2000) and that care is a mutual relationship between the patient and the carer, built on trust, understanding and respect (Binnie & Titchen 1999, Barker 2001, McCormack 2003, Nolan et al 2004, McCormack & McCance 2010. There are many models of person-centred practice in existence, and recent studies have begun to explore their use .…”

Discharge decision‐making with older people: The influence of the institutional environment

“…Many factors have been identified as supporting the adoption of a professionally dominated approach (Moats & Doble, in press). These include the Hippocratic tradition and the value of beneficence (Hofland, 1988), fear of legal liability (Kane, 1988), pressures from families (Wynne‐Harley, 1991), shorter hospital stays (Wells, 1997) with rushed decision‐making (Coulton, Dunkle, Chow, Haug & Vielhaber, 1988), managerial initiatives to standardise health‐care delivery (Lane, 2000), and lack of community care and alternate housing options (Health Canada, 1997). Resource allocation issues are important to consider (Hennessy, 1989; Unsworth, 2001) and have been used as the justification for adopting a professionally dominated approach to decision‐making.…”