Social work and transitions of care: Observations from an intervention for older adults

Vanessa D. Fabbre, Anne S. Buffington, Susan J. Altfeld, Gayle E. Shier, Robyn L. Golden

Research output: Contribution to journalReview articlepeer-review

37 Scopus citations

Abstract

Making the transition from hospital to home can be challenging for many older adults. This article presents practice perspectives on these transitions, based on a social work intervention for older adults discharged from an acute care setting to home. An analysis of interviews with clinical social workers who managed 356 cases (n = 3) and a review of their clinical notes (n = 581) were used to identify salient themes relevant to care transitions. Concepts developed and discussed identify the role of surprises after discharge, an expanded view of the client system, and relationship building as instrumental in carrying out effective care transitions.

Original languageEnglish (US)
Pages (from-to)615-626
Number of pages12
JournalJournal of Gerontological Social Work
Volume54
Issue number6
DOIs
StatePublished - Aug 2011
Externally publishedYes

Funding

Received 28 January 2011; accepted 10 May 2011. This project was supported by the department of Older Adult Programs at Rush University Medical Center as an extension of the Enhanced Discharge Planning Program. Thank you to Jung-Hwa Ha at the University of Chicago for reviewing this article. Address correspondence to Vanessa D. Fabbre, University of Chicago, School of Social Service Administration, 969 E. 60th Street, Chicago, IL 60637, USA. E-mail: [email protected]

Keywords

  • Discharge planning
  • Medical social work
  • Qualitative analysis
  • Transitions of care

ASJC Scopus subject areas

  • Social Sciences (miscellaneous)
  • Nursing (miscellaneous)

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