Physical health problems: Shaping transitions of care

In this chapter, we use the ecology of care model to provide a broader view for an older adult's transition out of the hospital after a complex illness. Hospitals are required to provide care to various age groups. This requirement is sometimes at odds with the special needs of older adults with physical problems. In the context of this chapter, a physical problem is any new onset illness in a person with preexisting functional limitations. Acute care hospitals are equipped to contain new illnesses. They are not equipped to reengage community-based caregivers (both informal and formal) who provide care once patients with acute illnesses are discharged. With an ecology of care perspective, we can create a larger view that starts and ends outside of the hospital. This view includes patients and their community-based caregivers. To illustrate the utility of this perspective, we discuss three main concepts that shape hospital discharge. The first concept is the process of entering the health care system. The second concept is the processhospitals use to define patients as both a biomedical case and an administrative case. The third concept is the philosophy governing our payment system. All insurance sources-Medicare included-assume that adults are autonomous, independent consumers of health care. In the health care marketplace, consumers use their cognitive and financial resources to make choices. When one or more of these abilities are limited, the fit between an acutely ill person and the delivery system diminishes. Through application of the ecology of care model, we can help all stakeholders create safer transitions for persons with physical problems.