Transitional Care for Seniors: What do Care Partners and Seniors Really Experience?

Background: Current senior’s care provided within the Canadian health care system is not often person-centred; nor is it always in accordance with gerontological best practices. Furthermore, gaps also exist in access to and continuity of care services, leading to poor quality of care and avoidable readmissions or setbacks in seniors’ health or chronic care conditions. The impacts of these gaps are compounded when critical information is not transferred with seniors when they change care settings (i.e. transferring between hospital, home, retirement communities, etc.). Research suggests that seniors do not always receive resources required to support them through these transitions, and advocates for their needs. Methods: This qualitative study’s objective was to explore 35 seniors’ and 25 care partners’ care transition experiences in a suburban community, in Canada. This study is part of a larger project aimed at developing a better understanding of how to enhance care and transitions through identifying seniors’ and care partners’ perspectives of access to and continuity of quality care, and awareness and information availability during care transitions. Results: A situational analysis revealed that several factors impede successful transitions for seniors, including not being listened to; needs being ignored; task-focused and splintered care; neglect of the care context; and absence of care continuity. Conclusion: Transitional care is often not person-centred, does not follow best practices, and presents with several gaps in access to and continuity of health care services. These findings informed subsequent stages of the overall research project aimed at creating better transitions and care experiences for seniors.