Discharge planning with older adults: toward a negotiated model of decision making

Occupational therapists are frequently involved in discharge accommodation decision making with older adults.

The literature regarding this process is reviewed. The ways in which risk avoidance and autonomy promotion philosophies influence decisions are examined and a new approach is proposed.

One approach is based on risk avoidance, where decisional control rests with professionals, but the client is left out of the process. Another is that of autonomy promotion, in which decisional control rests with the client. When risks are high, this can result in ethical dilemmas. The importance of the environment, its relationship to occupational performance, and differing interpretations of client-centred processes are important considerations.

In response to the inadequacy of models grounded in risk avoidance or autonomy promotion, occupational therapists are challenged to move toward a balanced approach to decision making with older people, grounded in partnership, shared power, and negotiation.