Coordination of hospital discharge for older people with dementia: insights from politicians and local government officials.

BACKGROUND: After hospital care, older people with dementia often require further health and social care services. Hospital discharge is a complex process in which such support is planned and coordinated. This typically requires collaboration between professionals with different responsibilities representing various authorities to ensure integrated care. In Sweden, the decentralised organisation of health and social care services may lead to variation in discharge procedures and in how collaboration across care providers and authorities is organised. Politicians and civil servants play a central role in shaping discharge practices and in organising collaboration and coordination of services within regions and municipalities. However, their perspectives remain relatively underrepresented in previous research on hospital discharges for older people with dementia.

METHODS: Maximum variation strategy was used to recruit four politicians and eleven local government officials. Semi-structured interviews were conducted and analysed using reflexive thematic analysis.

RESULTS: Our findings suggest that the discharge process from inpatient hospital care is governed by formal agreements outlining responsibilities between care providers. This process involves both a physical relocation and an administrative handover of responsibilities. Strategic workforce planning is essential to ensure sustained staff competence, and particular attention must be given to safeguarding the individual's representation throughout the discharge process.

CONCLUSIONS: Politicians and local government officials highlight the need for clearly defined procedures and guidelines, governed by formal agreements between care providers and care authorities. The findings problematize frequent staff turnover, which undermines the development of a stable organizational culture in relation to hospital discharges. Furthermore, there is a need for experienced professionals committed to working with people with dementia, applying a person-centred approach throughout discharges.