Trent Centre for Aging & Society, Trent University, 1600 West Bank Dr., Peterborough, ON, K9L 0G2, Canada.
Trent School of the Environment, Trent University, 1600 West Bank Dr., Peterborough, ON, K9L 0G2, Canada.
BMC Geriatr. 2023 Mar 28;23(1):180. doi: 10.1186/s12877-023-03807-3.
Establishing an effective continuum of care is a pivotal part of providing support for older populations. In contemporary practice; however, a subset of older adults experience delayed entry and/or are denied access to appropriate care. While previously incarcerated older adults often face barriers to accessing health care services to support community reintegration, there has been limited research on their transitions into long-term care. Exploring these transitions, we aim to highlight the challenges of securing long-term care services for previously incarcerated older adults and shed light on the contextual landscape that reinforces the inequitable care of marginalized older populations across the care continuum.
We performed a case study of a Community Residential Facility (CRF) for previously incarcerated older adults which leverages best practices in transitional care interventions. Semi-structured interviews were conducted with CRF staff and community stakeholders to determine the challenges and barriers of this population when reintegrating back into the community. A secondary thematic analysis was conducted to specifically examine the challenges of accessing long-term care. A code manual representing the project themes (e.g., access to care, long-term care, inequitable experiences) was tested and revised, following an iterative collaborative qualitative analysis (ICQA) process.
The findings indicate that previously incarcerated older adults experience delayed access and/or are denied entry into long-term care due to stigma and a culture of risk that overshadow the admissions process. These circumstances combined with few available long-term care options and the prominence of complex populations already in long-term care contribute to the inequitable access barriers of previously incarcerated older adults seeking entry into long-term care.
We emphasize the many strengths of utilizing transitional care interventions to support previously incarcerated older adults as they transition into long-term care including: 1) education & training, 2) advocacy, and 3) a shared responsibility of care. On the other hand, we underscore that more work is needed to redress the layered bureaucracy of long-term care admissions processes, the lack of long-term care options and the barriers imposed by restrictive long-term care eligibility criteria that sustain the inequitable care of marginalized older populations.
建立有效的连续护理是为老年人群提供支持的关键部分。然而，在当代实践中，一部分老年人延迟进入或被拒绝获得适当的护理。虽然以前被监禁的老年人在获得支持社区重新融入的医疗保健服务方面经常面临障碍，但对他们过渡到长期护理的研究有限。探索这些过渡，我们旨在强调为以前被监禁的老年人获得长期护理服务的挑战，并阐明强化整个护理连续体中边缘化老年人群体不平等护理的背景环境。
我们对以前被监禁的老年人社区居住设施（CRF）进行了案例研究，该设施利用了过渡性护理干预措施的最佳实践。对 CRF 工作人员和社区利益相关者进行了半结构化访谈，以确定该人群重新融入社区时面临的挑战和障碍。进行了二次主题分析，专门研究了获取长期护理的挑战。代表项目主题（例如，获得护理、长期护理、不平等体验）的代码手册经过测试和修订，遵循迭代协作定性分析（ICQA）过程。
研究结果表明，以前被监禁的老年人由于污名化和风险文化，导致延迟获得和/或被拒绝进入长期护理。这些情况加上可用的长期护理选择很少，以及已经在长期护理中的复杂人群的突出地位，导致以前被监禁的老年人在寻求进入长期护理时面临不平等的准入障碍。
我们强调利用过渡性护理干预措施来支持以前被监禁的老年人过渡到长期护理的许多优势，包括：1）教育和培训；2）倡导；3）共同承担护理责任。另一方面，我们强调需要做更多的工作来解决长期护理入院流程中的多层官僚主义、长期护理选择的缺乏以及限制长期护理资格标准的障碍，这些障碍维持了边缘化老年人群体的不平等护理。
