Descriptions and illustrative quotations of the stigma and missed opportunities, and prejudices themes in the health equity domain
| Domain | Theme and key findings | Illustrative quotations |
|---|---|---|
| Health equity | Stigma and missed opportunities The label comes with assumptions about the admitted patients’ medical needs, cognitive abilities, and behaviours, which in turn affects the underlying assumptions held by health care providers and subsequently the care patients receive. Participants described how patients being labelled as a “social admission” early in the care chain led to an belief that they were medically stable when, in fact, they were not always. | “… often they would come to the door and the paramedic would say to the charge nurse and myself … I was sitting beside the charge nurse …. They’d say, “Okay, this patient’s definitely going to be orphan.” So, of course, once they’re tagged with that label, it stuck, you know.” — HC236 “You know, from nursing’s perspective, it’s like, “Oh, an orphan patient. So, they’re going to be difficult behaviour, difficult discharge, and long stay.” — HC151 “An orphan patient’s usually a demented patient.” — HC075 “And they’re supposed to be categorized as, like, medically stable. Unfortunately, we’ve had several experiences where patients have been labelled as ‘orphans’ and they’ve not been medically stable.” — HC803 “So, you may miss a diagnosis of delirium and an opportunity to treat. And I think … and if the services aren’t as familiar with those issues then, you know, you miss things, I guess, and people can get worse.” — HC605 |
| Prejudices Participants described underlying group assumptions about “social admissions.” In particular, ageism that occurs when patients access acute care services for social issues was noted, for example, assuming all older patients have cognitive decline or lack capacity, or assuming certain health services would not benefit older patients. Participants reflected on how race and gender implicitly affect care. | “I just had a patient that came over from a [redacted] unit. And that patient was placed on the long-term care list …. They somehow removed their capacity but didn’t get their family members to sign …. But their family is adamant they go home. The patient is adamant [they go] home. So, how in the world did [they] lose [their] capacity? … A physician removed capacity, while this patient most likely is experiencing a delirium, and made a permanent future decision for them without consulting the family.” — HC676 “We take for granted what we feel and what we value is dignified aging, then we just don’t include them. So, you know, there’s these whole conversations occurring outside of the patient. And oftentimes myself and the other social worker on our unit will go, ‘Well, did anybody talk to the patient?’ ‘No.’” — HC231 “I think there’s just a general lack of respect for the aging process and aging with dignity …. You know, there’s so many levels of invisibility that can be added to a person. So, you know, if you’re a woman in comparison to a man, you’re made a little less visible. If you’re a minority in comparison to a White person, you’re made a little less visible. If you have the history of mental health in comparison to somebody who might not have had those challenges, you’re a little less visible.” — HC676 “You know, not understanding frailty, what it means to be frail, how it impacts patients who are vulnerable. And I think of my mom, who is quite frail, and I think any incident could take her over that edge. But if she were to show up in emerg, I don’t know that that would be so recognized. I don’t. So, I do believe ageism plays a big role.” — HC236 |