Hospital Discharge Planning for Older Adults

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When: Monday, January 22 to Sunday, February 18, 2024 (4 weeks) ONLINE weekly at your discretion
Cost:    $240 (Students $120) Registration Deadline: Monday, January 15, 2024

Improving transitional care planning increases patient satisfaction and reduces adverse events and avoidable hospital readmissions for older adults. In this workshop, participants will learn about the hospital discharge process, systemic and organizational challenges to effective discharge, how to navigate discharge with vulnerable patients and those with complex needs, and best practices to facilitate smooth transitions out of hospital.

WEEK 1: Overview of the discharge process

  • How discharge works
  • Roles and responsibilities of the healthcare team; interprofessional collaboration
  • Discharge pathways (e.g., to community, bidirectionally to LTC, rehabilitation, CCC, palliative care)

WEEK 2: Discharge readiness, risk and patient centredness

  • Post-discharge morbidity, mortality and rehospitalization
  • Delayed discharge and premature discharge – systemic and organizational challenges (e.g., quality indicators driving discharge policies) and impact on patients
  • Evaluating risk – weighing physical safety against QOL; self-determination
  • Patient/family centredness in discharge planning, patient satisfaction with discharge, managing expectations; Patient Ombudsman
  • Ethical and legal issues (e.g., informed consent, advanced directives, SDM, family conflict)

WEEK 3: Vulnerable populations

  • Addressing transitional care needs for older adults with cognitive impairment
  • Addressing transitional care needs for marginalized populations, including ethnic minorities, recent immigrants and those with limited or no English proficiency
  • Discharge in the context of addiction, mental health issues or homelessness

WEEK 4: Best practices in discharge planning

  • Facilitators to discharge (e.g., intersectoral hospital partnerships, publicly-funded community resources for home-bound patients, interprofessional collaboration, etc.)
  • Hospital discharge instructions – comprehension and compliance
  • Evidence-based discharge practices to reduce readmission and adverse events (e.g., early discharge planning, discharge templates, medication reconciliation, liaison nurse or pharmacist, teach-back, etc.)
  • Innovative models and tools (e.g., community-based discharge planning)

Instructors: Lauren Carrique, MSW, RSW & Jason A. Ferreirinha MSW,RSW

Lauren Carrique (she/her) completed her Master of Social Work at the University of Toronto. She has been working in various ambulatory and inpatient roles at Toronto General and Toronto Western Hospital for the past five years, including programs for those with end-stage organ failure, addiction and mental health concerns.

Jason A. Ferreirinha is a Hospital Social Worker for the Slow Stream Musculoskeletal Inpatient Rehabilitation program at Baycrest Hospital. Jason has a Masters in Social Work from the University of Toronto, with a specialization in gerontology and, a Masters in Critical Disability Studies from York University. His areas of expertise and teaching interests include hospital discharge planning, socio-behavioural determinants of health in older adults, and the influence of Disability, social isolation and loneliness on late-life social, mental and physical well-being.

Registration and payment available online at

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