Table 4.

What practices, strategies, or resources have you used to meet the needs of unbefriended older adults in your practice/institution?

Strategy	Setting	%	Example
Institutional Program or Position
Ethics committee	Outpt	9.2	We have a social worker who can help us with these issues. We also have an ethics committee where we can discuss difficult situations.
	Inpt	34.1
Leadership	Outpt	0.0	Managers/supervisors in hospital to consider ‘unusual’ ways of funding to allow transition of care to a more appropriate setting than the hospital.
	Inpt	4.9
State Protective Actions
Guardianship	Outpt	16.9	Social work department working with local authorities seeking court-appointed guardian.
	Inpt	43.9
Adult protective services	Outpt	30.8	Have collaborated with adult protective services to access some local legal groups that will pursue guardianship on behalf of the patient in some cases, but they will only take a few cases per year and the person has to live locally.
	Inpt	14.6
Clinical Consultation or Action
Social worker	Outpt	43.1	Use of social workers within our practice to connect patients with resources.
	Inpt	29.3
Nurse or case manager	Outpt	18.5	Within the practice we have a nurse manager and social worker and work closely with the county. However, I know we should and can do more.
	Inpt	7.3
Neurological or psychiatric specialist	Outpt	1.5	We have a work group to improve assessments and responses to capacity issues, and social work, psychiatry, neurology, neuropsychology and rehab therapy services (especially speech therapy).
	Inpt	7.3
Other clinician or third party	Outpt	6.2	Our chaplains seem to be the best detectives, better than the social workers, in tracking, identifying and locating relatives. They are also more persuasive in getting distant or alienated relatives to sign consents for custodial care.
	Inpt	12.2
Home-based services	Outpt	16.9	ALL Area on Aging services – Medicaid waiver – meals on wheels – pharmacy delivery – grocery delivery – home health – Adult Protective Services.
	Inpt	4.9
Community services	Outpt	26.2	We call on and call in all our community resource connections, ask for favors, try to advocate for the person.
	Inpt	19.5
Care transition	Outpt	3.1	I had provided services to patient in the outpatient setting until his physical condition precluded his being treated at home. Saw him in hospital and in SNF until he died. Provided psychological interventions.a
	Inpt	19.5
Team approach	Outpt	6.2	Advocate for and secure a devoted team of professionals to ensure unbefriended client functions to best of ability independently with supports and free from abuse and exploitation.
	Inpt	9.8
Procedural approach	Outpt	16.9	… We always engage the patient as much as is feasible given their deficits. We also always engage community programming and caseworkers. We will typically complete an extensive chart review to try to identify prior patient preferences documented in the record.a
	Inpt	24.4
Family search	Outpt	12.3	… Sometimes we can find family to get involved who did not know there was a problem, or how bad their family member had deteriorated, as such people are often self-isolating.
	Inpt	12.2

Note. N = 106. Many responses had more than one strategy; bold is used for text relevant to category. Chi-square was not calculated as percentages were based on qualitative data.

^aThe code does not refer to a specific part of the answer but rather the entire answer.