By Jon Moskin
In his 2014 essay about life’s transitions, Rabbi Bradley Shavit Artson, professor of philosophy at American Jewish University, wrote that we tend to “mark transitions generally when it is too late to mark them, and then you can’t do anything about it.”
But, James Harrison, a research scientist and associate professor of medicine at the University of California San Francisco (UCSF), has made it his mission to pay close attention to some of life’s most important transitions and make them easier and more graceful, especially for older adults.
“One of the things researchers have focused on is when people transition from hospitals to their homes. And, of course, that’s important. But a lot of people who need further rehabilitation might not be ready to go home and may need to go to a skilled nursing facility (SNF), and research in that space is significantly less,” James said. “And just as understudied is the transition people make from their homes into SNFs and assisted living facilities… So that’s been a big part of my research.”
Jame’s study of these transitions brought him to the San Francisco Campus for Jewish Living (the Campus). For 18 months, James interviewed patients, caregivers, and clinicians to gain a comprehensive understanding of the patient experience in light of these major changes in their lives and ultimately to improve outcomes not only for Campus patients and residents but also for older adults throughout our healthcare system.
“The scope of James’ work is quite broad but almost all of it is about bringing residents’ and patients’ voices to the forefront of their healthcare journeys.”
– James Harrison
“I wanted to understand transition experiences from the perspectives of patients and caregivers but also from the clinician side,” James said. “A lot of this type of research has looked at these two groups separately, but that’s not really how life is. Patients, caregivers, and clinicians all interact together. So, my job was to speak to all of them to understand their experiences of being discharged from the hospital, to hear how they were prepared for this admission, and to find out what life was like when they got to the campus or the SNF so we could identify targets for improvement and hopefully make things better.” Similarly, in a study conducted with his colleague Dr. Kenny Lam, examining the transition from homes in the community into skilled nursing facilities.
“We wanted to talk to those older adults and hear what advice they would give other people who were faced with the decision to move from home.”
– Dr. Kenny Lam
They learned quite a bit. “They were talking to each other, but not to me,” said one patient post-hospital discharge. Those words seemed emblematic of a culture that exists in many hospitals. Discharges often seem fragmented, and patients report feeling “disconnected from their care teams” and lacking important information that can lead to “uncertainty about their SNF admission and plans for recovery.” Moreover, hospitals do not always do a good job of setting expectations for when they leave the hospital. “Everyone’s trying to care for people, which they do excellently in the hospital, but even with their skills and experience, they don’t have the knowledge about skilled nursing facilities,” James said. “Many of them have never been to a place like the Campus. So, it’s very hard for them to counsel patients about what to expect… and that was a big finding.”
Regardless of where new residents come from, home, hospital, or rehabilitation center, a need for holistic care beyond the strictly clinical appears to be one of the most important factors in the transition and beyond.
“There’s so much more to a person than their medical needs,” James said. “There’s also social care, opportunities for spiritual care and nourishment… and the Campus understands this.”
– James Harrison
In fact, James was effusive in his praise for the support and accommodations provided by the Campus. “It was a great fit. There’s a wonderful relationship between the UCSF and the Campus,” James said. “But what was particularly special was how open and welcoming everybody was and how they went out of their way to provide access to talk with staff, patients, and families… They truly supported my research and I’d 100% recommend the San Franicsco Campus for Jewish Living to my colleagues. It’s just fantastic that places like this exist.”
