BC Patient Safety & Quality Council

48/6 Model of Care

Seniors - 48/6 Colour Logo - March 6 2013

Our Challenge

In Canada, over 55% of acute care hospital beds are currently occupied by seniors on any given day¹. Moreover, 30% of seniors are discharged at a significantly reduced level of functional ability and most will never recover to their previous level of independence².

The 48/6 Model of Care for hospitalized seniors (aged 70 and older) in BC is an integrated care initiative which addresses 6 care areas of functioning through patient screening and assessment (assessments are completed only where screening shows areas of concern) within the first 48 hours of hospital admission.

The six care areas, described below, have been shown to have interrelated effects on health which, when addressed, reduce functional decline and improve patient outcomes for seniors in hospital.

Managing these key areas of care includes consideration of:

  1. Bowel and Bladder Management: working with the patient to maintain their usual bowel and bladder function, intervening where necessary with additional interventions.
  2. Cognitive Functioning: refers to the mental processes including memory, thinking, judgement, calculation, and visuospatial skills. Attention must be paid to the possibility of delirium, depression, dementia, and mild cognitive impairment.
  3. Functional Mobility: a person’s ability to stand, walk, and transfer from bed to a chair. Bed rest inhibits a person’s capability to perform these functions as it contributes to muscle atrophy and reduced endurance.
  4. Medication Management: reviewing each person’s medication list, dosages (dose and dose interval), potential medication interactions and balancing the benefits versus the risks of medications.
  5. Nutrition and Hydration: ensuring adequate amount and type(s) of food and liquid consumed, assessing for any swallowing difficulties and/or food allergies, and supplementing intake, where necessary.
  6. Pain Management: refers to the use of medications and other interventions (such as massage, exercise, or physiotherapy) to prevent, reduce, or stop acute or chronic pain.

Screening and/or assessments are then supported by the development of an individualized care plan to address key areas of health for the senior. Care Plans must be developed within 48 hours of decision to admit and further supported by a discharge and/or transition plan to ensure the senior can return to home safely with established access to the health resources in the community they require.


  1. Canadian Institute for Health Information. (2012-2013). Inpatient hospitalizations: Volumes and length of stay.
  2. Covinsky, K.E., Palmer, R.M., Fortinsky, R.H., et al. (2003). Loss of independence in activities of daily living in older adults hospitalized with medical illnesses: Increased vulnerability with age. Journal of the American Geriatrics Society 51(4): 451-458.

At a Glance

Key Contacts

Chris Rauscher
Clinical Lead

Ben Ridout
Director, Patient & Public Engagement

Derek Rains,
Director, Medical Services
Health Services Policy | Acute & Provincial Services Branch | Ministry of Health