Navigating Hospital To Home Transitions: Exploring Israeli Older Adult And Informal Caregiver Experiences, Challenges And Opportunities.

Navigating Hospital To Home Transitions: Exploring Israeli Older Adult And Informal Caregiver Experiences, Challenges And Opportunities. | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Navigating Hospital To Home Transitions: Exploring Israeli Older Adult And Informal Caregiver Experiences, Challenges And Opportunities. Opeyemi Rashidat Kolade, Joshua Porat-Dahlerbruch, Theo van Achterberg, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4354721/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background Transitioning from hospital to home is not just a process but a crucial aspect of healthcare delivery, particularly for older adults and their informal caregivers. This transition from the structured environment of the hospital to the more independent home setting presents various challenges and opportunities that significantly impact the post-discharge journey and remains a critical and vulnerable phase for patients, especially those with complex medical needs or limited support systems. With a rapidly aging population, diverse cultural demographics, and a centralized healthcare system, Israel provides a multifaceted context to explore the intricacies of this transition process. This paper explores the experiences of older adults and informal caregivers navigating hospital-to-home care transitions in Israel and the challenges and opportunities in optimizing care transitions. Methods Conducted within the European TRANS-SENIOR consortium, we conducted a qualitative descriptive study using one-to-one interviews with Israeli older adults and informal caregivers. who experienced hospital-to-home transitions within the past 12 months. Interview questions explored negative and positive experiences navigating hospital-to-home transitions and challenges and opportunities for optimizing care transitions. Thematic analysis was used. Results Seven older adults and nine informal caregivers participated in interviews, revealing diverse perceptions of hospital-to-home transitions. The experiences of hospital-to-home transitions varied, with negative experiences characterized by abrupt farewells and a perceived lack of ongoing support, while positive experiences involved reassurance, empowerment, and follow-up care. Challenges included fragmented healthcare management and a lack of person-centered care, particularly for older adults without family support or facing critical conditions, Additional issues included bureaucratic hurdles, language barriers, and communication deficiencies. Opportunities for improvement in Israel's care transition system for older adults and informal caregivers include promoting individual autonomy, involvement in decision-making, and enhancing collaboration between hospitals and communities. Conclusion Challenges across the care continuum highlighted the need for targeted interventions to address communication, person-centered care, and continuity of care. Policymakers can use this information to develop and implement strategies to improve the transition process, ultimately leading to better patient outcomes and experiences. Older adults care transitions hospital-to-home transitions informal caregivers post-discharge journey challenges opportunities Israel Figures Figure 1 Background With the global population of older adults steadily increasing, there is a growing need to address the complex needs of this demographic ( 1 , 2 ). Economic strains arise as healthcare systems grapple with rising healthcare costs, increased service demand, and strained resources ( 3 ). Health systems must adapt to meet the unique healthcare needs of older adults, including chronic disease management, geriatric care, and transitional care management ( 3 , 4 ). Informal caregiving has emerged as a critical aspect of eldercare, particularly during transitions from hospital to home settings. Informal caregivers are spouses, family members, friends, and neighbors who offer unpaid assistance to older adults. Family caregivers shoulder the burden of providing comprehensive care, navigating complex medical tasks, and managing older adults' practical and emotional needs ( 5 ). The transition from hospital to home exacerbates these challenges, as caregivers face heightened responsibilities, limited support, and increased stress levels ( 6 ). Hospital-to-home transitions are not just a process but a crucial aspect of healthcare delivery for older adults and their informal caregivers ( 7 ). This transition from a structured hospital environment to an independent setting at home presents various challenges and opportunities that significantly impact post-discharge outcomes ( 8 , 9 ), and remains a critical and vulnerable phase for older adults with complex medical needs and/or limited support systems. Transitions from hospital to home for older adults with complex needs have been linked to hospital readmissions, diminished physical and mental capabilities ( 10 , 11 ), and low satisfaction with care ( 12 ). Transitional care services often fail to align with the actual requirements of older adults and informal caregivers and impede a safe and healthy transition process ( 4 , 13 , 14 ). Older adults and families should be acknowledged as key figures in their transitional care as involvement can potentially improve the transition of care ( 4 , 15 ). Israel offers a unique setting to study the experience of older adults and informal caregivers on hospital-to-home transitions. The cultural, social, religious, and ethnic diversity in Israel renders the study of older adults and informal caregivers particularly informative for heterogeneous populations ( 16 ). Furthermore, Israel's strong emphasis on family values underscores the pivotal role of informal caregivers ( 17 ). Israel is characterized as a multicultural, modern, industrialized state with a profound ethos of mutual support, especially within familial bonds. The extended family serves as a cornerstone social institution, with the expectation that family members will provide care for their kin throughout their lifespan, especially true in Israeli Arab families ( 17 ). There has not been any comprehensive research exploring older adult and informal caregiver experiences navigating hospital-to-home transitions of care in Israel. Understanding these dynamics offers valuable insights for customizing interventions to improve the transition process for older adults and their families in Israel. Finally, previous research has addressed the complex needs of aging populations and detrimental outcomes that result from inadequate care transitions ( 18 , 19 ), cultural and language discordance between patients and providers ( 20 ), and interventions for reducing hospital readmissions ( 21 ). However, there is a dearth of research, especially for older adults and informal caregivers, exploring challenges and opportunities for optimizing hospital-to-home care transitions for older adults and their informal caregivers. This current research thus aims to explore the experiences of older adults and informal caregivers navigating hospital-to-home transitions, highlighting challenges and opportunities for optimizing care transitions. By filling the existing research gap on hospital-to-home transitions within the Israeli context, this study aims to provide valuable insights for healthcare providers, policymakers, and other stakeholders to enhance the transition process and ultimately improve outcomes for older adults and their informal caregivers. Methodology Study Design In this study, we implemented a traditional citizen engagement method with Israeli older adults and informal caregivers. In-depth, one-to-one interviews are a conventional approach for gathering detailed information on views, experiences, and perspectives on a particular ( 22 ). Our objective was to explore experiences, challenges, and opportunities for optimizing hospital-to-home transitions in Israel. Participants and Recruitment Participants were older adults aged 65 years and above who were discharged within the last 12 months from any hospital admission and informal caregivers (unpaid family caregivers whose loved ones were recently discharged). Recruitment was managed by a marketing research agency specializing in participant identification and research methodology. A questionnaire containing desirable characteristics such as recent discharge, age, region, employment status, and educational status was disseminated to an online pool of several older adults and informal caregivers. Individuals who met the specified criteria were subsequently reached out to and recruited. Over the course of three months, seven older adults and nine informal caregivers from various regions across the country, both central and peripheral, were recruited. Recruitment involved contacting individuals via telephone calls and emails. Interviews were scheduled with consenting participants. Data collection The interviews were conducted using a semi-structured interview guide that was adapted from McMaster University’s citizen panel question guide focused on engaging older adults and informal caregivers to enhance hospital-to-home care transitions in Ontario ( 23 ). The interview sessions commenced with an introduction to the research and then discussions on older adults and informal caregivers' experiences during hospital-to-home transitions. On average, interviews lasted about an hour and were conducted online. A member of the research team led English interviews. Hebrew interviews were conducted by a member of the market research team proficient in both languages and knowledgeable about the research aims. With participants' consent, all interviews were audio-recorded. Data Analysis The transcribed data were imported into Atlas Ti 24.0 and analyzed using thematic analysis ( 24 ). Codes were generated from recurring statements in the interviews, which were then organized into coherent themes that reflected the understanding of care transitions by older adults and informal caregivers ( 25 ). Relevant quotations were selected to substantiate these themes. One research team member read all transcripts and compiled an initial list of codes. A second team member supervised the data analysis process closely, reviewed all codes and the coding process, providing feedback on code lists ( 26 ), while regular meetings involving all team members facilitated in-depth engagement with the data, review of developed codes, and discussion of emerging codes and themes. We immersed ourselves in the data, documented reflective thoughts, identified potential codes to which each concept was mapped, and then put the codes into context with each other to create themes ( 27 , 28 ). Study Rigor and Trustworthiness To ensure quality, the interview guide was translated into Hebrew by the market research agency and proofread to retain the intended meanings of the questions. The interviews were transcribed and, for those conducted in Hebrew, translated into English for data analysis. Trustworthiness and reproducibility were fostered throughout the process by maintaining detailed documentation and conducting regular research team debriefing sessions, ensuring confirmability, reducing analysis bias, and ensuring the accuracy and credibility of the findings. We verified accurate transcriptions and maintained an audit trail throughout the analysis, which enhanced dependability. For credibility, we used investigator triangulation ( 26 ), i.e., two team members analyzed data closely and compared findings to give a comprehensive understanding of the research findings. Finally, we described the methods and participant characteristics to ensure transferability so the audience can use these descriptions to determine the applicability of results to their setting ( 29 ). The study was guided by the recommendations presented by Guba for assessing trustworthiness ( 30 ). Ethics approval The study was approved by the Human Ethics Committee of the Ben-Gurion University of the Negev (ME30032003), and written informed consent was obtained from all participants involved in the study. Results Participant characteristics There were sixteen participants in this study; nine were informal caregivers, and seven were older adults. Each of the two groups contained English and Hebrew-speaking participants and participants from different regions in Israel—Tel Aviv metropolitan, Jerusalem, and periphery regions. All the participants had been recently discharged (less than a year). The mean age of older adults was 69 years, and for informal caregivers was 53 years. Four of the seven older adults were male, while two of the nine informal caregivers were male. Informal caregivers' relationships with older adults range from a spouse, child, in-law, or grandchild. Years of caregiving experience reported by the informal caregivers was 0–5 years (n = 5), 11–15 years (n = 1), and 20 years or more (n = 3). Many of the participants were on short stay admissions from 2 days being the least to 30 days being the most. The mean hospital stay was 7.5 days. Reasons for hospital admission included cardiovascular (n = 6), gastrointestinal (n = 1), orthopedic (n = 2), neurological (n = 2), respiratory (n = 1), vascular (n = 2), infectious (n = 1), and traumatic (n = 1). Participant characteristics are detailed in Table 1 . [Please insert here] Table 1 Participant characteristics Participant category N = 16 Older adult N = 7 Gender Male 4 Female 3 Mean age (years) 69 Range of duration of hospital stay (days) 3–7 Region Central & Tel-Aviv 5 Jerusalem 1 Southern 1 Education High school/Postsecondary 3 University 4 Employment status Working for pay (full or part-time) 3 Retired 4 Reason for hospital admission Cardiovascular (Heart attack, bypass surgery, cardiac catheterization) 3 Gastrointestinal (bowel obstruction) 1 Neurological (Cerebral stroke) 1 Respiratory (lung resection) 1 Orthopedic (Knee replacement surgery) 1 Informal caregivers N = 9 Gender Male 2 Female 7 Mean age (years) 53 Range of duration of hospital stay (days) 2–30 Region Central & Tel-Aviv 5 North 3 South 1 Education High school/Postsecondary 1 University 8 Employment status Working for pay (full or part-time) 7 Retired 2 Relationship with older adult Child 5 Spouse 2 Grandchild 1 In-law 1 Reason for hospital admission Cardiovascular (Peacemaker, Heart valve replacement, Stroke, Heart failure) 4 Neurological (Vertigo) 1 Respiratory (Smoke inhalation from house fire) 1 Orthopedic (Hip surgery) 1 Infectious (liver infection) 1 Vascular (Vascular catheterization in the leg) 1 Figure 1 provides a layout of the main themes and sub-themes discussed in subsequent sections below. Theme 1 focuses on describing the negative and positive experiences highlighted by participants as they navigated hospital-to-home transitions, from hospital care to discharge and post-discharge. Theme 2 describes the challenges participants encountered as they navigated hospital-to-home transitions. Sub-themes explored here are issues of care coordination and person-centered attention, bureaucratic hurdles, and caregiver burden and responsibility. Finally, the third theme describes opportunities identified for optimizing experiences of hospital-to-home care transitions. They include individual autonomy and self-advocacy, involvement in transitional care decision-making, and strengthening collaborations and partnerships between hospital and community. 1. Navigating hospital-to-home transitions Our findings revealed negative and positive experiences of navigating hospital-to-home transitions during care, discharge, and post-discharge. Negative experiences were characterized by feelings of isolation and self-reliance, abrupt discontinuity of care, and lack of ongoing support and guidance. On the other hand, positive experiences were characterized by feelings of reassurance and empowerment, a sense of security due to the presence of a medical team during care, and positive experiences of follow-up care through phone calls and home visits. The older adults and informal caregivers shared diverse perceptions of their care experiences during transitions from hospital to home settings. Some described their transition as smooth and positive during their hospital stay, at discharge, and upon returning home, while for some, experiencing a sudden health crisis and then returning home, where life is expected to resume as normal, can be incredibly distressing. “I received intensive neurological care there. The attending physician assumed full responsibility for my case, evidently concerned about preventing further complications. While a hospital provides a sense of security due to the presence of a medical team, it is not a pleasant place to be, and the transition home brings with it a sense of isolation and self-reliance”. Older adult Thus, medical oversight provided during hospital stays provides a sense of security; however, adjusting to post-discharge life and managing their care independently creates isolation. Another older adult linked the transition to a transactional experience characterized by abrupt farewells and a lack of ongoing guidance or support. Another older adult echoed this sentiment and described feeling frustrated and disheartened by the perceived lack of genuine care and support post-discharge. “It felt quite abrupt and impersonal, ‘OK, goodbye...next! My experience was far from simple, transcending a mere physical injury. Upon returning home, I was beset with questions about permissible activities, necessary lifestyle modifications, and overall future conduct. Initially, I found myself consulting various medical professionals on a daily basis, including a cardiologist and an internal medical specialist”. Older adult Participants expressed disappointment with the perceived discontinuity of care once their immediate medical needs were addressed, emphasizing the importance of ongoing support and follow-up beyond the hospital setting. “I needed someone to advise me on the right course of action and assess whether I was proceeding correctly…There lacks a single entity who can oversee and coordinate my ongoing care.” Older adult. Furthermore, the discharge process was mainly characterized by receiving a discharge letter from the hospital staff, whereas a more relaxed process of understanding discharge instructions and receiving adequate information would have been more desired. “…At the time of discharge, I received merely a letter instructing me to refer to it for information, which was all the guidance provided.” Older adult. Conversely, other participants reported feeling reassured and empowered. Detailed written guidelines, medical professionals' contact information, and healthcare home visits were cited as valuable resources that facilitated the transition and reduced the need for additional travel or logistical arrangements. “It was reassuring to receive clear guidance and support. Additionally, I was given detailed written guidelines about dietary recommendations, including what foods to consume, what to avoid, and guidelines for healthy and unhealthy eating choices. Furthermore, they provided me with the contact number for the department of the professor who performed the surgery, should I have any questions”. Older adult Other expressions of positive experiences focused on receiving appropriate support at the appropriate time e.g., “It instilled a feeling of confidence, reassuring us that we were receiving the appropriate support precisely when it was most needed.”- Informal caregiver “With regard to transition, I had very, very good treatment. The doctor came, he explained every single thing, with regard to showers, with regard to exercises, who would be in touch with me, who wouldn't be in touch with me, very, very positive, and he was very, very nice.” Older adult Overall, the responses highlight the varied experiences and perceptions of older adults and informal caregivers during hospital-to-home transitions, underscoring the need for comprehensive and patient-centered approaches to post-discharge care to ensure the well-being of both patients and caregivers throughout the transition process. Challenges of hospital-to-home transitions. Challenges were expressed under three main sub-themes: 1) Care coordination and person-centered attention, 2) bureaucratic hurdles, and 3) caregiver burden and responsibility. a. Care coordination and person-centered attention Older adults and informal caregivers expressed frustration with the lack of coordination among specialists, leading to confusion regarding medication, treatment plans, and follow-up care. “I perceived no significant preparations. I received a discharge letter outlining recommended follow-up actions and necessary tests. These tests require independent scheduling and are often at various locations, which can be challenging. Despite lifelong health insurance contributions, securing timely appointments is difficult. For instance, I received a referral for an additional MRI appointment set for six months from now.” Older adult The absence of personalized attention and support during the discharge process contributes to feelings of anxiety and uncertainty and a sense of being left to fend for themselves. They often felt like they were left to navigate their healthcare journey alone, with little guidance or reassurance from medical professionals. This fragmented approach to healthcare management can exacerbate patients' concerns and diminish their overall satisfaction with the healthcare system. Furthermore, they expressed frustration with the lack of attention to their individual needs and concerns, feeling like they were treated as just another case rather than receiving tailored guidance and assistance. Older adults and informal caregivers reported desiring more attention, communication, and follow-up from healthcare providers to ensure a smoother and more supportive transition back home. “It was kind of aggravated for her, for me, all the questions that we had and no answers. It felt like, okay we have plenty of patients here. You are not the only one. That was the feeling we got. On top of that, that she was elder, and it felt like they were giving her very fast answers and not really taking the time to explain and so on. it was it is kind of a bad experience.” Informal caregiver “I felt treated as just another customer in the queue. The greatest challenge arises when you're discharged from the hospital, metaphorically thrown into turbulent waters to fend for yourself, carrying the burden of uncertainty about when a potential health crisis might reoccur - be it in a week, a month, or a year” Older adult. Participant expressed dissatisfaction with the uncertainty surrounding diagnoses, treatment plans, and follow-up care. They highlighted the need for healthcare providers to offer clear explanations, timely answers, and comprehensive support to alleviate anxiety and ensure better patient outcomes. Additionally, they expressed a desire for healthcare professionals to take more responsibility for providing transparent information and guidance to patients and their families. Difficulties and frustrations experienced specifically during the hospital discharge process were also highlighted. Participants expressed concerns about delays in receiving discharge instructions, difficulties understanding the discharge letter, and a lack of personalized guidance regarding post-discharge care. They emphasized the need for clearer communication from healthcare providers, including detailed explanations of medications and follow-up instructions. Additionally, they stressed the importance of having someone available to address their questions and concerns before leaving the hospital. Delays in the discharge process, uncertainty about post-discharge care, and insufficient preparation contribute to feelings of anxiety and dissatisfaction among patients and caregivers were highlighted. “The discharge letter was supposed to contain all necessary information, but no one was available for a detailed discussion or to answer questions.” Older adult “The doctor briefly handed me the letter, offering minimal explanation, approximately four to five words, and advised me to consult my GP for further guidance.” Older adult b. Bureaucratic hurdles Bureaucratic hurdles in accessing healthcare assistance, especially during and post-discharge were equally a significant challenge. Older adults, especially those with less social support, struggled with navigating bureaucratic processes to access healthcare assistance, particularly when seeking support such as home care or nursing assistance, ,or government aid. Participants expressed frustration with the cumbersome paperwork, lengthy procedures, and lack of streamlined processes, which hinder their ability to obtain the necessary assistance promptly. They emphasize the need to simplify administrative requirements and advocate for dedicated teams or organizations to facilitate access to support services, especially for elderly individuals and those with serious health conditions. Additionally, there's a call for a more efficient assessment of patient's needs to ensure timely assistance and minimize unnecessary delays caused by bureaucratic hurdles. “Sometimes there's a lot of bureaucracy. They say, oh, okay, well, it'll take a month. by the time the papers go through, and by the time this and in the meantime, the patient's dying at home and needs her diapers changed, and it is not fair”. Older adult “I would like to manage it together with them but the bureaucracy in Israel is so difficult that you don't always have the strength. And when you are in pain and after surgery, then to deal with it is a job that I would prefer someone do for me; but I would like to make the decisions myself”. Older adult c. Caregiver burden and responsibility Finally, struggles of family caregiving and the need for external support were equally highlighted by informal caregivers.Informal caregivers play a crucial role in the care and transition of older adults from hospital to home; thus, recognizing and addressing the needs of family caregivers is essential for ensuring their well-being and ability to provide effective support to older adults during the transition process. They emphasized some of the challenges faced by family members in providing care for a seriously ill loved one, particularly in the absence of external support such as home care or nursing assistance, the emotional and physical toll of caring for their sick loved ones, highlighting the burden placed on the entire family, especially when balancing caregiving responsibilities with other commitments like work and family. The importance of accessible and affordable assistance, particularly for elderly caregivers who were physically exhausted by their caregiving responsibilities, whether through home care services or financial support from institutions like National Insurance, to ease the burden on families during difficult times was highlighted. “It demands immense responsibility on my part, particularly in the meticulous management of his medication regimen. I am tasked with preparing and overseeing the accurate and timely administration of his medications, as any omission may lead to severe consequences.” Informal caregiver Informal caregivers of older adults faced significant challenges during the hospital-to-home transitions of their loved ones. The caregivers described the demanding nature of providing around-the-clock care for their sick family members. The caregiving responsibilities often fell on multiple family members, leading to a constant rotation of caregiving duties. “Most of the days we had turns, like, who's gonna sleep with her at home and who's gonna stay with her… around the clock, we were there… we didn't have any nurse or a woman that come or anybody that come to take care of her. It was all our responsibility. It was a very hard obligation.” Informal caregiver The emotional toll of caregiving was also evident, with caregivers experiencing stress, anxiety, and emotional distress throughout the transition period. “The entire family experienced considerable stress during this period. From the moment I returned home, my wife was constantly by my side, accompanying me to every medical appointment and examination. She remained with me continuously, sharing in the stress and anxiety and eager to understand the unfolding situation.” Older adult Overall, the challenges encountered by informal caregivers underscore the need for comprehensive support services to assist caregivers during hospital-to-home transitions and alleviate the burden of caregiving responsibilities on families. Opportunities for optimizing hospital-to-home transitions. This theme highlights opportunities for maximizing transitions. By identifying opportunities for optimization, we seek to contribute to support systems that promote seamless transitions and improve outcomes for older adults and their caregivers during the transition from hospital to home settings. Findings show that individual autonomy and self-advocacy, involvement in collaborative transitional care decision-making, and hospital and community collaboration and partnerships are opportunities that may be leveraged for optimizing hospital-to-home transitions. These sub-themes are discussed in detail below. a. Individual autonomy and self-advocacy Findings from this study show that the desire for individual autonomy and self-advocacy among older adults and family caregivers during hospital-to-home transitions presents an opportunity for optimizing and improving care transition experiences and outcomes. Empowering them to actively engage in decision-making, express preferences, and advocate for their needs may further enable healthcare providers to tailor transition plans to suit their values and preferences better. Our findings show that some older adults and family caregivers expressed a strong sense of independence and self-sufficiency, preferring to manage their care autonomously whenever possible, feelingreluctant to rely on others for assistance, emphasizing a desire to maintain self-reliance even during periods of difficulty. “A few years ago, when he had bypass surgery, before his discharge his surgeon told us that he could go to heart rehabilitation. I knew that wasn't for (him) and I asked the doctor what he thought, and he said 'it's subjective, when someone does not have family support they have to go to rehab, no question, but when someone has family to support them, I believe that the best place for a person to heal is in their own home.” Informal caregiver Our findings also highlighted some participants’ proactive approach to healthcare, actively seeking information and asking questions to ensure a thorough understanding of their medical needs and treatment plans. This proactive stance enabled some participants to navigate the healthcare system effectively and advocate for themselves during hospitalization and upon discharge. These personality attributes underscore the significance of tailoring transitional care interventions to align with individuals' preferences, attitudes, and behaviors, thereby enhancing their ability to successfully transition from hospital to home while maintaining a sense of autonomy and agency. Additionally, they highlighted the importance of being well-informed about their health condition and treatment, actively engaging with healthcare providers, and asking pertinent questions to ensure clarity and understanding. “I always ask questions. I don't bury my head in the sand; I research, I take an interest, and I always ask all the questions. I'm not shy about asking the doctor questions… I knew to ask the questions because I knew that the doctors usually give a general sort of answer or they let the nurses give you the instructions for what to do when you go home: which pills to take, how many times a day, and when to visit your local health care providers.” Informal caregiver b. Involvement in collaborative transitional care decision-making Our findings show that engaging older adults and families in the decision-making process may allow for a comprehensive understanding of the older adult's needs and preferences, leading to more personalized care plans. This underscores the importance of family involvement, patient preferences, and caregiver support in healthcare transitions, highlighting the need for collaborative decision-making to ensure better outcomes. Our findings illuminate that some participants expressed a desire for active participation in healthcare decisions, particularly regarding treatment options and post-discharge plans. They highlighted the importance of considering individual preferences and needs and the role of family support in decision-making. Some participants described proactive engagement with healthcare providers, advocating for personalized care and treatment adjustments based on their own assessments and experiences, “To make the transition easier,… the loved one the daughter or the granddaughter or whoever, should also, the nurses and doctor should explain to the family because sometimes, as I said before, the patient doesn't always understand. Especially if we are going for older, much older people, they don't understand… it is important that the family know exactly what's going on. It makes the transition easier…” Older adult while some others were content relying on the healthcare professionals' judgment. “I believe it is best for medical professionals to make these decisions. If they recommend discharge, I trust their judgment. At my age, it is not fitting to challenge their expertise”. Older adult Overall, empowering older adults and family caregivers to participate in decision-making processes actively offers a promising avenue for enhancing hospital-to-home transitions of care and improving overall health outcomes. On the flip side, our findings reveal that the desire for active involvement of older adults and their informal caregivers in transitional care decision-making can sometimes be hampered by health conditions, bureaucratic hurdles, and challenges within the healthcare system. “If feasible, despite my limitations owing to post-operative pain and physical weakness from the surgery, I would have been eager to contribute. Nonetheless, the immediate post-operative period is challenging due to the effects of substantial pain medication, which weakens the body”. Older adult “I would have been happy for her to have stayed longer, that way I would have been more relaxed. I asked if they didn't need to keep her in and they said there was no reason to keep her, because what they were doing for her there could be done at home.I had no say in the matter”. Informal caregiver “I wanted my father to have a say in that too. Um. he's clear in his mind and, and whatnot, but, you know, after certain major health events, you know, you, you don't always think clear and you're afraid.” Informal caregiver c. Strengthening hospital and community collaboration, coordination, and partnerships Since hospital-to-home transitions are often complex, involving multiple healthcare providers, caregivers, and community support services, a seamless transition requires effective communication, collaboration, and coordination between these stakeholders. Collaboration between hospitals and community organizations can enhance access to support services for patients transitioning home. “I think that for anyone who has been hospitalized for a certain period, the health system has to follow up with them much more through the nurses or require the family doctor to initiate contact with the patient, because often if you don't go afterward to the family doctor and bring him the discharge, letter, they don't even know you were hospitalized.” Older adult Strengthening these collaborations allows for more effective follow-up and home care support and highlights proactive measures that can be taken to ensure patient well-being and the role of supportive community frameworks in facilitating a smooth transition to home-based care. “The fact that the house was organized and ready for the person coming back from the hospital is something that has a positive impact on the patient. It feels like he's back where he belongs, and that makes him comfortable.” Informal caregiver Discussion The present study explores participants’ experiences navigating hospital-to-home care transitions and also highlights challenges and opportunities for optimizing hospital-to-home care transitions for older adults and their family caregivers in the Israeli context. For some participants, navigating the transition process felt impersonal and transactional, with inadequate support and guidance post-discharge leading to frustration and disheartenment. In contrast, others felt well-supported and empowered, appreciating clear guidance and access to medical professionals for ongoing assistance. Previous studies can be comparable to our study findings in the sense of experiences navigating hospital-to-home transitions. In the broader context of transitions of care for older adults who require care across different settings, e.g., from hospital to home, home to hospital, hospital to a nursing home, etc., older adults and informal caregivers have similarly reported experiences indicating satisfaction, while others have reported a lack of person-centered care and negative care outcomes ( 8 , 15 , 31 – 34 ). The varied experiences encountered during hospital-to-home transitions suggest the importance of assessing individual older adult health conditions and family dynamics and providing tailored practical information to address unique situations ( 31 ). Furthermore, our study highlighted challenges and opportunities for optimizing hospital-to-home care transitions for Israeli older adults and informal caregivers. Lack of coordination and person-centered care highlights the need for a context-specific or context-sensitive discharge education program, which would include healthcare providers trained to provide education to older adults in the presence of their family caregivers in a relaxed environment ( 35 ). Participants in this study wanted to be provided with more tailored and clarifying information regarding diagnosis and post-discharge expectations and instructions similar to reports by ( 36 ). Similar to our findings regarding caregiving responsibility and burden in care transitions, multiple integral roles played by family caregivers in the hospital-to-home transitions for older adults and their impact on transitional care experiences have equally been highlighted in previous research ( 8 , 37 ). Finally, our findings show that some informal caregivers and older adults in this current study desired to be involved in transitional care decision-making, coordinated discharge planning, and self-advocacy, as is similar to findings by ( 37 ). A distinctive aspect of our study is perhaps the emphasis on opportunities within participants’ experiences. This sets this research apart and enriches our understanding of navigating and optimizing care transitions for older adults and informal caregivers, providing practical recommendations for healthcare practitioners, policymakers, and stakeholders. Similarly, having highlighted the opportunities and challenges, it is important to highlight the different positive and negative experiences navigating care transitions described by the participants A possible explanation could be the seemingly inadequate information of some older adults and informal caregivers who participated in our interviews regarding the availability and accessibility of services, especially post-discharge services for older adults after discharge. Contextually, these differences in experiences may have also risen from various factors such as the quality of communication and coordination between healthcare providers, the adequacy of discharge planning and information provision, and individual preferences and expectations regarding post-discharge care. This highlights the importance of adequately informing and equipping older adults and informal caregivers with knowledge about their health conditions, self-management post-discharge, and available services to enhance their transition from hospital care to community care while also emphasizing the necessity for comprehensive support mechanisms tailored to individual needs to ensure a smooth and positive transition for both patients and caregivers from hospital to home settings. Finally, Israel's centralized health system offers unique opportunities for older adults and informal caregiver engagement in transitional care decision-making. Drawing from international examples ( 38 ) and leveraging the centralized nature of the healthcare system, Israel can implement initiatives for involvement in decision-making processes, ultimately enhancing the quality of care transitions and improving patient outcomes. For example, in the UK, initiatives like patient and public involvement forums, patient feedback mechanisms, and shared decision-making programs have been implemented to involve citizens in healthcare decision-making processes ( 39 ). With a centralized system, there is greater potential for standardization of care protocols, coordination among healthcare providers, and implementation of patient-centered initiatives across the healthcare system. This can facilitate more consistent and cohesive approaches to transitional care, leading to improved quality of transitions for older adults and their families. Practice and policy implications. Our study findings have both practice and policy implications. Enhanced communication and education strategies are needed to provide clear information and support to older adults and informal caregivers throughout the transition process. Person-centered care planning should be prioritized, involving older adults and caregivers in decision-making and tailoring care plans to their individual needs. Strengthening care coordination mechanisms between healthcare settings is essential to ensure seamless transitions, while support services for informal caregivers should be expanded to alleviate caregiver burden. By implementing these recommendations, healthcare systems can enhance the quality of care transitions and promote better outcomes for older adults and their caregivers. Strengths and limitations Our research explored the perspectives of older adults and informal caregivers regarding hospital-to-home transitions, focusing on their experiences, challenges, and opportunities. Through in-depth one-on-one interviews, participants were afforded the opportunity to candidly express their views without inhibition, allowing for a comprehensive exploration of their struggles and experiences. However, it is important to acknowledge the limitations of this study. While we aimed to recruit a diverse population encompassing various linguistic, cultural, and religious backgrounds in Israel, resource and time constraints limited the extent to which this goal could be realized, thus impacting the generalizability of our findings. Recommendations for future research The current research has made a number of important findings about the experiences of patients and their families regarding the transition of care. Nonetheless, there are some aspects that future research should focus on. Health policy and system-level research can be conducted to focus on investigating the role of health policy and system-level factors in shaping hospital-to-home transitions for older adults and informal caregivers in Israel. This could include examining policies related to discharge planning, care coordination, and reimbursement for home-based care services, as well as assessing the impact of healthcare system reforms on transition outcomes. Future studies may also explore more deliberative engagement methods, such as citizen panels or citizen juries, to understand how older adults and informal caregivers navigate hospital-to-home transitions. Finally, future research efforts should focus on underrepresented and marginalized groups of older adults and informal caregivers. Research is needed in developing and implementing interventions to support the needs of both older adults and caregivers alike. Conclusion Addressing the challenges of informal caregiving requires recognizing the vital role of older adults and informal caregivers as having a central role in their care. It involves providing tailored support services and fostering collaboration between healthcare providers, community organizations, and caregivers to ensure the well-being of both older adults and their caregivers throughout the care continuum. Declarations Ethics approval and consent to participate The study was approved by the Human Ethics Committee of the Ben-Gurion University of the Negev (ME30032003), and written informed consent was obtained from all participants involved in the study. All methods were performed per the ethical standards laid down in the Declaration of Helsinki and its later amendments. Consent for publication Not applicable Availability of data and materials Due to ethics restrictions, the datasets generated during the current study cannot be made publicly available. The research data, coding, and materials utilized in this study are available on a secured server to which the primary researcher has exclusive access. Competing interests The authors declare they have no competing interests. Funding This work was supported by the European Union’s Horizon 2020 research and innovation program under the Marie Sklodowska-Curie grant agreement No 812656. The sponsors had no role in the project. Authors’ contributions The authors confirm their contribution to the paper as follows: MEE and TvA contributed substantially to the study conception and design. ORK was in charge of acquiring data and preparing the initial draft of the manuscript. ORK performed data analysis, with JPD making substantial contributions to data analysis and the initial manuscript draft. All authors contributed to data interpretation, discussion, and presentation of the results. All authors reviewed and approved the final version of the manuscript. Acknowledgment We appreciate the time commitment of all the older adults and informal caregivers who participate din this research. 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Heal Res Policy Syst [Internet]. 2024 Dec 1 [cited 2024 Apr 22];22(1):1–17. Available from: https://health-policy-systems.biomedcentral.com/articles/10.1186/s12961-024-01107-9 Gauvin F-P, J M, M M-R, R G, C M, G H-T, et al. Panel summary: Engaging older adults with complex health and social needs, and their caregivers, to improve hospital-to-home transitions in Ontario. Hamilton, Canada. McMaster Health Forum. 2019 Nov. Braun V, Clarke V. Thematic analysis. APA Handb Res methods Psychol Vol 2 Res Des Quant Qual Neuropsychol Biol. 2012;2:57–71. Braun V, Clarke V. Using thematic analysis in psychology. Qual Res Psychol [Internet]. 2006 [cited 2024 Apr 22];3(2):77–101. Available from: https://www.tandfonline.com/action/journalInformation?journalCode=uqrp20 Campbell R, Goodman-Williams R, Feeney H, Fehler-Cabral G. Assessing Triangulation Across Methodologies, Methods, and Stakeholder Groups: The Joys, Woes, and Politics of Interpreting Convergent and Divergent Data. Am J Eval. 2020;41(1):125–44. Nowell LS, Norris JM, White DE, Moules NJ. Thematic Analysis: Striving to Meet the Trustworthiness Criteria. Int J Qual Methods. 2017;16(1):1–13. Castleberry A, Nolen A. Thematic analysis of qualitative research data: Is it as easy as it sounds? Curr Pharm Teach Learn [Internet]. 2018;10(6):807–15. Available from: https://doi.org/10.1016/j.cptl.2018.03.019 Morse JM. Critical Analysis of Strategies for Determining Rigor in Qualitative Inquiry. http://dx.doi.org/101177/1049732315588501 [Internet]. 2015 Jul 16 [cited 2024 Apr 22];25(9):1212–22. Available from: https://journals.sagepub.com/doi/10.1177/1049732315588501 Guba EG. Annual Review Paper Criteria for Assessing the Trustworthiness of Naturalistic Inquiries. Educ Commun Technol. 1981;29(2):75–91. Giosa JL, Stolee P, Dupuis SL, Mock SE, Santi SM. An examination of family caregiver experiences during care transitions of older adults. Can J Aging. 2014;33(2):137–53. Scheibl F, Fleming J, Buck J, Barclay S, Brayne C, Farquhar M. The experience of transitions in care in very old age: Implications for general practice. Fam Pract. 2019;36(6):778–84. Groenvynck L, De Boer B, Beaulen A, De Vries E, Hamers JPH, Van Achterberg T, et al. The paradoxes experienced by informal caregivers of people with dementia during the transition from home to a nursing home. Age Ageing [Internet]. 2022 Feb 2 [cited 2024 Apr 23];51(2):1–9. Available from: https://dx.doi.org/10.1093/ageing/afab241 Hestevik CH, Molin M, Debesay J, Bergland A, Bye A. Older persons’ experiences of adapting to daily life at home after hospital discharge: A qualitative metasummary. BMC Health Serv Res. 2019;19(1):1–13. Dimech N, Cassar M, Carabott J. Hospital Discharge Process: Context-Sensitive Care. Creat Nurs. 2024; Hladkowicz E, Auais M, Kidd G, McIsaac DI, Miller J. “I can’t imagine having to do it on your own”: a qualitative study on postoperative transitions in care from the perspectives of older adults with frailty. BMC Geriatr [Internet]. 2023;23(1):1–12. Available from: https://doi.org/10.1186/s12877-023-04576-9 Allen J, Woolford M, Livingston PM, Lobchuk M, Muldowney A, Hutchinson AM. Informal carer support needs, facilitators and barriers in transitional care for older adults from hospital to home: A scoping review. J Clin Nurs. 2023;32(19–20):6773–95. NHS. NHS Long Term Plan [Internet]. Vol. 12, Department of Health and Social Care (UK). 2019 [cited 2024 Apr 15]. p. 10–1. Available from: https://www.longtermplan.nhs.uk/wp-content/uploads/2019/08/nhs-long-term-plan-version-1.2.pdf Légaré F, Boivin A, Van Der Weijden T, Pakenham C, Burgers J, Légaré J, et al. Patient and public involvement in clinical practice guidelines: A knowledge synthesis of existing programs. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4354721","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":306250123,"identity":"ef6c2ee8-99eb-4faa-b58c-4fc9d3afbc23","order_by":0,"name":"Opeyemi Rashidat Kolade","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA9klEQVRIiWNgGAWjYBACPiA+wGDAwMAP4R+AihtY4NTCBtMi2QBmwbVI4NUCUXMARQsDHi3sxx8e/FFgk2d8u/nw5w8Md+w2HGB++IGhAI8WnhyDwzwGacVmd46lSRxgeJa84QCbsQR+h+UwHGYwOJy47UaOGdBZh5OBLjTD7xf+5w8O/gBq2Twjx/gDRAv7N/xaJBIMDvAAtWyQyDEAOuywHZBLwBaJNxC/SID8csbgWYLkYZ5ioDm4tfDzpz/++OOPTR7/7ObDHyoq7tjzHW/f+OHDHxucWmAgARIRBgyJDcxgLmGQAIs7eyIUj4JRMApGwQgDAMbYVW9rjSrOAAAAAElFTkSuQmCC","orcid":"https://orcid.org/0000-0002-9746-2863","institution":"Ben-Gurion University of the Negev","correspondingAuthor":true,"prefix":"","firstName":"Opeyemi","middleName":"Rashidat","lastName":"Kolade","suffix":""},{"id":306250124,"identity":"1fb6e190-b446-4c87-a167-9365cfe0ef20","order_by":1,"name":"Joshua Porat-Dahlerbruch","email":"","orcid":"","institution":"University of Pittsburgh School of Nursing","correspondingAuthor":false,"prefix":"","firstName":"Joshua","middleName":"","lastName":"Porat-Dahlerbruch","suffix":""},{"id":306250125,"identity":"2ba15e9f-01b4-4693-b013-d9ec7db900e6","order_by":2,"name":"Theo van Achterberg","email":"","orcid":"","institution":"KU Leuven: Katholieke Universiteit Leuven","correspondingAuthor":false,"prefix":"","firstName":"Theo","middleName":"van","lastName":"Achterberg","suffix":""},{"id":306250126,"identity":"f786b3cc-5aa2-45e6-a03c-6f3b367ce1f5","order_by":3,"name":"Moriah Esther Ellen","email":"","orcid":"https://orcid.org/0000-0001-7127-7283","institution":"Ben-Gurion University of the Negev Faculty of Health Sciences","correspondingAuthor":false,"prefix":"","firstName":"Moriah","middleName":"Esther","lastName":"Ellen","suffix":""}],"badges":[],"createdAt":"2024-05-01 14:14:59","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4354721/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4354721/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":58070586,"identity":"bcc54a83-fa9f-407d-b4d4-0b4b5055c09f","added_by":"auto","created_at":"2024-06-10 18:33:45","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":136627,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eThematic map of main themes\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-4354721/v1/ef003a04698e34a1e9f21552.png"},{"id":58449434,"identity":"5d4607ff-113c-4ee3-a9b1-b0b9a422c10d","added_by":"auto","created_at":"2024-06-16 16:20:11","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":745996,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4354721/v1/d0433596-3086-4617-9796-63d692abd0fd.pdf"}],"financialInterests":"","formattedTitle":"Navigating Hospital To Home Transitions: Exploring Israeli Older Adult And Informal Caregiver Experiences, Challenges And Opportunities.","fulltext":[{"header":"Background","content":"\u003cp\u003eWith the global population of older adults steadily increasing, there is a growing need to address the complex needs of this demographic (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e). Economic strains arise as healthcare systems grapple with rising healthcare costs, increased service demand, and strained resources (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e). Health systems must adapt to meet the unique healthcare needs of older adults, including chronic disease management, geriatric care, and transitional care management (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eInformal caregiving has emerged as a critical aspect of eldercare, particularly during transitions from hospital to home settings. Informal caregivers are spouses, family members, friends, and neighbors who offer unpaid assistance to older adults. Family caregivers shoulder the burden of providing comprehensive care, navigating complex medical tasks, and managing older adults' practical and emotional needs (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e). The transition from hospital to home exacerbates these challenges, as caregivers face heightened responsibilities, limited support, and increased stress levels (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eHospital-to-home transitions are not just a process but a crucial aspect of healthcare delivery for older adults and their informal caregivers (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e). This transition from a structured hospital environment to an independent setting at home presents various challenges and opportunities that significantly impact post-discharge outcomes (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e), and remains a critical and vulnerable phase for older adults with complex medical needs and/or limited support systems. Transitions from hospital to home for older adults with complex needs have been linked to hospital readmissions, diminished physical and mental capabilities (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e), and low satisfaction with care (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e). Transitional care services often fail to align with the actual requirements of older adults and informal caregivers and impede a safe and healthy transition process (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e). Older adults and families should be acknowledged as key figures in their transitional care as involvement can potentially improve the transition of care (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eIsrael offers a unique setting to study the experience of older adults and informal caregivers on hospital-to-home transitions. The cultural, social, religious, and ethnic diversity in Israel renders the study of older adults and informal caregivers particularly informative for heterogeneous populations (\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e). Furthermore, Israel's strong emphasis on family values underscores the pivotal role of informal caregivers (\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e). Israel is characterized as a multicultural, modern, industrialized state with a profound ethos of mutual support, especially within familial bonds. The extended family serves as a cornerstone social institution, with the expectation that family members will provide care for their kin throughout their lifespan, especially true in Israeli Arab families (\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e). There has not been any comprehensive research exploring older adult and informal caregiver experiences navigating hospital-to-home transitions of care in Israel. Understanding these dynamics offers valuable insights for customizing interventions to improve the transition process for older adults and their families in Israel.\u003c/p\u003e \u003cp\u003eFinally, previous research has addressed the complex needs of aging populations and detrimental outcomes that result from inadequate care transitions (\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e), cultural and language discordance between patients and providers (\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e), and interventions for reducing hospital readmissions (\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e). However, there is a dearth of research, especially for older adults and informal caregivers, exploring challenges and opportunities for optimizing hospital-to-home care transitions for older adults and their informal caregivers. This current research thus aims to explore the experiences of older adults and informal caregivers navigating hospital-to-home transitions, highlighting challenges and opportunities for optimizing care transitions. By filling the existing research gap on hospital-to-home transitions within the Israeli context, this study aims to provide valuable insights for healthcare providers, policymakers, and other stakeholders to enhance the transition process and ultimately improve outcomes for older adults and their informal caregivers.\u003c/p\u003e"},{"header":"Methodology","content":"\u003cp\u003eStudy Design\u003c/p\u003e \u003cp\u003eIn this study, we implemented a traditional citizen engagement method with Israeli older adults and informal caregivers. In-depth, one-to-one interviews are a conventional approach for gathering detailed information on views, experiences, and perspectives on a particular (\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e). Our objective was to explore experiences, challenges, and opportunities for optimizing hospital-to-home transitions in Israel.\u003c/p\u003e \u003cp\u003eParticipants and Recruitment\u003c/p\u003e \u003cp\u003eParticipants were older adults aged 65 years and above who were discharged within the last 12 months from any hospital admission and informal caregivers (unpaid family caregivers whose loved ones were recently discharged). Recruitment was managed by a marketing research agency specializing in participant identification and research methodology. A questionnaire containing desirable characteristics such as recent discharge, age, region, employment status, and educational status was disseminated to an online pool of several older adults and informal caregivers. Individuals who met the specified criteria were subsequently reached out to and recruited. Over the course of three months, seven older adults and nine informal caregivers from various regions across the country, both central and peripheral, were recruited. Recruitment involved contacting individuals via telephone calls and emails. Interviews were scheduled with consenting participants.\u003c/p\u003e \u003cp\u003eData collection\u003c/p\u003e \u003cp\u003eThe interviews were conducted using a semi-structured interview guide that was adapted from McMaster University\u0026rsquo;s citizen panel question guide focused on engaging older adults and informal caregivers to enhance hospital-to-home care transitions in Ontario (\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e). The interview sessions commenced with an introduction to the research and then discussions on older adults and informal caregivers' experiences during hospital-to-home transitions. On average, interviews lasted about an hour and were conducted online. A member of the research team led English interviews. Hebrew interviews were conducted by a member of the market research team proficient in both languages and knowledgeable about the research aims. With participants' consent, all interviews were audio-recorded.\u003c/p\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eData Analysis\u003c/h2\u003e \u003cp\u003eThe transcribed data were imported into Atlas Ti 24.0 and analyzed using thematic analysis (\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e). Codes were generated from recurring statements in the interviews, which were then organized into coherent themes that reflected the understanding of care transitions by older adults and informal caregivers (\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e). Relevant quotations were selected to substantiate these themes. One research team member read all transcripts and compiled an initial list of codes. A second team member supervised the data analysis process closely, reviewed all codes and the coding process, providing feedback on code lists (\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e), while regular meetings involving all team members facilitated in-depth engagement with the data, review of developed codes, and discussion of emerging codes and themes. We immersed ourselves in the data, documented reflective thoughts, identified potential codes to which each concept was mapped, and then put the codes into context with each other to create themes (\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e, \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eStudy Rigor and Trustworthiness\u003c/p\u003e \u003cp\u003eTo ensure quality, the interview guide was translated into Hebrew by the market research agency and proofread to retain the intended meanings of the questions. The interviews were transcribed and, for those conducted in Hebrew, translated into English for data analysis. Trustworthiness and reproducibility were fostered throughout the process by maintaining detailed documentation and conducting regular research team debriefing sessions, ensuring confirmability, reducing analysis bias, and ensuring the accuracy and credibility of the findings. We verified accurate transcriptions and maintained an audit trail throughout the analysis, which enhanced dependability. For credibility, we used investigator triangulation (\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e), i.e., two team members analyzed data closely and compared findings to give a comprehensive understanding of the research findings. Finally, we described the methods and participant characteristics to ensure transferability so the audience can use these descriptions to determine the applicability of results to their setting (\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e). The study was guided by the recommendations presented by Guba for assessing trustworthiness (\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cstrong\u003eEthics approval\u003c/strong\u003e \u003cp\u003eThe study was approved by the Human Ethics Committee of the Ben-Gurion University of the Negev (ME30032003), and written informed consent was obtained from all participants involved in the study.\u003c/p\u003e \u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003eParticipant characteristics\u003c/h2\u003e \u003cp\u003eThere were sixteen participants in this study; nine were informal caregivers, and seven were older adults. Each of the two groups contained English and Hebrew-speaking participants and participants from different regions in Israel\u0026mdash;Tel Aviv metropolitan, Jerusalem, and periphery regions. All the participants had been recently discharged (less than a year). The mean age of older adults was 69 years, and for informal caregivers was 53 years. Four of the seven older adults were male, while two of the nine informal caregivers were male. Informal caregivers' relationships with older adults range from a spouse, child, in-law, or grandchild. Years of caregiving experience reported by the informal caregivers was 0\u0026ndash;5 years (n\u0026thinsp;=\u0026thinsp;5), 11\u0026ndash;15 years (n\u0026thinsp;=\u0026thinsp;1), and 20 years or more (n\u0026thinsp;=\u0026thinsp;3). Many of the participants were on short stay admissions from 2 days being the least to 30 days being the most. The mean hospital stay was 7.5 days. Reasons for hospital admission included cardiovascular (n\u0026thinsp;=\u0026thinsp;6), gastrointestinal (n\u0026thinsp;=\u0026thinsp;1), orthopedic (n\u0026thinsp;=\u0026thinsp;2), neurological (n\u0026thinsp;=\u0026thinsp;2), respiratory (n\u0026thinsp;=\u0026thinsp;1), vascular (n\u0026thinsp;=\u0026thinsp;2), infectious (n\u0026thinsp;=\u0026thinsp;1), and traumatic (n\u0026thinsp;=\u0026thinsp;1). Participant characteristics are detailed in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e. [Please insert here]\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eParticipant characteristics\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"2\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eParticipant category\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eN\u0026thinsp;=\u0026thinsp;16\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOlder adult\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eN\u0026thinsp;=\u0026thinsp;7\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGender\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMean age (years)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e69\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRange of duration of hospital stay (days)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3\u0026ndash;7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRegion\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCentral \u0026amp; Tel-Aviv\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eJerusalem\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSouthern\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEducation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHigh school/Postsecondary\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUniversity\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEmployment status\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWorking for pay (full or part-time)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRetired\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eReason for hospital admission\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCardiovascular (Heart attack, bypass surgery, cardiac catheterization)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGastrointestinal (bowel obstruction)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNeurological (Cerebral stroke)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRespiratory (lung resection)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOrthopedic (Knee replacement surgery)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eInformal caregivers\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eN\u0026thinsp;=\u0026thinsp;9\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGender\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMean age (years)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e53\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRange of duration of hospital stay (days)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2\u0026ndash;30\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRegion\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCentral \u0026amp; Tel-Aviv\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNorth\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSouth\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEducation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHigh school/Postsecondary\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUniversity\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEmployment status\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWorking for pay (full or part-time)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRetired\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRelationship with older adult\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eChild\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSpouse\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGrandchild\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIn-law\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eReason for hospital admission\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCardiovascular (Peacemaker, Heart valve replacement, Stroke, Heart failure)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNeurological (Vertigo)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRespiratory (Smoke inhalation from house fire)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOrthopedic (Hip surgery)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eInfectious (liver infection)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVascular (Vascular catheterization in the leg)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eFigure \u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e provides a layout of the main themes and sub-themes discussed in subsequent sections below. Theme 1 focuses on describing the negative and positive experiences highlighted by participants as they navigated hospital-to-home transitions, from hospital care to discharge and post-discharge. Theme 2 describes the challenges participants encountered as they navigated hospital-to-home transitions. Sub-themes explored here are issues of care coordination and person-centered attention, bureaucratic hurdles, and caregiver burden and responsibility. Finally, the third theme describes opportunities identified for optimizing experiences of hospital-to-home care transitions. They include individual autonomy and self-advocacy, involvement in transitional care decision-making, and strengthening collaborations and partnerships between hospital and community.\u003c/p\u003e \u003cdiv id=\"Sec6\" class=\"Section3\"\u003e \u003ch2\u003e1. Navigating hospital-to-home transitions\u003c/h2\u003e \u003cp\u003eOur findings revealed negative and positive experiences of navigating hospital-to-home transitions during care, discharge, and post-discharge. Negative experiences were characterized by feelings of isolation and self-reliance, abrupt discontinuity of care, and lack of ongoing support and guidance. On the other hand, positive experiences were characterized by feelings of reassurance and empowerment, a sense of security due to the presence of a medical team during care, and positive experiences of follow-up care through phone calls and home visits. The older adults and informal caregivers shared diverse perceptions of their care experiences during transitions from hospital to home settings. Some described their transition as smooth and positive during their hospital stay, at discharge, and upon returning home, while for some, experiencing a sudden health crisis and then returning home, where life is expected to resume as normal, can be incredibly distressing.\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e \u003cem\u003e\u0026ldquo;I received intensive neurological care there. The attending physician assumed full responsibility for my case, evidently concerned about preventing further complications. While a hospital provides a sense of security due to the presence of a medical team, it is not a pleasant place to be, and the transition home brings with it a sense of isolation and self-reliance\u0026rdquo;. Older adult\u003c/em\u003e \u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003eThus, medical oversight provided during hospital stays provides a sense of security; however, adjusting to post-discharge life and managing their care independently creates isolation. Another older adult linked the transition to a transactional experience characterized by abrupt farewells and a lack of ongoing guidance or support. Another older adult echoed this sentiment and described feeling frustrated and disheartened by the perceived lack of genuine care and support post-discharge.\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e \u003cem\u003e\u0026ldquo;It felt quite abrupt and impersonal, \u0026lsquo;OK, goodbye...next! My experience was far from simple, transcending a mere physical injury. Upon returning home, I was beset with questions about permissible activities, necessary lifestyle modifications, and overall future conduct. Initially, I found myself consulting various medical professionals on a daily basis, including a cardiologist and an internal medical specialist\u0026rdquo;. Older adult\u003c/em\u003e \u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003eParticipants expressed disappointment with the perceived discontinuity of care once their immediate medical needs were addressed, emphasizing the importance of ongoing support and follow-up beyond the hospital setting.\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e \u003cem\u003e\u0026ldquo;I needed someone to advise me on the right course of action and assess whether I was proceeding correctly\u0026hellip;There lacks a single entity who can oversee and coordinate my ongoing care.\u0026rdquo; Older adult.\u003c/em\u003e \u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003eFurthermore, the discharge process was mainly characterized by receiving a discharge letter from the hospital staff, whereas a more relaxed process of understanding discharge instructions and receiving adequate information would have been more desired.\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e \u003cem\u003e\u0026ldquo;\u0026hellip;At the time of discharge, I received merely a letter instructing me to refer to it for information, which was all the guidance provided.\u0026rdquo; Older adult.\u003c/em\u003e \u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003eConversely, other participants reported feeling reassured and empowered. Detailed written guidelines, medical professionals' contact information, and healthcare home visits were cited as valuable resources that facilitated the transition and reduced the need for additional travel or logistical arrangements.\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e\u003cem\u003e\u0026ldquo;It was reassuring to receive clear guidance and support. Additionally, I was given detailed written guidelines about dietary recommendations, including what foods to consume, what to avoid, and guidelines for healthy and unhealthy eating choices. Furthermore, they provided me with the contact number for the department of the professor who performed the surgery, should I have any questions\u0026rdquo;. Older adult\u003c/em\u003e\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003eOther expressions of positive experiences focused on receiving appropriate support at the appropriate time e.g.,\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e\u003cem\u003e\u0026ldquo;It instilled a feeling of confidence, reassuring us that we were receiving the appropriate support precisely when it was most needed.\u0026rdquo;- Informal caregiver\u003c/em\u003e\u003c/p\u003e\u003cp\u003e\u003cem\u003e\u0026ldquo;With regard to transition, I had very, very good treatment. The doctor came, he explained every single thing, with regard to showers, with regard to exercises, who would be in touch with me, who wouldn't be in touch with me, very, very positive, and he was very, very nice.\u0026rdquo; Older adult\u003c/em\u003e\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003eOverall, the responses highlight the varied experiences and perceptions of older adults and informal caregivers during hospital-to-home transitions, underscoring the need for comprehensive and patient-centered approaches to post-discharge care to ensure the well-being of both patients and caregivers throughout the transition process.\u003c/p\u003e \u003cp\u003e \u003col\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003e \u003cb\u003eChallenges of hospital-to-home transitions.\u003c/b\u003e \u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003c/ol\u003e \u003c/p\u003e \u003cp\u003eChallenges were expressed under three main sub-themes: 1) Care coordination and person-centered attention, 2) bureaucratic hurdles, and 3) caregiver burden and responsibility.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec7\" class=\"Section3\"\u003e \u003ch2\u003ea. Care coordination and person-centered attention\u003c/h2\u003e \u003cp\u003eOlder adults and informal caregivers expressed frustration with the lack of coordination among specialists, leading to confusion regarding medication, treatment plans, and follow-up care.\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e \u003cem\u003e\u0026ldquo;I perceived no significant preparations. I received a discharge letter outlining recommended follow-up actions and necessary tests. These tests require independent scheduling and are often at various locations, which can be challenging. Despite lifelong health insurance contributions, securing timely appointments is difficult. For instance, I received a referral for an additional MRI appointment set for six months from now.\u0026rdquo; Older adult\u003c/em\u003e \u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003eThe absence of personalized attention and support during the discharge process contributes to feelings of anxiety and uncertainty and a sense of being left to fend for themselves. They often felt like they were left to navigate their healthcare journey alone, with little guidance or reassurance from medical professionals. This fragmented approach to healthcare management can exacerbate patients' concerns and diminish their overall satisfaction with the healthcare system. Furthermore, they expressed frustration with the lack of attention to their individual needs and concerns, feeling like they were treated as just another case rather than receiving tailored guidance and assistance. Older adults and informal caregivers reported desiring more attention, communication, and follow-up from healthcare providers to ensure a smoother and more supportive transition back home.\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e \u003cem\u003e\u0026ldquo;It was kind of aggravated for her, for me, all the questions that we had and no answers. It felt like, okay we have plenty of patients here. You are not the only one. That was the feeling we got. On top of that, that she was elder, and it felt like they were giving her very fast answers and not really taking the time to explain and so on. it was it is kind of a bad experience.\u0026rdquo; Informal caregiver\u003c/em\u003e \u003c/p\u003e\u003cp\u003e \u003cem\u003e\u0026ldquo;I felt treated as just another customer in the queue. The greatest challenge arises when you're discharged from the hospital, metaphorically thrown into turbulent waters to fend for yourself, carrying the burden of uncertainty about when a potential health crisis might reoccur - be it in a week, a month, or a year\u0026rdquo; Older adult.\u003c/em\u003e \u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003eParticipant expressed dissatisfaction with the uncertainty surrounding diagnoses, treatment plans, and follow-up care. They highlighted the need for healthcare providers to offer clear explanations, timely answers, and comprehensive support to alleviate anxiety and ensure better patient outcomes. Additionally, they expressed a desire for healthcare professionals to take more responsibility for providing transparent information and guidance to patients and their families.\u003c/p\u003e \u003cp\u003eDifficulties and frustrations experienced specifically during the hospital discharge process were also highlighted. Participants expressed concerns about delays in receiving discharge instructions, difficulties understanding the discharge letter, and a lack of personalized guidance regarding post-discharge care. They emphasized the need for clearer communication from healthcare providers, including detailed explanations of medications and follow-up instructions. Additionally, they stressed the importance of having someone available to address their questions and concerns before leaving the hospital. Delays in the discharge process, uncertainty about post-discharge care, and insufficient preparation contribute to feelings of anxiety and dissatisfaction among patients and caregivers were highlighted.\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e \u003cem\u003e\u0026ldquo;The discharge letter was supposed to contain all necessary information, but no one was available for a detailed discussion or to answer questions.\u0026rdquo; Older adult\u003c/em\u003e \u003c/p\u003e\u003cp\u003e \u003cem\u003e\u0026ldquo;The doctor briefly handed me the letter, offering minimal explanation, approximately four to five words, and advised me to consult my GP for further guidance.\u0026rdquo; Older adult\u003c/em\u003e \u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec8\" class=\"Section3\"\u003e \u003ch2\u003eb. Bureaucratic hurdles\u003c/h2\u003e \u003cp\u003eBureaucratic hurdles in accessing healthcare assistance, especially during and post-discharge were equally a significant challenge. Older adults, especially those with less social support, struggled with navigating bureaucratic processes to access healthcare assistance, particularly when seeking support such as home care or nursing assistance, ,or government aid. Participants expressed frustration with the cumbersome paperwork, lengthy procedures, and lack of streamlined processes, which hinder their ability to obtain the necessary assistance promptly. They emphasize the need to simplify administrative requirements and advocate for dedicated teams or organizations to facilitate access to support services, especially for elderly individuals and those with serious health conditions. Additionally, there's a call for a more efficient assessment of patient's needs to ensure timely assistance and minimize unnecessary delays caused by bureaucratic hurdles.\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e\u003cem\u003e\u0026ldquo;Sometimes there's a lot of bureaucracy. They say, oh, okay, well, it'll take a month. by the time the papers go through, and by the time this and in the meantime, the patient's dying at home and needs her diapers changed, and it is not fair\u0026rdquo;. Older adult\u003c/em\u003e\u003c/p\u003e\u003cp\u003e\u003cem\u003e\u0026ldquo;I would like to manage it together with them but the bureaucracy in Israel is so difficult that you don't always have the strength. And when you are in pain and after surgery, then to deal with it is a job that I would prefer someone do for me; but I would like to make the decisions myself\u0026rdquo;. Older adult\u003c/em\u003e\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec9\" class=\"Section3\"\u003e \u003ch2\u003ec. Caregiver burden and responsibility\u003c/h2\u003e \u003cp\u003eFinally, struggles of family caregiving and the need for external support were equally highlighted by informal caregivers.Informal caregivers play a crucial role in the care and transition of older adults from hospital to home; thus, recognizing and addressing the needs of family caregivers is essential for ensuring their well-being and ability to provide effective support to older adults during the transition process. They emphasized some of the challenges faced by family members in providing care for a seriously ill loved one, particularly in the absence of external support such as home care or nursing assistance, the emotional and physical toll of caring for their sick loved ones, highlighting the burden placed on the entire family, especially when balancing caregiving responsibilities with other commitments like work and family. The importance of accessible and affordable assistance, particularly for elderly caregivers who were physically exhausted by their caregiving responsibilities, whether through home care services or financial support from institutions like National Insurance, to ease the burden on families during difficult times was highlighted.\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e \u003cem\u003e\u0026ldquo;It demands immense responsibility on my part, particularly in the meticulous management of his medication regimen. I am tasked with preparing and overseeing the accurate and timely administration of his medications, as any omission may lead to severe consequences.\u0026rdquo; Informal caregiver\u003c/em\u003e \u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003eInformal caregivers of older adults faced significant challenges during the hospital-to-home transitions of their loved ones. The caregivers described the demanding nature of providing around-the-clock care for their sick family members. The caregiving responsibilities often fell on multiple family members, leading to a constant rotation of caregiving duties.\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e \u003cem\u003e\u0026ldquo;Most of the days we had turns, like, who's gonna sleep with her at home and who's gonna stay with her\u0026hellip; around the clock, we were there\u0026hellip; we didn't have any nurse or a woman that come or anybody that come to take care of her. It was all our responsibility. It was a very hard obligation.\u0026rdquo; Informal caregiver\u003c/em\u003e \u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003eThe emotional toll of caregiving was also evident, with caregivers experiencing stress, anxiety, and emotional distress throughout the transition period.\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e \u003cem\u003e\u0026ldquo;The entire family experienced considerable stress during this period. From the moment I returned home, my wife was constantly by my side, accompanying me to every medical appointment and examination. She remained with me continuously, sharing in the stress and anxiety and eager to understand the unfolding situation.\u0026rdquo; Older adult\u003c/em\u003e \u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003eOverall, the challenges encountered by informal caregivers underscore the need for comprehensive support services to assist caregivers during hospital-to-home transitions and alleviate the burden of caregiving responsibilities on families.\u003c/p\u003e \u003cp\u003e \u003col\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003e \u003cb\u003eOpportunities for optimizing hospital-to-home transitions.\u003c/b\u003e \u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003c/ol\u003e \u003c/p\u003e \u003cp\u003eThis theme highlights opportunities for maximizing transitions. By identifying opportunities for optimization, we seek to contribute to support systems that promote seamless transitions and improve outcomes for older adults and their caregivers during the transition from hospital to home settings. Findings show that individual autonomy and self-advocacy, involvement in collaborative transitional care decision-making, and hospital and community collaboration and partnerships are opportunities that may be leveraged for optimizing hospital-to-home transitions. These sub-themes are discussed in detail below.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec10\" class=\"Section3\"\u003e \u003ch2\u003ea. Individual autonomy and self-advocacy\u003c/h2\u003e \u003cp\u003e Findings from this study show that the desire for individual autonomy and self-advocacy among older adults and family caregivers during hospital-to-home transitions presents an opportunity for optimizing and improving care transition experiences and outcomes. Empowering them to actively engage in decision-making, express preferences, and advocate for their needs may further enable healthcare providers to tailor transition plans to suit their values and preferences better. Our findings show that some older adults and family caregivers expressed a strong sense of independence and self-sufficiency, preferring to manage their care autonomously whenever possible, feelingreluctant to rely on others for assistance, emphasizing a desire to maintain self-reliance even during periods of difficulty.\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e\u003cem\u003e\u0026ldquo;A few years ago, when he had bypass surgery, before his discharge his surgeon told us that he could go to heart rehabilitation. I knew that wasn't for (him) and I asked the doctor what he thought, and he said 'it's subjective, when someone does not have family support they have to go to rehab, no question, but when someone has family to support them, I believe that the best place for a person to heal is in their own home.\u0026rdquo; Informal caregiver\u003c/em\u003e\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003eOur findings also highlighted some participants\u0026rsquo; proactive approach to healthcare, actively seeking information and asking questions to ensure a thorough understanding of their medical needs and treatment plans. This proactive stance enabled some participants to navigate the healthcare system effectively and advocate for themselves during hospitalization and upon discharge. These personality attributes underscore the significance of tailoring transitional care interventions to align with individuals' preferences, attitudes, and behaviors, thereby enhancing their ability to successfully transition from hospital to home while maintaining a sense of autonomy and agency. Additionally, they highlighted the importance of being well-informed about their health condition and treatment, actively engaging with healthcare providers, and asking pertinent questions to ensure clarity and understanding.\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e \u003cem\u003e\u0026ldquo;I always ask questions. I don't bury my head in the sand; I research, I take an interest, and I always ask all the questions. I'm not shy about asking the doctor questions\u0026hellip; I knew to ask the questions because I knew that the doctors usually give a general sort of answer or they let the nurses give you the instructions for what to do when you go home: which pills to take, how many times a day, and when to visit your local health care providers.\u0026rdquo; Informal caregiver\u003c/em\u003e \u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eb. Involvement in collaborative transitional care decision-making\u003c/h2\u003e \u003cp\u003e Our findings show that engaging older adults and families in the decision-making process may allow for a comprehensive understanding of the older adult's needs and preferences, leading to more personalized care plans. This underscores the importance of family involvement, patient preferences, and caregiver support in healthcare transitions, highlighting the need for collaborative decision-making to ensure better outcomes. Our findings illuminate that some participants expressed a desire for active participation in healthcare decisions, particularly regarding treatment options and post-discharge plans. They highlighted the importance of considering individual preferences and needs and the role of family support in decision-making. Some participants described proactive engagement with healthcare providers, advocating for personalized care and treatment adjustments based on their own assessments and experiences,\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e\u003cem\u003e\u0026ldquo;To make the transition easier,\u0026hellip; the loved one the daughter or the granddaughter or whoever, should also, the nurses and doctor should explain to the family because sometimes, as I said before, the patient doesn't always understand. Especially if we are going for older, much older people, they don't understand\u0026hellip; it is important that the family know exactly what's going on. It makes the transition easier\u0026hellip;\u0026rdquo; Older adult\u003c/em\u003e\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003ewhile some others were content relying on the healthcare professionals' judgment.\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e \u003cem\u003e\u0026ldquo;I believe it is best for medical professionals to make these decisions. If they recommend discharge, I trust their judgment. At my age, it is not fitting to challenge their expertise\u0026rdquo;. Older adult\u003c/em\u003e \u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003eOverall, empowering older adults and family caregivers to participate in decision-making processes actively offers a promising avenue for enhancing hospital-to-home transitions of care and improving overall health outcomes. On the flip side, our findings reveal that the desire for active involvement of older adults and their informal caregivers in transitional care decision-making can sometimes be hampered by health conditions, bureaucratic hurdles, and challenges within the healthcare system.\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e \u003cem\u003e\u0026ldquo;If feasible, despite my limitations owing to post-operative pain and physical weakness from the surgery, I would have been eager to contribute. Nonetheless, the immediate post-operative period is challenging due to the effects of substantial pain medication, which weakens the body\u0026rdquo;. Older adult\u003c/em\u003e \u003c/p\u003e\u003cp\u003e \u003cem\u003e\u0026ldquo;I would have been happy for her to have stayed longer, that way I would have been more relaxed. I asked if they didn't need to keep her in and they said there was no reason to keep her, because what they were doing for her there could be done at home.I had no say in the matter\u0026rdquo;. Informal caregiver\u003c/em\u003e \u003c/p\u003e\u003cp\u003e \u003cem\u003e\u0026ldquo;I wanted my father to have a say in that too. Um. he's clear in his mind and, and whatnot, but, you know, after certain major health events, you know, you, you don't always think clear and you're afraid.\u0026rdquo; Informal caregiver\u003c/em\u003e \u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003ec. Strengthening hospital and community collaboration, coordination, and partnerships\u003c/h2\u003e \u003cp\u003eSince hospital-to-home transitions are often complex, involving multiple healthcare providers, caregivers, and community support services, a seamless transition requires effective communication, collaboration, and coordination between these stakeholders. Collaboration between hospitals and community organizations can enhance access to support services for patients transitioning home.\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e \u003cem\u003e\u0026ldquo;I think that for anyone who has been hospitalized for a certain period, the health system has to follow up with them much more through the nurses or require the family doctor to initiate contact with the patient, because often if you don't go afterward to the family doctor and bring him the discharge, letter, they don't even know you were hospitalized.\u0026rdquo; Older adult\u003c/em\u003e \u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003eStrengthening these collaborations allows for more effective follow-up and home care support and highlights proactive measures that can be taken to ensure patient well-being and the role of supportive community frameworks in facilitating a smooth transition to home-based care.\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e \u003cem\u003e\u0026ldquo;The fact that the house was organized and ready for the person coming back from the hospital is something that has a positive impact on the patient. It feels like he's back where he belongs, and that makes him comfortable.\u0026rdquo; Informal caregiver\u003c/em\u003e \u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe present study explores participants\u0026rsquo; experiences navigating hospital-to-home care transitions and also highlights challenges and opportunities for optimizing hospital-to-home care transitions for older adults and their family caregivers in the Israeli context.\u003c/p\u003e \u003cp\u003e For some participants, navigating the transition process felt impersonal and transactional, with inadequate support and guidance post-discharge leading to frustration and disheartenment. In contrast, others felt well-supported and empowered, appreciating clear guidance and access to medical professionals for ongoing assistance. Previous studies can be comparable to our study findings in the sense of experiences navigating hospital-to-home transitions. In the broader context of transitions of care for older adults who require care across different settings, e.g., from hospital to home, home to hospital, hospital to a nursing home, etc., older adults and informal caregivers have similarly reported experiences indicating satisfaction, while others have reported a lack of person-centered care and negative care outcomes (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan additionalcitationids=\"CR32 CR33\" citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e). The varied experiences encountered during hospital-to-home transitions suggest the importance of assessing individual older adult health conditions and family dynamics and providing tailored practical information to address unique situations (\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e Furthermore, our study highlighted challenges and opportunities for optimizing hospital-to-home care transitions for Israeli older adults and informal caregivers. Lack of coordination and person-centered care highlights the need for a context-specific or context-sensitive discharge education program, which would include healthcare providers trained to provide education to older adults in the presence of their family caregivers in a relaxed environment (\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e). Participants in this study wanted to be provided with more tailored and clarifying information regarding diagnosis and post-discharge expectations and instructions similar to reports by (\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e). Similar to our findings regarding caregiving responsibility and burden in care transitions, multiple integral roles played by family caregivers in the hospital-to-home transitions for older adults and their impact on transitional care experiences have equally been highlighted in previous research (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e). Finally, our findings show that some informal caregivers and older adults in this current study desired to be involved in transitional care decision-making, coordinated discharge planning, and self-advocacy, as is similar to findings by (\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eA distinctive aspect of our study is perhaps the emphasis on opportunities within participants\u0026rsquo; experiences. This sets this research apart and enriches our understanding of navigating and optimizing care transitions for older adults and informal caregivers, providing practical recommendations for healthcare practitioners, policymakers, and stakeholders. Similarly, having highlighted the opportunities and challenges, it is important to highlight the different positive and negative experiences navigating care transitions described by the participants A possible explanation could be the seemingly inadequate information of some older adults and informal caregivers who participated in our interviews regarding the availability and accessibility of services, especially post-discharge services for older adults after discharge. Contextually, these differences in experiences may have also risen from various factors such as the quality of communication and coordination between healthcare providers, the adequacy of discharge planning and information provision, and individual preferences and expectations regarding post-discharge care. This highlights the importance of adequately informing and equipping older adults and informal caregivers with knowledge about their health conditions, self-management post-discharge, and available services to enhance their transition from hospital care to community care while also emphasizing the necessity for comprehensive support mechanisms tailored to individual needs to ensure a smooth and positive transition for both patients and caregivers from hospital to home settings.\u003c/p\u003e \u003cp\u003eFinally, Israel's centralized health system offers unique opportunities for older adults and informal caregiver engagement in transitional care decision-making. Drawing from international examples (\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e) and leveraging the centralized nature of the healthcare system, Israel can implement initiatives for involvement in decision-making processes, ultimately enhancing the quality of care transitions and improving patient outcomes. For example, in the UK, initiatives like patient and public involvement forums, patient feedback mechanisms, and shared decision-making programs have been implemented to involve citizens in healthcare decision-making processes (\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e). With a centralized system, there is greater potential for standardization of care protocols, coordination among healthcare providers, and implementation of patient-centered initiatives across the healthcare system. This can facilitate more consistent and cohesive approaches to transitional care, leading to improved quality of transitions for older adults and their families.\u003c/p\u003e \u003cp\u003e \u003cb\u003ePractice and policy implications.\u003c/b\u003e \u003c/p\u003e \u003cp\u003eOur study findings have both practice and policy implications. Enhanced communication and education strategies are needed to provide clear information and support to older adults and informal caregivers throughout the transition process. Person-centered care planning should be prioritized, involving older adults and caregivers in decision-making and tailoring care plans to their individual needs. Strengthening care coordination mechanisms between healthcare settings is essential to ensure seamless transitions, while support services for informal caregivers should be expanded to alleviate caregiver burden. By implementing these recommendations, healthcare systems can enhance the quality of care transitions and promote better outcomes for older adults and their caregivers.\u003c/p\u003e \u003cdiv id=\"Sec14\" class=\"Section2\"\u003e \u003ch2\u003eStrengths and limitations\u003c/h2\u003e \u003cp\u003eOur research explored the perspectives of older adults and informal caregivers regarding hospital-to-home transitions, focusing on their experiences, challenges, and opportunities. Through in-depth one-on-one interviews, participants were afforded the opportunity to candidly express their views without inhibition, allowing for a comprehensive exploration of their struggles and experiences. However, it is important to acknowledge the limitations of this study. While we aimed to recruit a diverse population encompassing various linguistic, cultural, and religious backgrounds in Israel, resource and time constraints limited the extent to which this goal could be realized, thus impacting the generalizability of our findings.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec15\" class=\"Section2\"\u003e \u003ch2\u003eRecommendations for future research\u003c/h2\u003e \u003cp\u003eThe current research has made a number of important findings about the experiences of patients and their families regarding the transition of care. Nonetheless, there are some aspects that future research should focus on. Health policy and system-level research can be conducted to focus on investigating the role of health policy and system-level factors in shaping hospital-to-home transitions for older adults and informal caregivers in Israel. This could include examining policies related to discharge planning, care coordination, and reimbursement for home-based care services, as well as assessing the impact of healthcare system reforms on transition outcomes. Future studies may also explore more deliberative engagement methods, such as citizen panels or citizen juries, to understand how older adults and informal caregivers navigate hospital-to-home transitions. Finally, future research efforts should focus on underrepresented and marginalized groups of older adults and informal caregivers. Research is needed in developing and implementing interventions to support the needs of both older adults and caregivers alike.\u003c/p\u003e \u003c/div\u003e"},{"header":"Conclusion","content":"\u003cp\u003eAddressing the challenges of informal caregiving requires recognizing the vital role of older adults and informal caregivers as having a central role in their care. It involves providing tailored support services and fostering collaboration between healthcare providers, community organizations, and caregivers to ensure the well-being of both older adults and their caregivers throughout the care continuum.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study was approved by the Human Ethics Committee of the Ben-Gurion University of the Negev (ME30032003), and written informed consent was obtained from all participants involved in the study. All methods were performed per the ethical standards laid down in the Declaration of Helsinki and its later amendments.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eDue to ethics restrictions, the datasets generated during the current study cannot be made publicly available. The research data, coding, and materials utilized in this study are available on a secured server to which the primary researcher has exclusive access.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare they have no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThis work was supported by the European Union\u0026rsquo;s Horizon 2020 research and innovation program under the Marie Sklodowska-Curie grant agreement No 812656. The sponsors had no role in the project.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026rsquo; contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors confirm their contribution to the paper as follows: MEE and TvA contributed substantially to the study conception and design. ORK was in charge of acquiring data and preparing the initial draft of the manuscript. ORK performed data analysis, with JPD making substantial contributions to data analysis and the initial manuscript draft. All authors contributed to data interpretation, discussion, and presentation of the results. All authors reviewed and approved the final version of the manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgment\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe appreciate the time commitment of all the older adults and informal caregivers who participate din this research. We also acknowledge MIDGAM marketing research agency for assistance with identifying and recruiting research participants.\u003c/p\u003e\n"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eZhao Y. The Impact of Population Ageing on the Economy. Int J Soc Sci Public Adm [Internet]. 2024;Volume 2,(2):100\u0026ndash;17. 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McMaster Health Forum. 2019 Nov. \u003c/li\u003e\n\u003cli\u003eBraun V, Clarke V. Thematic analysis. APA Handb Res methods Psychol Vol 2 Res Des Quant Qual Neuropsychol Biol. 2012;2:57\u0026ndash;71. \u003c/li\u003e\n\u003cli\u003eBraun V, Clarke V. Using thematic analysis in psychology. Qual Res Psychol [Internet]. 2006 [cited 2024 Apr 22];3(2):77\u0026ndash;101. Available from: https://www.tandfonline.com/action/journalInformation?journalCode=uqrp20\u003c/li\u003e\n\u003cli\u003eCampbell R, Goodman-Williams R, Feeney H, Fehler-Cabral G. Assessing Triangulation Across Methodologies, Methods, and Stakeholder Groups: The Joys, Woes, and Politics of Interpreting Convergent and Divergent Data. Am J Eval. 2020;41(1):125\u0026ndash;44. \u003c/li\u003e\n\u003cli\u003eNowell LS, Norris JM, White DE, Moules NJ. Thematic Analysis: Striving to Meet the Trustworthiness Criteria. Int J Qual Methods. 2017;16(1):1\u0026ndash;13. \u003c/li\u003e\n\u003cli\u003eCastleberry A, Nolen A. 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The experience of transitions in care in very old age: Implications for general practice. Fam Pract. 2019;36(6):778\u0026ndash;84. \u003c/li\u003e\n\u003cli\u003eGroenvynck L, De Boer B, Beaulen A, De Vries E, Hamers JPH, Van Achterberg T, et al. The paradoxes experienced by informal caregivers of people with dementia during the transition from home to a nursing home. Age Ageing [Internet]. 2022 Feb 2 [cited 2024 Apr 23];51(2):1\u0026ndash;9. Available from: https://dx.doi.org/10.1093/ageing/afab241\u003c/li\u003e\n\u003cli\u003eHestevik CH, Molin M, Debesay J, Bergland A, Bye A. Older persons\u0026rsquo; experiences of adapting to daily life at home after hospital discharge: A qualitative metasummary. BMC Health Serv Res. 2019;19(1):1\u0026ndash;13. \u003c/li\u003e\n\u003cli\u003eDimech N, Cassar M, Carabott J. Hospital Discharge Process: Context-Sensitive Care. Creat Nurs. 2024; \u003c/li\u003e\n\u003cli\u003eHladkowicz E, Auais M, Kidd G, McIsaac DI, Miller J. \u0026ldquo;I can\u0026rsquo;t imagine having to do it on your own\u0026rdquo;: a qualitative study on postoperative transitions in care from the perspectives of older adults with frailty. BMC Geriatr [Internet]. 2023;23(1):1\u0026ndash;12. Available from: https://doi.org/10.1186/s12877-023-04576-9\u003c/li\u003e\n\u003cli\u003eAllen J, Woolford M, Livingston PM, Lobchuk M, Muldowney A, Hutchinson AM. Informal carer support needs, facilitators and barriers in transitional care for older adults from hospital to home: A scoping review. J Clin Nurs. 2023;32(19\u0026ndash;20):6773\u0026ndash;95. \u003c/li\u003e\n\u003cli\u003eNHS. NHS Long Term Plan [Internet]. Vol. 12, Department of Health and Social Care (UK). 2019 [cited 2024 Apr 15]. p. 10\u0026ndash;1. Available from: https://www.longtermplan.nhs.uk/wp-content/uploads/2019/08/nhs-long-term-plan-version-1.2.pdf\u003c/li\u003e\n\u003cli\u003eL\u0026eacute;gar\u0026eacute; F, Boivin A, Van Der Weijden T, Pakenham C, Burgers J, L\u0026eacute;gar\u0026eacute; J, et al. Patient and public involvement in clinical practice guidelines: A knowledge synthesis of existing programs. Med Decis Mak. 2011;31(6). \u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Older adults, care transitions, hospital-to-home transitions, informal caregivers, post-discharge journey, challenges, opportunities, Israel","lastPublishedDoi":"10.21203/rs.3.rs-4354721/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4354721/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eTransitioning from hospital to home is not just a process but a crucial aspect of healthcare delivery, particularly for older adults and their informal caregivers. This transition from the structured environment of the hospital to the more independent home setting presents various challenges and opportunities that significantly impact the post-discharge journey and remains a critical and vulnerable phase for patients, especially those with complex medical needs or limited support systems. With a rapidly aging population, diverse cultural demographics, and a centralized healthcare system, Israel provides a multifaceted context to explore the intricacies of this transition process. This paper explores the experiences of older adults and informal caregivers navigating hospital-to-home care transitions in Israel and the challenges and opportunities in optimizing care transitions.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eConducted within the European TRANS-SENIOR consortium, we conducted a qualitative descriptive study using one-to-one interviews with Israeli older adults and informal caregivers. who experienced hospital-to-home transitions within the past 12 months. Interview questions explored negative and positive experiences navigating hospital-to-home transitions and challenges and opportunities for optimizing care transitions. Thematic analysis was used.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eSeven older adults and nine informal caregivers participated in interviews, revealing diverse perceptions of hospital-to-home transitions. The experiences of hospital-to-home transitions varied, with negative experiences characterized by abrupt farewells and a perceived lack of ongoing support, while positive experiences involved reassurance, empowerment, and follow-up care. Challenges included fragmented healthcare management and a lack of person-centered care, particularly for older adults without family support or facing critical conditions, Additional issues included bureaucratic hurdles, language barriers, and communication deficiencies. Opportunities for improvement in Israel's care transition system for older adults and informal caregivers include promoting individual autonomy, involvement in decision-making, and enhancing collaboration between hospitals and communities.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eChallenges across the care continuum highlighted the need for targeted interventions to address communication, person-centered care, and continuity of care. Policymakers can use this information to develop and implement strategies to improve the transition process, ultimately leading to better patient outcomes and experiences.\u003c/p\u003e","manuscriptTitle":"Navigating Hospital To Home Transitions: Exploring Israeli Older Adult And Informal Caregiver Experiences, Challenges And Opportunities.","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-06-10 18:33:40","doi":"10.21203/rs.3.rs-4354721/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"7234c44a-ce1b-427c-add4-064aa2e64d14","owner":[],"postedDate":"June 10th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2024-06-16T16:12:05+00:00","versionOfRecord":[],"versionCreatedAt":"2024-06-10 18:33:40","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-4354721","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4354721","identity":"rs-4354721","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}