Hospital-to-home care transition for dementia patients and family caregivers : discharge planning and decision-making experience of family caregivers

Hospital-to-home transitions for persons living with dementia (PLWD) are critical periods that often expose family caregivers (FCGs) to significant decisional, informational, and emotional challenges. This dissertation explored the discharge planning and decision-making experiences of culturally diverse caregivers using longitudinal qualitative data analyzed across two time points. Guided by the Ottawa Decision Support Framework (ODSF), the study examined FCGs’ perceptions of the discharge process, the types and levels of decisions they were engaged in, their support needs, and the clarity they held regarding decision choices available to them. A qualitative descriptive method using a content analysis approach was applied to 30 interviews with FCGs of PLWD, with themes and subthemes mapped to the research aims. Findings revealed that FCGs entered discharge planning with varied expectations, often shaped by cultural values and prior healthcare encounters. While some reported satisfaction with clear communication and early involvement, many described fragmented processes, inconsistent initiation of discharge discussions, and limited preparedness. FCGs were frequently tasked with weighing complex decision options such as home care, rehabilitation, or hospice, without adequate information or structured support. Across time, some FCGs developed greater confidence and clarity, while others faced increasing decisional conflict as PLWD health declined and care needs intensified. The study highlights the central role of nurses and interdisciplinary teams in identifying caregiver decisional needs and providing timely, culturally responsive support. Policies that embed caregiver engagement into discharge standards, alongside interventions such as decision aids, interpreter services, and palliative consults, may reduce disparities and improve care alignment with PLWD values. Despite limitations associated with secondary qualitative analysis and small sample size, the dissertation makes an important contribution by amplifying caregiver voices and documenting how decision-making evolves across the trajectory of dementia care transitions. These findings provide direction for future research, policy, and practice to strengthen caregiver preparedness, reduce readmissions, and promote value-concordant care at home.

Name thesis:degree_name

Doctor of Philosophy

Discipline thesis:degree_discipline

Nursing

Grantor

The University of Texas at Austin

Year dc:date.issued

2025

Author dc:creator

• Oppong, Kwaku Duah

Advisor dc:contributor.advisor

• Kwak, Jung, Ph. D.

Committee members dc:contributor.committeemember

• Garcia, Alexandra A.
• Carolyn Phillips
• Elizabeth, Kvale

• Hospital-to-home care transition
• Decision-making experience
• Persons living with dementia
• Family caregivers
• Discharge planning

Language dc:language.iso

English

Identifier URI

https://doi.org/10.26153/tsw/63272

OAI identifier oai:identifier

oai:repositories.lib.utexas.edu:2152/135961