{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,9]],"date-time":"2026-09-09T01:55:44Z","timestamp":1788918944902,"version":"build-2803163510"},"reference-count":46,"publisher":"Public Library of Science (PLoS)","issue":"11","license":[{"start":{"date-parts":[[2024,11,8]],"date-time":"2024-11-08T00:00:00Z","timestamp":1731024000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Barbara and Richard Csomay Gerontology Research Award at the University of Iowa College of Nursing"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:p>Unpaid\/family caregivers provide support critical to older adult hospital-to-home transitions, but lack time and preparation. There is limited evidence regarding important collaboration for caregivers during the transition. The objective was to examine caregivers\u2019 process of collaborating with others, including other family members, healthcare professionals, and community, social, and professional networks, during older adult hospital-to-home transitions. This study utilized grounded theory methodology. One-on-one interviews were conducted with unpaid\/family caregivers of an older adult during a hospital-to-home transition. Data were analyzed using open, axial, and selective coding. Participants (N = 16) relationship to the older adult included: partners (n = 8), friends (n = 4), children (n = 3), and siblings (n = 1). Most were female (n = 14) and living with the older adult (n = 10). A conceptual model was developed which illustrates participants\u2019 process through 3 stages: 1) identifying and learning the caregiver role, 2) collaborating with others to provide care and support to the older adult, while supporting themselves, during the hospital-to-home transition, and 3) supporting the older adult\u2019s progress in recovering independence or planning to provide long-term care and support. Participants described multiple approaches to collaborating with others: caring on own, caring in network, caring with healthcare professionals, and caring with social and professional networks. Implications include the need to recognize and promote utilization of care networks, as it may help address negative outcomes associated with caregiving. We also identified opportunities to further leverage caregivers\u2019 social\/professional networks and increase focus on caregiver needs in healthcare encounters.<\/jats:p>","DOI":"10.1371\/journal.pone.0310204","type":"journal-article","created":{"date-parts":[[2024,11,8]],"date-time":"2024-11-08T18:31:07Z","timestamp":1731090667000},"page":"e0310204","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":2,"title":["Unpaid caregivers\u2019 process of collaborating with others during older adult hospital-to-home transitions: A grounded theory study"],"prefix":"10.1371","volume":"19","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2384-7410","authenticated-orcid":true,"given":"Daniel J.","family":"Liebzeit","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Saida","family":"Jaboob","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Samantha","family":"Bjornson","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Olivia","family":"Geiger","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Harleah","family":"Buck","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sato","family":"Ashida","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicole E.","family":"Werner","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2024,11,8]]},"reference":[{"issue":"4","key":"pone.0310204.ref001","first-page":"704","article-title":"Getting Back to Normal: A Grounded Theory Study of Function in Post-hospitalized Older Adults.","volume":"60","author":"D Liebzeit","year":"2020","journal-title":"The Gerontologist."},{"issue":"4","key":"pone.0310204.ref002","doi-asserted-by":"crossref","first-page":"549","DOI":"10.1046\/j.1532-5415.2003.51185.x","article-title":"Falling Through the Cracks: Challenges and Opportunities for Improving Transitional Care for Persons with Continuous Complex Care Needs.","volume":"51","author":"EA Coleman","year":"2003","journal-title":"J Am Geriatr Soc."},{"key":"pone.0310204.ref003","doi-asserted-by":"crossref","first-page":"218","DOI":"10.1016\/j.gerinurse.2023.08.010","article-title":"A scoping review of unpaid caregivers\u2019 experiences during older adults\u2019 hospital-to-home transitions.","volume":"53","author":"D Liebzeit","year":"2023","journal-title":"Geriatr Nur (Lond)."},{"issue":"Suppl 1","key":"pone.0310204.ref004","doi-asserted-by":"crossref","first-page":"S747","DOI":"10.1093\/geroni\/igz038.2740","article-title":"Home alone revisited: Family caregivers providing complex care","volume":"3","author":"S. Reinhard","year":"2019","journal-title":"Innov Aging"},{"key":"pone.0310204.ref005","doi-asserted-by":"crossref","first-page":"103070","DOI":"10.1016\/j.apergo.2020.103070","article-title":"Conceptualizing caregiving activities for persons with dementia (PwD) through a patient work lens.","volume":"85","author":"S Ponnala","year":"2020","journal-title":"Appl Ergon"},{"issue":"7","key":"pone.0310204.ref006","doi-asserted-by":"crossref","first-page":"1563","DOI":"10.1093\/geronb\/gbz065","article-title":"Change over time in caregiving networks for older adults with and without dementia","volume":"75","author":"BC Spillman","year":"2020","journal-title":"J Gerontol Ser B"},{"issue":"1","key":"pone.0310204.ref007","doi-asserted-by":"crossref","first-page":"26","DOI":"10.1093\/geront\/30.1.26","article-title":"A critique of the caregiving literature.","volume":"30","author":"BM Barer","year":"1990","journal-title":"The Gerontologist"},{"issue":"6","key":"pone.0310204.ref008","doi-asserted-by":"crossref","first-page":"695","DOI":"10.1093\/geront\/39.6.695","article-title":"Caregiving networks of elderly persons: Variation by marital status.","volume":"39","author":"AE Barrett","year":"1999","journal-title":"The Gerontologist."},{"issue":"5","key":"pone.0310204.ref009","first-page":"216","article-title":"Caregiving in the post-hospitalization period: findings from a national survey.","volume":"20","author":"C DesRoches","year":"2002","journal-title":"Nurs Econ."},{"issue":"4","key":"pone.0310204.ref010","doi-asserted-by":"crossref","first-page":"792","DOI":"10.1111\/scs.12019","article-title":"The needs of informal caregivers of elderly people living at home: an integrative review.","volume":"27","author":"AL Silva","year":"2013","journal-title":"Scand J Caring Sci"},{"issue":"3","key":"pone.0310204.ref011","doi-asserted-by":"crossref","first-page":"128","DOI":"10.1016\/S0897-1897(99)80034-2","article-title":"Mutuality and preparedness of family caregivers for elderly women after bypass surgery","volume":"12","author":"MF Kneeshaw","year":"1999","journal-title":"Appl Nurs Res. 1999\/08\/24 ed"},{"key":"pone.0310204.ref012","doi-asserted-by":"crossref","first-page":"688","DOI":"10.2307\/353570","article-title":"Caregiver burden from a social exchange perspective: Caring for older people after hospital discharge.","author":"KT Call","year":"1999","journal-title":"J Marriage Fam."},{"issue":"9","key":"pone.0310204.ref013","doi-asserted-by":"crossref","first-page":"1005","DOI":"10.1023\/A:1016693825758","article-title":"Discharge planning quality from the carer perspective.","volume":"9","author":"KA Grimmer","year":"2000","journal-title":"Qual Life Res. 2001\/05\/03 ed."},{"issue":"1","key":"pone.0310204.ref014","doi-asserted-by":"crossref","first-page":"39","DOI":"10.2105\/AJPH.80.1.39","article-title":"Post-hospital support program for the frail elderly and their caregivers: a quasi-experimental evaluation.","volume":"80","author":"JS Oktay","year":"1990","journal-title":"Am J Public Health. 1990\/01\/01 ed."},{"key":"pone.0310204.ref015","doi-asserted-by":"crossref","first-page":"617","DOI":"10.2147\/PPA.S201054","article-title":"Engaging patients and informal caregivers to improve safety and facilitate person-and family-centered care during transitions from hospital to home\u2013A qualitative descriptive study.","volume":"13","author":"C Backman","year":"2019","journal-title":"Patient Preference and Adherence"},{"key":"pone.0310204.ref016","doi-asserted-by":"crossref","first-page":"331","DOI":"10.1186\/1472-6963-14-331","article-title":"The indispensable intermediaries: a qualitative study of informal caregivers\u2019 struggle to achieve influence at and after hospital discharge. 2014\/08\/01 ed.","volume":"14","author":"LK Bragstad","year":"2014","journal-title":"BMC Health Serv Res"},{"key":"pone.0310204.ref017","doi-asserted-by":"crossref","first-page":"174","DOI":"10.3928\/19404921-20190319-01","article-title":"Caregivers\u2019 Perceptions Managing Functional Needs Among Older Adults Receiving Post-Acute Home Health Care.","volume":"12","author":"JAD Chase","year":"2019","journal-title":"Research in Gerontological Nursing."},{"key":"pone.0310204.ref018","doi-asserted-by":"crossref","first-page":"1786","DOI":"10.1177\/0733464820961259","article-title":"\u201cDoing the Right Thing\u201d: Family Caregivers Managing Medical and Nursing Tasks in the Postacute Home Health Care Setting.","volume":"40","author":"JAD Chase","year":"2021","journal-title":"Journal of Applied Gerontology"},{"key":"pone.0310204.ref019","doi-asserted-by":"crossref","DOI":"10.1891\/RTNP-D-20-00067","article-title":"A Qualitative Study of Older Patients\u2019 and Family Caregivers\u2019 Perspectives of Transitional Care From Hospital to Home.","author":"\u0130 Dolu","year":"2021","journal-title":"Res Theory Nurs Pr. 2021\/03\/07 ed"},{"issue":"2","key":"pone.0310204.ref020","doi-asserted-by":"crossref","first-page":"129","DOI":"10.1093\/hsw\/hlw009","article-title":"Care Transition Experiences of Older Veterans and Their Caregivers.","volume":"41","author":"BK Ford","year":"2016","journal-title":"Health Soc Work. 2016\/06\/07 ed"},{"key":"pone.0310204.ref021","doi-asserted-by":"crossref","first-page":"619","DOI":"10.1046\/j.1365-2648.2000.01519.x","article-title":"Needs of family caregivers of frail elders during the transition from hospital to home: a Taiwanese sample.","volume":"32","author":"YIL Shyu","year":"2000","journal-title":"Journal of Advanced Nursing"},{"issue":"4","key":"pone.0310204.ref022","first-page":"13p","article-title":"Becoming a carer for an elderly person after discharge from an acute hospital admission","volume":"2","author":"K Grimmer","year":"2004","journal-title":"Internet J Allied Health Sci Pract"},{"issue":"3","key":"pone.0310204.ref023","doi-asserted-by":"crossref","first-page":"277","DOI":"10.1111\/j.1369-7625.2011.00714.x","article-title":"Seamless care? Just a list would have helpedOlder people and their carer\u2019s experiences of support with medication on discharge home from hospital.","volume":"16","author":"DA Knight","year":"2013","journal-title":"Health Expect. 2011\/08\/16 ed."},{"key":"pone.0310204.ref024","doi-asserted-by":"crossref","first-page":"90","DOI":"10.1017\/S0714980814000518","article-title":"Experiences of older adults in transition from hospital to community. 2014\/12\/31 ed.","volume":"34","author":"E Neiterman","year":"2015","journal-title":"Can J Aging"},{"issue":"6","key":"pone.0310204.ref025","doi-asserted-by":"crossref","first-page":"2807","DOI":"10.1111\/jan.14828","article-title":"The course of readmission in frail older cardiac patients.","volume":"77","author":"CJ Rijpkema","year":"2021","journal-title":"J Adv Nurs. 2021\/03\/20 ed."},{"key":"pone.0310204.ref026","doi-asserted-by":"crossref","first-page":"e20200474","DOI":"10.1590\/0034-7167-2020-0474","article-title":"Management of home care by family caregivers to elderly after hospital discharge. 2020\/12\/10 ed.","author":"RAE Silva","year":"2020","journal-title":"73, Rev Bras Enferm."},{"key":"pone.0310204.ref027","doi-asserted-by":"crossref","first-page":"220","DOI":"10.1186\/s12913-019-4042-0","article-title":"Caregivers\u2019 experiences of a home support program after the hospital discharge of an older family member: a qualitative analysis. 2019\/04\/12 ed","volume":"19","author":"S Slatyer","year":"2019","journal-title":"BMC Health Serv Res"},{"key":"pone.0310204.ref028","article-title":"Older Adults\u2019 Process of Collaborating with a Support Team during Transitions from Hospital to Home: A Grounded Theory Study.","volume":"gnad096","author":"D Liebzeit","year":"2023","journal-title":"The Gerontologist."},{"issue":"10","key":"pone.0310204.ref029","doi-asserted-by":"crossref","first-page":"1497","DOI":"10.1007\/s11606-015-3359-6","article-title":"A Look at Person-Centered and Family-Centered Care Among Older Adults: Results from a National Survey.","volume":"30","author":"JL Wolff","year":"2015","journal-title":"J Gen Intern Med"},{"key":"pone.0310204.ref030","volume-title":"Symbolic interactionism: Perspective and method","author":"H. Blumer","year":"1986"},{"key":"pone.0310204.ref031","article-title":"Symbolic interactionism: An introduction, an interpretation, an integration","author":"JM Charon","year":"2009","journal-title":"Pearson College Division;"},{"key":"pone.0310204.ref032","volume-title":"Constructing grounded theory.","author":"K. Charmaz","year":"2014"},{"key":"pone.0310204.ref033","article-title":"Basics of qualitative research: Grounded theory procedures and techniques.","volume":"41","author":"J Corbin","year":"1990","journal-title":"Basics Qual Res Grounded Theory Proced Tech."},{"key":"pone.0310204.ref034","volume-title":"Qualitative research in nursing: Advancing the humanistic imperative","author":"HS Speziale","year":"2011"},{"key":"pone.0310204.ref035","doi-asserted-by":"crossref","DOI":"10.1017\/CBO9780511557842","volume-title":"Qualitative analysis for social scientists","author":"A. Strauss","year":"1987"},{"key":"pone.0310204.ref036","article-title":"Basics of qualitative research: Procedures and techniques for developing grounded theory.","author":"A Strauss","year":"1998"},{"issue":"3","key":"pone.0310204.ref037","doi-asserted-by":"crossref","first-page":"312","DOI":"10.1177\/104973239600600302","article-title":"Dimensional analysis: Broadening the conception of grounded theory.","volume":"6","author":"S Kools","year":"1996","journal-title":"Qual Health Res"},{"key":"pone.0310204.ref038","doi-asserted-by":"crossref","first-page":"103971","DOI":"10.1016\/j.archger.2019.103971","article-title":"Challenges and needs of informal caregivers in elderly care: Qualitative research in four European countries, the TRACE project.","volume":"87","author":"E Akgun-Citak","year":"2020","journal-title":"Arch Gerontol Geriatr"},{"key":"pone.0310204.ref039","unstructured":"AARP [Internet]. 2019 [cited 2023 Oct 22]. New State Law to Help Family Caregivers. Available from: https:\/\/www.aarp.org\/politics-society\/advocacy\/caregiving-advocacy\/info-2014\/aarp-creates-model-state-bill.html"},{"issue":"1","key":"pone.0310204.ref040","doi-asserted-by":"crossref","first-page":"40","DOI":"10.1002\/adsp.12068","article-title":"Care for caregivers: Understanding the need for caregiver support.","volume":"18","author":"M Kepic","year":"2019","journal-title":"Adultspan J."},{"key":"pone.0310204.ref041","first-page":"07334648231218091","article-title":"Critical Elements of Care Coordination for Older Persons in Rural Communities: An Evaluation of the Iowa Return to Community Service Demonstration.","author":"B Kaskie","year":"2023","journal-title":"J Appl Gerontol."},{"key":"pone.0310204.ref042","doi-asserted-by":"crossref","first-page":"e022747","DOI":"10.1136\/bmjopen-2018-022747","article-title":"Hospital postdischarge intervention trialled with family caregivers of older people in Western Australia: potential translation into practice. 2018\/11\/11 ed","volume":"8","author":"SM Aoun","year":"2018","journal-title":"BMJ Open"},{"key":"pone.0310204.ref043","doi-asserted-by":"crossref","first-page":"210","DOI":"10.1017\/S071498081800051X","article-title":"Pilot Study of a Transitional Intervention for Family Caregivers of Older Adults.","volume":"38","author":"J McCusker","year":"2019","journal-title":"Canadian Journal on Aging"},{"key":"pone.0310204.ref044","doi-asserted-by":"crossref","first-page":"32","DOI":"10.1016\/j.ijnurstu.2016.09.012","article-title":"Outcomes for family carers of a nurse-delivered hospital discharge intervention for older people (the Further Enabling Care at Home Program): Single blind randomised controlled trial. 2016\/09\/30 ed","volume":"64","author":"C Toye","year":"2016","journal-title":"Int J Nurs Stud"},{"key":"pone.0310204.ref045","doi-asserted-by":"crossref","first-page":"S83","DOI":"10.1097\/01.FCH.0000342843.28477.72","article-title":"Engaging communities in evidence-based interventions for dementia caregivers.","author":"AB Stevens","year":"2009","journal-title":"Fam Community Health."},{"issue":"Supplement_1","key":"pone.0310204.ref046","doi-asserted-by":"crossref","first-page":"S14","DOI":"10.1093\/geront\/gnz148","article-title":"Social Determinants of Health: Underreported Heterogeneity in Systematic Reviews of Caregiver Interventions.","volume":"60","author":"HM Young","year":"2020","journal-title":"The Gerontologist."}],"container-title":["PLOS ONE"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0310204","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,11,8]],"date-time":"2024-11-08T18:31:24Z","timestamp":1731090684000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0310204"}},"subtitle":[],"editor":[{"given":"Moustaq Karim Khan","family":"Rony","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2024,11,8]]},"references-count":46,"journal-issue":{"issue":"11","published-online":{"date-parts":[[2024,11,8]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0310204","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,11,8]]}}}