“There doesn't seem to be the help there for people who are carers”: Qualitative findings from a realist evaluation of hospital-to-home transitions

Background and Objectives: Unpaid carers play a significant role in supporting older adults with multiple long-term conditions including dementia (MLTCiD), during complex hospital-to-home transitions. However, their needs are often overlooked during hospital discharge, highlighting a gap in how meaningful support can be provided. This study explored how, for whom, and under which circumstances these transitions work (or not) for carers. Research Design and Methods Fifteen semi-structured interviews were conducted with carers as part of a realist evaluation. Interviews were coded to identify patterns of contexts and outcomes, explained through causal mechanisms, and used to refine an explanatory framework capturing what works, for whom, and under which circumstances in promoting safer transitions. Results Three interdependent themes that shaped carer experiences were identified: Managing information, Carer well-being, and Engagement with support. Fragmented or inaccessible information increased carers’ uncertainty, reduced engagement, and negatively influenced well-being. Many carers felt overwhelmed by excessive or conflicting information and reported barriers to accessing reliable guidance, such as limited trustworthy sources and low digital literacy. Carers valued a single point of contact to coordinate information and provide relational support, but implementation of this role was rare. Discussion and Implications: Care during hospital-to-home transitions remains fragmented, with limited support for carers. Although digital solutions have the potential to improve efficiency and safety, current systems overlook carers’ roles, capacity, and needs. Involving carers in service design, improving communication, and providing personalised guidance could strengthen safety in transitional care.