title: The indispensable intermediaries: a qualitative study of informal caregivers' struggle to achieve influence at and after hospital discharge.
abstract: BACKGROUND
  The care policy and organization of the care sector is shifting to accommodate projected demographic changes and to ensure a sustainable model of health care provision in the future. Adult children and spouses are often the first to assume care giving responsibilities for older adults when declining function results in increased care needs. By introducing policies tailored to enabling family members to combine gainful employment with providing care for older relatives, the sustainability of the future care for older individuals in Norway is more explicitly placed on the family and informal caregivers than previously. Care recipients and informal caregivers are expected to take an active consumer role and participate in the care decision-making process. This paper aims to describe the informal caregivers' experiences of influencing decision-making at and after hospital discharge for home-bound older relatives.
  
  
  METHODS
  This paper reports findings from a follow-up study with an exploratory qualitative design. Qualitative telephone interviews were conducted with 19 informal caregivers of older individuals discharged from hospital in Norway. An inductive thematic content analysis was undertaken.
  
  
  RESULTS
  Informal caregivers take on comprehensive all-consuming roles as intermediaries between the care recipient and the health care services. In essence, the informal caregivers take the role of the active participant on behalf of their older relative. They describe extensive efforts struggling to establish dialogues with the "gatekeepers" of the health care services. Achieving the goal of the best possible care for the care recipient seem to depend on the informal caregivers having the resources to choose appropriate strategies for gaining influence over decisions.
  
  
  CONCLUSIONS
  The care recipients' extensive frailty and increasing dependence on their families coupled with the complexity of health care services contribute to the perception of the informal caregivers' indispensable role as intermediaries. These findings accentuate the need to further discuss how frail older individuals and their informal caregivers can be supported and enabled to participate in decision-making regarding care arrangements that meet the care recipient's needs.
authors: Department of Nursing Science, Institute of Health and Society, University of Oslo, P,O, Box 1130, Blindern, NO-0318 Oslo, Norway. l.k.bragstad@medisin.uio.no.
authors: Line Kildal
authors: LK
authors: Bragstad
authors: Marit
authors: M
authors: Kirkevold
authors: Christina
authors: C
authors: Foss
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017028:Caregivers / Q000523:psychology*; D003657:Decision Making; D005260:Female; D005500:Follow-Up Studies; D006701:Home Nursing; D006801:Humans; D008297:Male; D008875:Middle Aged; D009664:Norway; D010351:Patient Discharge; D036301:Qualitative Research; D012380:Role; D012944:Social Support