Themes of Incongruence in the Relationships between Care Partners and Care Recipients During Discharge from Hospital to Home.

BACKGROUND AND OBJECTIVES: Hospital-to-home transitions constitute vulnerable periods during which health systems increasingly rely on unpaid care partners to help care recipients execute discharge plans. We examine how mutuality and incongruence within care partner-care recipient dyads may shape discharge preparedness and dyadic self-efficacy during care transitions. RESEARCH DESIGN AND METHODS: We conducted a secondary qualitative analysis of PROJECT ACHIEVE focus groups and key informant interviews with 248 participants (138 care recipients, 110 care partners) across six U.S. health systems, examining their experiences of hospital-to-home transitions. A multidisciplinary team conducted thematic analysis and compared themes across stakeholder groups, guided by Social Cognitive Theory and Interdependence Theory. RESULTS: Care recipients and care partners shared goals but often differed in their appraisals of discharge readiness and post-discharge roles. Three domains of incongruence emerged: (1) preparedness for transitions home, as care recipients prioritized going home despite ongoing symptoms while care partners worried about premature discharge and inadequate training; (2) burdensomeness and struggle for independence, as care recipients desired to preserve autonomy while care partners absorbed the emotional and practical strain of supporting such desires; and (3) role changes and evolving relational identities, as spouses and adult children assumed caregiving roles that disrupted prior identities in the relationship. Lower mutuality was linked to reduced dyadic self-efficacy and, consequently, increased risk of readmission. DISCUSSION AND IMPLICATIONS: Findings highlight dyadic incongruence as a target for intervention in care transitions. Care strategies that assess care recipient-care partner mutuality may enhance dyadic self-efficacy and improve post-discharge outcomes.