Table 3.

Involvement work across time and location

Time	Admission early hospital stay	Hospital stay predischarge and discharge period	Postdischarge
Location	Hospital	Hospital	Home or intermediate care (IC)
Involvement work	Outsourcing	Variable: Delegating; desire to contribute to decision‐making; outsourcing; desire to resume autonomy with activities of daily living (ADLs)	Variable: Desire to/resuming autonomy; outsourcing to social care; delegating
Summary	Patients often relinquished control of their treatment and care to healthcare professionals (HCPs) at admission. Patients viewed themselves as ‘non‐experts’ and HCPs as experts. This was the case even when patients were used to doing these activities for themselves at home	Some people wanted to resume normal daily activities as they started to feel better, though opportunities were often limited. Others, however, were happy to continue being cared for by staff and continued to outsource responsibility, even when encouraged to start resuming some autonomy	Desired and actual involvement work varied postdischarge. Some patients resumed autonomy with few problems; others struggled to readjust to independent living. Sometimes, this was because they still felt unwell. Others, however, had adapted to institutional living, had become deconditioned, and were unable to manage at home. This was often a surprise to patients and relatives, despite a hospital stay where most ADLs had been managed for them and sedentary behaviour was common.
	Early in admission, outsourcing decisions and care‐related activities were often done because patients were not able, or did not want, to do these for themselves. Some expressed relief that staff were undertaking activities for them, experiencing their hospital stay as respite	As discharge planning continued, many patients became more interested in being involved in decision‐making; being able to decide place of residence was a concern across the sample. Some patients felt able to contribute to discussions themselves. However, many patients preferred to delegate their involvement to relatives.	Sometimes resuming involvement work was made more difficult by inadequate information, especially when prescriptions had changed, and patients were unaware of this. This caused confusion and unintentional noncompliance
			Patients were more likely to continue entrusting care‐related activities to others when they were in IC settings (outsourcing); had packages of care (outsourcing); or family involvement (delegating). Regardless of setting, almost all participants were happy to continue to outsource medical decisions, especially those who had good relationships with their GP
Participant examples/quotes	‘That's a medical decision, isn't it? I have nothing to do with it… I don't know zilch’, (Leslie, 84; acute medical unit for older people [AMUfOP])	Pearl (91) did not speak during care planning meetings with her social worker. Instead, Pearl outlined her wishes to her daughters for them to discuss on her behalf. Pearl felt that her daughters were more effective in these meetings than she could be—this was due to hearing loss and a lack of confidence in her own ability to navigate a complex system.	Leslie (84) did little for himself in hospital, but once back at home he recommenced cooking for himself, managing his medicines, and tracking and chasing up appointments
	‘I know the kids are worried because I'm in hospital… but I'm having a bit of a rest’. (Pearl, 91; AMUfOP)		‘[We thought] it would all fall into place once she got here [home], but that's not the case, she's refusing to walk, she's fallen twice so far because she can't get in or out of her bed, she's struggling. She was ringing for a cup of tea’. (Lillian's niece ‐ Lillian, 80)
			‘I mean, I don't want a miracle, I just want them [the doctors] to explain it to me and then I can sort things, you know. Because I mean now, before, how many tablets? Now I'm taking about six I think, I was taking three before then’. (Katherine, 83)