Factors that contribute to the diversion of patients from long-term care.

This service evaluation aimed to identify the factors at an interim care unit that contributed to the diversion of patients from long-term care to care at home. A triangulated, mixed methods approach was adopted. Data were collated from an analysis of individual patient case notes; interviews with patients, carers and relatives; and workshops with unit staff. Distinctive and overlapping core themes emerged from the data. Patients and relatives cited having extra time in the unit to adjust, with staff encouragement and persistence to tackle their main problems, in addition to achieving seamless care at home and the ability to envisage a life after hospital. The staff workshops revealed attitudes that supported patient empowerment, shared decision making and patient-centred solutions. The successful diversion of patients from long-term care is multifaceted and dynamic. It is clear that a decision to pursue a different end-point destination has to occur, with patients' and relatives' consent; that is, to avoid transfer from acute care to long-term care. The optimism and self-belief created by this decision drive staff and patients towards the same goal: improved patient outcomes and, for some, eventual diversion from long-term care.