Factors Influencing the Implementation of Unaccompanied Care for Older Inpatients in Chinese Tertiary Hospitals: A Qualitative Study

Yaping He,1,* Ruilian Li,1,* Taofang Jiao,1 Chunyu Liu,1 Ying Chen,1 Li Li2 1School of Nursing, Southwest Medical University, Luzhou, Sichuan, 646000, People’s Republic of China; 2Department of Nursing, the Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, 646000, People’s Republic of China*These authors contributed equally to this workCorrespondence: Li Li, Department of Nursing, the Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, 646000, People’s Republic of China, Email [email protected]: In China, tertiary hospitals are piloting an “unaccompanied care” model in which trained care attendants, instead of constantly present family caregivers, provide 24-hour bedside and daily living care for older inpatients under nurses’ supervision. This hospital-based service aims to relieve family caregiving shortages and advance integrated care but remains non-standardised and faces major implementation challenges.Objective: Guided by a social-ecological framework, this study examined the multilevel factors influencing the implementation of unaccompanied care and generated evidence to inform the optimization of service design, risk communication with family members, and the allocation of staffing and financial resources.Methods: We used a qualitative descriptive design with a phenomenological orientation. Using purposive sampling with maximum variation, we recruited 36 participants: 21 older inpatients and family caregivers and 15 healthcare professionals (administrators, clinicians, nurses) and staff from companion-care companies. Data were collected through semi-structured interviews conducted between November 2024 and January 2025 and analysed using Colaizzi’s seven-step method.Results: A total of five main themes and 15 sub-themes were identified: personal cognition, economy, and triple constraints; interpersonal support and interaction; organization resource integration and driving; social environment constraints and demands; public policy support and promotion.Conclusion: The implementation of unaccompanied care in Chinese tertiary hospitals faces challenges such as economic burden, cultural expectations of family caregiving, and insurance policy gaps. Through targeted communication, joint development of infrastructure and staff capabilities, along with supportive payment and regulatory policies, this pilot model can be integrated into sustainable, high-quality care for elderly inpatients.Keywords: “unaccompanied care” services, social ecosystem theory, stakeholders, barrier, facilitator, qualitative research