Background:

Acute Hospital-at-Home (HaH) programs depend on family caregivers to support older adults during acute illness. Despite their central role, caregiver burden at the time of HaH admission has not been well characterized in real-world settings.

Research questions:

We sought to answer the following research questions: (1) What is the prevalence of caregiver burden at admission to acute Hospital-at-Home? and (2) Which caregiver- and patient-related factors are associated with high caregiver burden at admission?

Method:

We conducted a cross-sectional observational study of family caregivers of patients admitted to an acute HaH program within Clalit Health Services, Israel (2023–2024). Caregiver burden was assessed within 48 hours of admission using the Caregiver Strain Index (CSI). Caregiver characteristics, caregiving context, health-related quality of life (EQ-5D-5L, UK value set), resilience (CD-RISC-2), and perceived social support (single adapted item) were collected by telephone interview. High burden was defined as CSI ≥7. We examined associations using bivariate analyses and hierarchical logistic regression.

Results:

Among 125 caregivers, 77 (61.6%) reported high burden at admission. Compared with those with low burden, caregivers with high burden more frequently reported EQ-5D anxiety/depression, pain/discomfort, and limitations in usual activities, and had lower EQ-5D index scores. High burden was also associated with lower resilience and perceived social support. Nearly all caregivers with high burden had provided prior care for the same patient. In multivariable analysis, paid caregiver assistance was associated with higher odds of high burden (adjusted odds ratio [aOR] 5.23, 95% CI 1.17–23.37), whereas perceived social support (aOR 0.22, 95% CI 0.06–0.74) and high resilience (aOR 0.33, 95% CI 0.11–0.95) were independently associated with lower odds.

Conclusions:

High caregiver burden is common at admission to acute HaH and reflects pre-existing caregiving strain, emotional distress, and limited psychosocial resources. Early caregiver assessment at HaH entry may help identify vulnerable caregivers and guide targeted supportive interventions.

Points for discussion: