Caregiver Burden at the Onset of Acute Hospital-At-Home

Caregiver burden at the onset of acute Hospital-at-Home (HaH) episodes, particularly in programs where caregiver availability is required for admission, remains insufficiently characterized in real-world settings.

Caregivers of patients admitted to an acute HaH program within Clalit Health Services, Northern District, Israel, between 2023 and 2024.

We conducted a cross-sectional observational study of 125 caregivers assessed within the first 48 h of the HaH episode. Caregiver burden was measured using the Caregiver Strain Index (CSI; range 0-13), with high burden defined as CSI ≥ 7. Structured telephone interviews collected caregiver demographics, caregiving context, health-related quality of life (EQ-5D-5L; UK value set), resilience (CD-RISC-2), and perceived social support. Associations with high burden were examined using bivariate analyses and hierarchical logistic regression.

High caregiver burden was present in 77 caregivers (61.6%) within the first 48 h of the HaH episode. Prior caregiving experience was more prevalent among caregivers with high burden than among those with low burden (97.4% vs. 50.0%, p < 0.001). High burden was also associated with anxiety/depression on the EQ-5D-5L (63.6% vs. 29.2%, p < 0.001), lower resilience (52.0% vs. 79.2%, p = 0.002), and lower perceived social support (59.7% vs. 83.3%, p = 0.006). In multivariable analysis, perceived social support (OR 0.22, 95% CI 0.06-0.74) and high resilience (OR 0.33, 95% CI 0.11-0.95) were associated with lower odds of high burden, whereas paid caregiver assistance was associated with higher odds of high burden (OR 5.23, 95% CI 1.17-23.37).

High caregiver burden is common at the onset of acute HaH care. These exploratory findings suggest that caregiver vulnerability at admission is related to pre-existing caregiving context and psychosocial resources, supporting systematic caregiver assessment early in the HaH episode to identify individuals who may benefit from targeted support.