Background
With the rise of in-home alternatives to traditional hospital care, there’s increasing concern about the potential strain it might place on family caregivers. As healthcare embraces more home-based care, a pressing question emerges: are these caregivers inadvertently placed under undue stress due to the increased responsibility of managing a sicker loved one at home?
Prominent organizations, including AARP1, have spotlighted the need for in-depth studies to truly grasp the lived experiences and potential challenges caregivers face. Media outlets, such as NPR2, have echoed these sentiments, shedding light on the myriad difficulties caregivers may grapple with.
A caregiver, universally recognized and as defined by The Centers for Medicare & Medicaid Services (CMS), is an individual who steps up to offer voluntary, continuous, or sporadic care to a loved one—be it a family member, friend, or community member. They support those struggling with short-term or enduring challenges stemming from ailments, injuries, disabilities, or the inevitable aging process. Their roles are diverse, from assisting with routine daily tasks, overseeing medication regimes, and facilitating medical visits to being a pillar of emotional strength and an advocate in healthcare dialogues.
As stakeholders in the healthcare industry, it is essential that we not only acknowledge but also actively protect the well-being of these individuals. Within the hospital-at-home model of care, it is vital to ensure caregivers are not inadvertently overwhelmed with additional tasks and responsibilities that exceed their capacity and resources.
1 Caregiving in the U.S. 2020 - AARP Research Report
2 Family caregivers take on a lot of responsibility in ‘hospital-at-home’ trend : Shots - Health News : NPR
Objective
The primary aim of this case study is to examine the impact of DispatchHealth’s Advanced Care service line, a novel hospital-at-home model, on the lives and well-being of caregivers. We focus on understanding if this shift from traditional in-patient hospitalization to home-based treatment introduces more or fewer challenges specific to caregivers, particularly regarding access to necessary information and support. To achieve this, we developed a comprehensive 22-question survey administered by non-clinical surveyors with no direct affiliation to the service line. This method emphasizes the crucial role of caregivers and aims to offer a thorough evaluation of this innovative care model from various stakeholder perspectives.
Description
We utilized a randomized approach to select a broad spectrum of caregiver participants from 11 unique markets spanning nine states. These caregivers are those whose associated patients were treated under our Advanced Care service from May to July 2023. Our survey team made over 250 telephone calls, successfully connecting with 73 patients. Of these, 48 former patients identified a primary caregiver. Forty-four of those met the eligibility criteria of having provided care for the same patient sometime in the past five years during a hospital admission. All 44 eligible caregivers chose to participate in the survey.
Results
The surveyed caregiver pool served patients with an average age of 78 and an average of 11 co-morbid conditions. These patients were treated for 16 different admitting diagnoses. Seventy-eight percent of admitting diagnoses were for non-respiratory infections and sepsis (37%), heart failure (24%), and pneumonia (17%). Hypoxic respiratory illnesses, including COPD and COVID-19, constituted another 15%.
Most patients (75%) were covered by insurance other than traditional Medicare and were contracted for in-home hospitalization services, facilitating seamless community admissions from primary care physicians or DispatchHealth’s in-home emergency room substitution clinical model. The remainder of patients integrated into the program from hospital settings, taking advantage of the CMS waiver program (25%).
Among the caregiver participants, most were either a spouse or an adult child; 75% lived with the patient,11% made multiple visits per day, 5% visited once per day, and 9% visited less than once per day.
- 95% of respondents preferred in-home care over the traditional hospital setting, with 68% stating a strong preference for hospital-level care in the home. The remaining 5% selected hospital-based care as their preference.
- Regarding stress level, 96% of caregivers found in-home care less stressful than a previous in-patient hospital experience, 2% rated the experience as similar, and 2% found the in-home care episode more stressful.
- 86% of caregivers felt more informed about the patient’s daily care plan than during traditional hospital stays; 14% said information sharing was similar, and none of the respondents felt less informed.
- 100% of caregivers reported help was readily available when they called DispatchHealth or pressed the call button; 84% stated help was always available, and 16% stated it was usually available. None of the caregivers reported slow response times or an inability to get timely service.
We posed an open-ended query to caregivers who reported a perception of decreased stress when participating in the in-home care model, asking them to explain the factors that contributed to this sentiment. The responses yielded several recurring qualitative themes:
Enhanced Comfort
Both caregivers and patients reported an increased sense of comfort and ease within the familiar confines of their homes, significantly contributing to the overall positive experience.
Reduced Transit Time
Participants highlighted the tangible benefits of eliminating time-consuming and potentially exhausting journeys to and from the hospital.
Minimized Infection Risk
The avoidance of hospital environments, and the potential exposure to viruses and bacteria was identified as a crucial advantage.
Improved Sleep and Nutrition
Caregivers noted improvements in the patient’s sleep quality and appreciated the ability to prepare familiar and comforting meals.
Animal Companionship
The opportunity for patients to interact with their pets was mentioned as a unique and invaluable aspect of in-home care.
Tailored Care
The ability to receive personalized and patient-centric care was highlighted as a distinct advantage.
Care Team Accessibility
24/7 virtual nursing, coupled with advanced monitoring technology was recognized as an essential resource.
Effective Communication
Clear, timely, and empathetic communication from the care team was pivotal in creating trust and a supportive care environment.
One caregiver summarized the essence of the benefits as the freedom for the patient to move and engage in activities within their home, which they believed expedited the recovery process.
Conversely, a single respondent reported heightened stress stemming from an unexpected illness they experienced and concerns about how it might affect the patient.
Conclusion
This research underscores the benefits and feasibility of home-based care. While concerns about caregiver stress are understandable, our findings suggest that in-home care, for qualified patients with appropriate conditions, frequently produces a better experience for caregivers, in a more relaxed, convenient, and less taxing environment than traditional hospital settings.
