Hospital At Home Is A Viable Alternative With Low Caregiver Burden, Study Finds

As more high-acuity care moves into the home, providers are keeping an eye on how workers in the field are responding to new types of work.

A new study found that caregiver burden is mild to moderate in both the home and acute care facility settings.

The study results, according to its authors, suggest that hospital-at-home programs are a viable alternative for acutely ill patients.


Hospital-at-home programs have already been shown to decrease costs and readmissions while maintaining or improving quality and safety. The Centers for Medicare & Medicaid Services’ (CMS) Acute Hospital Care at Home waiver has allowed over 290 hospitals in the U.S. to engage in these programs, while others have done it outside the waiver.

As utilization increases, researchers at Harvard Medical School wanted to take a closer look at the potential burden being put on paid and unpaid caregivers as the care shifts into the home.

“Concern for increased caregiver burden was cited as a reason for declining participation in home hospitals among 6% of eligible patients,” the authors wrote. “We demonstrate caregiver burden is mild to moderate upon admission and discharge in both home and traditional hospitalization.”


The study included nearly 100 patients who were split up between hospital-at-home and a controlled group that stayed in the hospital. Home patients received twice-daily nurse visits, once-daily physician visits, in-home diagnostics, continuous monitoring, intravenous medications and other hospital-level care.

Home health aides were also used for 12-hour shifts to assist with caregiving.

After the trial period, caregivers completed the Zarit Burden Interview-12 (ZBI-12), which uses a number system to determine workload and burden levels.

“Our study is reassuring against large differences in caregiver burden caused by [hospital at home], suggesting these programs are a viable alternative for acutely ill patients with caregivers insofar as it is unlikely to cause undue burden on caregivers,” the authors wrote. “There was no significant difference in burden between the groups on admission, discharge or burden change.”

The study’s findings come a few weeks after a Medicare Payment Advisory Commission September meeting where the group expressed support for hospital-at-home programs.

Since CMS established the waiver program, it has shown significant results, particularly as it pertains to readmissions and discharges.

Source: MedPAC

Most hospitals in the program had no discharges under the program. When discharges did happen, according to CMS, they were concentrated among a minority of active hospitals.

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