Caregiver Experiences with Hospital at Home in U.S. Programs: A Qualitative Study

Introduction: Hospital at Home (HaH) is an innovative model of acute care delivery in a patient’s home that is currently provided by hundreds of U.S. hospitals. Caregivers play a crucial role in this model but relatively little is known about their experience with HaH so far. We explored caregiver experiences to identify best practices and opportunities for improvement.  

Goals and Methods: This study examined how caregivers perceive their role and responsibilities in HaH, and how their experience could be improved. We used rapid qualitative design with semi-structured interviews with caregivers recruited through HaH programs. Interviewers filled out individual rapid templates following each Zoom interview, synthesized them in groups of 4-5 then all together, and completed focused coding of transcripts for specific themes.  

Results: We interviewed 19 caregivers. Seven of 19 were clinical and healthcare professionals; patients had progressive conditions requiring monitoring and autoimmune conditions prior to HaH admission. Trigger events for HaH admission included acute infections (pneumonia, flu, sepsis), cardiac events, and fall-related injuries. Length of stay ranged from 3 days to 1 month, with a mean duration of 1 week.  Only a third of caregivers were involved in the decision for HaH admission. Most caregivers reported preferring HaH over traditional hospitalization. Our analysis revealed the following themes: 1) HaH benefits such as extended time with providers, team consistency, hands-on training on patient care; 2) caregiving challenges including inconsistent communication about logistics, inconsistent teams, technical difficulties with medical equipment, inability to leave home during HaH hospitalization; 3) home routines that enhanced recovery and were occasionally disrupted with HaH; 4) opportunities for improvement.

Conclusions: While caregivers reported a positive experience with HaH overall, clearer and more explicit communication about the caregiver role and daily visits could improve their experience and make them feel more integrated into the care team.