The effects of informal caregivers on the outcomes of older adults receiving formal home health care

Although informal caregivers historically have provided most home health care, a paucity of empirical evidence exists concerning the effects of informal caregivers on patient outcomes. Therefore, the purpose of this study was to describe the variation in caregiver arrangements among recipients of home health care and to examine differences in patient outcomes (depressive symptoms, functional dependence, and the likelihood of rehospitalization) among home health care recipients with different caregiver arrangements. This study used a computerized patient care database, the Outcome and Assessment Information Set (OASIS), from the Visiting Nurse Service of New York (VNSNY), and included 9,832 patients who received home health care between January 1, 2002 and June 30, 2002. Descriptive data analyses were performed in order to examine the characteristics of the study population and to compare the characteristics across various caregiver arrangements. The relationships of caregiver arrangements with depressive symptoms, functional dependence, and the likelihood of rehospitalization for a 60-day episode of home health care services were analyzed using cumulative logit regressions, multiple regressions, and logistic regressions, respectively. This study found that characteristics of patients were significantly different across various caregiver arrangements, and the paid helper group was distinctively different from the other groups. This study also found that the effects of the caregiver arrangements on patients' function at the end-of-episode depend on the level of baseline function. Among patients whose baseline function was higher, function at the end-of-episode was the best in the paid helper group and the worst in the non-relative caregiver group. However, among patients whose baseline function was lower, function at the end-of-episode was the best in the non-relative group and the worst in the paid helper group. This study showed that older adults receiving formal home health care had similar depressive symptoms and the likelihood of rehospitalization regardless of the presence or types of primary caregivers. These study findings suggest that the appropriate choice of outcome variables in research is important when the effects of informal caregivers are evaluated. The findings from this study will help to identify vulnerable, at-risk, or special needs home health care patients in potential need of distinct interventions from home health care agencies.