No place like home - even at the cost of excessive health care use?

Abstract Informal caregivers support the care needs of older people, supplementing formal services even for those with multiple needs. Extensive caring tasks can lead to caregiver burden, which may increase the use of formal health and social care services. We studied older home care clients in Finland and examined how their caregivers’ distress was linked to the use of health and remote (health and social) care services. Data from RAI assessments (January -June 2022) of home care clients were linked with national care register data. Informal carers’ distress was measured by questions on stress and inability to continue caring. The data included 23,731 individuals receiving informal care. Using logistic regression, we examined the association between caregiver distress and the use of emergency, inpatient, and outpatient care, and remote services, considering the characteristics of the cared-for individuals and their use of home-based services. Of informal caregivers of home care clients, 11% reported distress. The clients were more often male, younger, and had more ADL and cognitive difficulties, dementia, multiple diagnoses, depressive symptoms, loneliness, and financial issues. Clients with distressed caregivers used services more than those without distress: outpatient visits 39% vs 36%, emergency care 35% vs 29%, inpatient care 31% vs 26%, and remote services 56% vs 52%. After adjusting for health needs and socio-demographic information, higher service use remained more likely for clients whose caregivers reported distress. Greater care needs did not explain the higher health care use by home care clients with distressed caregivers. Caregivers may struggle to meet extensive care needs at home, leading to greater use of already limited health care resources.