Abstract
<jats:p>Duhamel and colleagues report that 61.6% of caregivers met the threshold for high burden within 48 hours of an acute hospital-at-home (HaH) episode, with prior caregiving experience emerging as the strongest correlate. This commentary proposes that prior caregiving is not only an attribute of the caregiver but also, by definition, an attribute of the patient: a patient who required caregiving before the acute episode was already functionally dependent. Reanalysis of the authors' cross-tabulation shows that stratifying by prior caregiving experience separates high- from low-burden caregivers far more sharply (75.8% vs. 7.7%) than stratifying by prior HaH experience (56.8% vs. 70.5%), suggesting that pre-existing patient dependency, rather than caregiver strain or familiarity with the HaH model, may be the dominant driver of burden at episode onset. Because patient functional status was not collected, this interpretation cannot be directly tested, and no established framework yet exists for measuring patient function in HaH settings, unlike inpatient care. The commentary further notes that burden prevalence and the association between paid caregiver assistance and burden may not generalise across countries with differently structured long-term care systems, using Japan's long-term care insurance system as a contrasting example. Both patient function and caregiver burden need to be measured — at present, only the latter is.</jats:p>