The Overlooked Factor in Readmissions

Caregiver stress isn’t just a family issue—it’s a healthcare issue. When caregivers are overwhelmed, patient outcomes suffer. Hospital readmissions often follow, creating a cycle that’s hard to break. Healthcare professionals can play a key role in identifying and addressing caregiver stress to improve recovery and reduce avoidable hospitalizations.

The Growing Burden of Caregiving

More than 41 million Americans provide unpaid care to an aging adult. Many spend an average of 20 hours a week supporting loved ones—often while juggling work and family responsibilities.

A 2023 AARP and S&P Global survey revealed that:

• 67% of family caregivers struggle to balance work and care.

• 27% have reduced hours or passed on promotions.

• 16% left the workforce entirely for a time.

Behind each statistic is a caregiver experiencing emotional, physical, and financial strain—stress that directly impacts the quality of care a patient receives.

Defining Caregiver Stress

The World Health Organization defines stress as “a state of worry or mental tension caused by a difficult situation.” For caregivers, that “difficult situation” can last for years.

Common symptoms include:

• Fatigue or insomnia

• Irritability or anger

• Weight changes

• Headaches or frequent illness

• Depression or social withdrawal

• Forgetfulness or “brain fog”

Unchecked stress can lead to burnout or even compassion fatigue—the emotional exhaustion that results from prolonged caregiving. For patients, that can mean missed medications, delayed follow-up, and eventually, a trip back to the hospital.

The Connection Between Caregiver Stress and Readmissions

Since 2010, Centers for Medicare and Medicaid Services (CMS) have tied reimbursement to hospital readmission rates. While hospitals focus on medication management and discharge planning, caregiver well-being is often overlooked—even though it’s one of the most significant predictors of rehospitalization.

Common post-discharge risks include:

• Missed follow-up appointments

• Medication errors or non-adherence

• Poor coordination between care providers

• Lack of patient or caregiver education

• Social barriers like transportation or food insecurity

When a caregiver is exhausted, anxious, or confused, these risks multiply. The result? Preventable readmissions and poorer outcomes for patients and families.

Assessing Caregiver Stress

Identifying stress early can change the trajectory of both the caregiver and the patient. The American Medical Association’s Caregiver Self-Assessment is a practical tool healthcare professionals can recommend or integrate into discharge planning. It asks simple yes/no questions about concentration, decision-making, sleep, loneliness, and overall well-being—yielding valuable insights in minutes.

The Family Caregiver Alliance also emphasizes that caregiver assessments should:

• Validate caregiver needs and emotions

• Promote therapeutic dialogue

• Encourage self-care and confidence in caregiving tasks

• Identify barriers to support, such as finances or family dynamics

Assessment legitimizes the caregiver’s experience—and gives clinicians actionable data to guide interventions.

What Happens When Stress Goes Unchecked

Unaddressed caregiver stress has serious consequences:

For caregivers: physical illness, depression, anxiety, and social isolation.

For patients: increased risk of neglect, abuse, or unnecessary rehospitalizations.

In fact, caregiver stress is one of the leading causes of elder neglect, often unintentional but deeply impactful.

Practical Ways to Support Caregivers

Healthcare professionals can make a real difference by equipping caregivers with the right tools and encouragement.

1. Encourage asking for help.

Remind caregivers that accepting help is not a weakness—it’s essential. Encourage them to list specific tasks they can delegate to friends or family.

2. Provide education – offer disease-specific resources and information about community services, respite programs, or hospice options.

3. Connect them to support groups – peer support helps caregivers share experiences, reduce isolation, and learn coping strategies.

4. Recommend organization tools – a caregiver binder—with medication lists, medical bills, and appointment logs—can reduce anxiety and prevent mistakes.

5. Promote routines and self-care – regular schedules, exercise, and rest are vital. Encourage caregivers to care for themselves with the same dedication they give to others.

Integrating Caregiver Support into Professional Practice

As nurses, case managers, and social workers, our responsibility extends beyond the patient. When we assess and support caregivers, we indirectly improve the patient’s safety, satisfaction, and outcomes.

Ask yourself:

1. Do we routinely assess caregiver stress?

2. Are we providing education on community and respite resources?

3. Do we follow up on caregiver well-being after discharge?

By answering “yes” to these questions, healthcare professionals help prevent readmissions and strengthen the circle of care.

The Takeaway

Caregiver stress and hospital readmissions are closely linked. When caregivers are supported, patients heal better, hospitals perform better, and communities grow stronger.

References

1. AARP & S&P Global. (2023). Understanding the Impact of Caregiving on Work. AARP Research Report. Retrieved from https://www.aarp.org/research
2. National Academies of Sciences, Engineering, and Medicine. (2016). Families Caring for an Aging America. Washington, DC: The National Academies Press. https://nap.nationalacademies.org/catalog/23606/families-caring-for-an-aging-america
3. World Health Organization. (2023). Stress. Retrieved from https://www.who.int/news-room/questions-and-answers/item/stress
4. Centers for Medicare & Medicaid Services (CMS). (2023). Readmissions Reduction Program (HRRP). Retrieved from https://www.cms.gov/medicare/medicare-fee-for-service-payment/acuteinpatientpps/readmissions-reduction-program
5. Agency for Healthcare Research and Quality (AHRQ). (2024). Rehospitalization and Discharge Planning. In Patient Safety and Quality: An Evidence-Based Handbook for Nurses. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK606114
6. StatsPearls. (2024). Reducing Hospital Readmissions. National Center for Biotechnology Information, Journal of General Internal Medicine Reducing Hospital Readmissions – StatPearls – NCBI Bookshelf
7. Centers for Disease Control and Prevention (CDC). (2024). Caregivers of a Person with Alzheimer’s Disease or a Related Dementia. Caregivers of a Person with Alzheimer’s Disease or a Related Dementia | Caregiving | CDC