Respite care, a short-term service for family caregivers to take a break from caregiving activities, is an important intervention support for caregivers (CG) and older care recipients (CR). During the respite, CR are taken care of by trained workers and CG can use the time to relax or do other activities.1,2 Respite care can be offered at various locations, including healthcare facilities (e.g., nursing home), daycare community centers, and in-home (i.e., respite workers go into older adults’ homes and provide the service), or remotely via video.3 Among them, in-home respite care has been consistently reported as a preferred choice for many CR and CG.4 However, controversy and difficulties remain for in-home respite care because it is relatively expensive, has high costs in human power and service management, lacks the social interaction with other families that could have been attained in community-based respite care, etc.3, 4, 5

Despite the growing need and use of respite care, only several research reviewed the factors that influence the use of respite care. The factors can be categorized into four major domains, including individual characteristics (e.g., CG demographics, health), service features (e.g., availability, quality, cost), experiential factors (e.g., past usage experience), and relational factors (e.g., family norm and cultural values), according to a review article published in 2013.6 These review studies have primarily focused on dementia caregiving, finding major barriers such as service attributes (e.g., geographical distance, administrative complexity, financial requirements), poor information exchange, unmet service needs, and among others.7,8 A study reviewed the barriers under the Andersen’s Behavioral Model and reported similar findings on predisposing, enabling, and need factors.9 Nevertheless, in-home respite care was not specifically examined in these studies but was considered as part of the caregiver support service.

More research has been conducted on reviewing the effect of respite care, finding no or limited evidence that respite care has significantly positive effects on CG.3,10, 11, 12 In the dementia caregiving context, the evidence is even more controversial. One study summarized that respite care did not significantly improve CG psychological well-being or CR health condition.13 In contrast, a study indicated daycare respite could effectively reduce CG burden and CR behavioral problems, although it facilitated the nursing home placement.4 Another review suggested respite care increased CG burden, citing reasons such as respite care was not well accepted and utilized by dementia CG, and the concern of service quality.14 Several other studies examined the evidence on respite care for people with severe mental illness, finding the need for high-quality, sufficient, flexible service remains unmet.15,16

Despite the existing efforts on reviewing the influencing factors and program effect of respite care, there are two major gaps. First, extant studies predominantly focus on dementia caregiving context, with very few attentions on other diseases such as cancer,17 severe mental illness.16 Second, most research was conducted in daycare or residential settings.16 Only a 2004 review study summarized the effects of in-home respite care among dementia caregivers, finding no significant evidence that in-home respite care can improve a range of outcomes.18 However, this review study was conducted more than 20 years ago and only focused on dementia caregiving. Evidence has emerged since then, calling for a state-of-the-art review to update scientific evidence on the effects of in-home respite care beyond the dementia caregiving context. Only by synthesizing the updated knowledge, implications can be drawn to effectively allocate resources and formulate evidence-based policy.

To fill these gaps, this study conducted a systematic review to offer a comprehensive summary of the current knowledge of in-home respite care. Rather than focusing on dementia caregiving context, this review examined evidence on all types of caregiving context, which can extend our understanding of in-home respite care to the general caregiving context. We specifically focused on in-home respite, an understudied topic, and reviewed both the influencing factor and effectiveness of the program. By providing an updated review on published articles up to 2024, this study also summarized the extant evidence on in-home respite care. Findings can shed light on how future research can advance the scientific inquiry on who were the users of in-home respite and whether the in-home respite care was effective, as well as provide implications for clinical practice and policymaking to improve service design and delivery.