Military Caregivers – Who are They Actually And Who Is Promoting Them?

More than 2.5 million U.S. military personnel have been deployed to Afghanistan and Iraq since 2001. Their wartime experiences have led to a sharp increase in the number of veterans with disabilities. Many veterans of these and previous conflicts rely for their daily needs on care provided by family or friends.

These informal caregivers, which we refer to as military caregivers, provide a number of indispensable services, saving the nation millions of dollars in health and long-term care costs. RAND researchers estimate that there are currently 5.5 million military caregivers in the United States.

To improve the nation's understanding of this understudied group and the programs and services available to them, we set out to describe who these caregivers are, the burden of care they carry, their support needs, the constellation of programs and other resources that exist to support them, and areas where additional support is needed.

Research on military caregivers is sparse; to better understand their characteristics and needs, RAND conducted the only nationally representative survey of military caregivers to date, as well as complementary surveys of civilian caregivers and noncaregivers. In addition, we conducted a comprehensive review of the programs and support resources available to address the many needs of military caregivers.

Post-9/11 military caregivers differ from other and former caregivers

Of the 5.5 million military caregivers in the United States, 1.1 million (20 percent) care for veterans and service members who served after September 11, 2001. These post-9/11 caregivers differ dramatically from military caregivers assisting veterans from earlier eras, who tend to more closely resemble civilian caregivers.

For example, among pre-9/11 civilian and military caregivers, children caring for their parents make up the majority (37%) of caregivers, while the majority of post-9/11 caregivers are spouses (33%), many of whom are also raising children; in addition, a quarter are friends of the care recipient.

Most relevant programs and policies serve caregivers only incidentally

More than 100 programs offer direct services to military caregivers. However, few are designed specifically for the caregiver population. Many target wounded, ill or injured service members and veterans, and extend services to family caregivers, or target military or veteran families, some of whom may be caregivers. Other programs are often not as relevant to post-9/11 caregivers because they are geared toward caregivers of older populations-more than 80 percent of post-9/11 caregivers care for someone under age 60.

We also found gaps in service offerings. The chart on the previous page describes the types of services we identified and the number of programs offering them. The range of programs skews toward direct assistance (“helping hand”) and social services programs-more than 50 of each, while fewer than 10 programs offer assistance in other key areas, such as respite care, financial support, and medical care.

Biggest gaps in support

Among the specialty areas covered by the 127 military caregiver support programs nationwide, these are the ones covered by the fewest programs:

10% provide
Mental health care:

Mental health care provided outside of normal institutional channels.

7% provide
Respite care:

Care provided by a surrogate to give the caregiver a break.

3% provide
Health care

Care provided outside normal institutional channels

3% provide
Religious support

Religious or spiritual guidance/counseling

2% provide
Financial stipend

Compensation for caregiver time

Recommendations

Policymakers should promote these strategies to support military caregivers:

• Provide high-quality education and training to help military caregivers understand their roles and teach them necessary skills.
• Help caregivers obtain health coverage and use existing structured social support.
• Increase public awareness of the role, value and consequences of military caregiving.
• Promote work environments that support caregivers, protect them from discrimination, and promote workplace accommodations.
• Incorporate caregivers as part of the health care team in all health care settings that serve military and veteran recipients.
• Ensure that caregivers are supported based on the tasks and duties they perform, rather than their relationship to the care recipient.
• Make more comprehensive respite care available to military caregivers, including alternative respite strategies.
• Encourage caregivers to create financial and legal plans to ensure continuity of care for care recipients.
• Enable program sustainability by integrating and coordinating services across sectors and organizations through formal partnership agreements.
• Promote the health and well-being of caregivers through access to high-quality services.
• Invest in research to document the evolving need for caregiver assistance among veterans and the long-term impact of caregiving on caregivers.

Caregiving is a heavy burden

Caring for a loved one is a demanding task. Military caregivers consistently experience poorer health, greater strains on family relationships, and more workplace problems than non-caregivers, and it is worse for post-9/11 caregivers. Military caregivers also face an elevated risk of depression; caregivers who spend more time caregiving and those who help care recipients cope with behavioral problems are the most likely to show symptoms of depression. In addition, 33% of military caregivers who have been through 9/11 lack health coverage.

Caregiving can also place a financial burden on caregivers, employers and society. Forty-seven percent of post-9/11 caregivers report needing to adjust their work schedules as a result of caregiving, and 62 percent reported that caregiving caused them financial strain. Caregiving for veterans and military service members after 9/11 costs the U.S. economy an estimated $5.9 billion annually in lost work productivity for caregivers.

The future of caregiver support is uncertain

Three factors make the future of caregiver support uncertain, especially for service members and post-9/11 veterans:

• 25 percent rely on their aging parents, who, at age 15 and older, will no longer be able to provide caregiver support.
• Thirty-three percent are dependent on spouses; these relationships are young and up to one-third of these marriages may dissolve.
• More than half of caregiver support programs were created in the last ten years, and 80% are not-for-profit. They are vulnerable to declining public interest, reduced philanthropic support, and a lack of capacity to deliver services effectively.

The bottom line

• Pre-9/11 caregivers resemble civilian caregivers: they tend to be older adults caring for an elderly parent or a spouse caring for an elderly partner.
• In contrast, post-9/11 military caregivers present a different profile. They are younger, are more likely to be the spouse or a friend of the care recipient, perform different caregiving tasks, and are more likely to combine work with caregiving commitments.
• All military caregivers face elevated risks of poor health, strained family relationships, and financial loss due to missed work; these risks are greatest among post-9/11 military caregivers.
• Programs supporting military caregivers often do so incidentally, extending services for service members and veterans to family caregivers or including caregivers in services provided to military families. Few services are designed specifically for military caregivers, and some caregivers are excluded from services that could benefit them.
• Few caregiver support programs offer respite care, health coverage, and financial support to compensate for lost income, although these may be the areas of the greatest need.
• Caregivers' needs will change over time due to age and changes in relationships, requiring planning for future contingencies.