A Nationwide Plan for Supporting Caregivers

When U.S. soldiers, sailors and Marines are wounded in the wars in Iraq and Afghanistan, they receive the best medical care in the world. When these wounded soldiers recover and eventually leave the hospital, the responsibility for their care and support shifts to their spouses, parents, children and loved ones. Little is known about the extent of this support and who these soldiers' caregivers are.

Military caregivers can be any relative or friend who provides some level of care or support to an ill or injured soldier or veteran. A study by the National Alliance for Caregiving (NAC) revealed that the vast majority (96%) of military caregivers are women. Although similar to civilian caregivers in many respects, they differ considerably.

Civilian caregivers are predominantly women caring for their elderly family members with dementia, and only a quarter of them live with the person they are caring for. Military caregivers are young women caring for their spouses, and most live with a caregiver who has dependent children.

In these families, children often share some of the caregiving responsibilities. Single veterans often rely on their parents for care. “My mother-in-law and father-in-law moved to help us….. [and] since my in-laws are here, I get to spend time with the kids.”

Soldiers' caregivers care not only for those with significant physical injuries, but also for those with post-traumatic stress disorder or traumatic brain injury, so-called “invisible war injuries.” RAND researchers heard reports from several target groups that echoed a 2010 NAC study finding that many wounded soldiers suffer from a range of medical problems.

“I was told I had symptoms [of serious illness]. I haven't seen any doctors. Logistically, I don't understand when I have to go to a doctor…….. My schedule is filled every day with responsibilities with my veteran.”

Caring for a veteran takes a high physical, mental and financial toll on caregivers and their families. Caregivers put the health and well-being of their loved ones before their own. One study revealed that approximately two-thirds of civilian caregivers suffer from some form of emotional distress.

Other studies have shown that depression is generally more prevalent – between 40% and 70% – and that the prevalence of chronic health problems is nearly twice as high as among non-caregivers. “I was only gone for an hour. I felt guilty about leaving her. I wasn't there for her. I could have prevented it [the onset of illness].

Like their colleagues who care for the elderly, military nurses say they feel compelled to take on this task. Unlike caring for the elderly, relatively young Iraq and Afghanistan veterans may need care for several decades. Those who have taken on this role often find themselves socially isolated and struggling in their work.

The only ‘free time' I have is late at night, when I can sit at my computer and chat with other caregivers on the Internet.” What policy changes can help caregivers? Some changes have already been introduced: a recent amendment to the Family and Medical Leave Act increases the amount of leave that families of family members in “insured” service can take to care for their loved ones.

Other programs are intended to improve the lives of those who assist veterans with activities of daily living (such as bathing and dressing). While important, these programs only target the most vulnerable people, which can be a very large group.

The starting point is what is currently known about caregivers, but there is also much that is not known. The next step would be to map the military caregiver pool and determine how they will be affected in the long term by this role.

How will decades of caregiving affect military spouses? What happens when a parent can no longer care for their veteran and needs a caregiver of their own? How does caregiving by a veteran parent affect the health and well-being of a child in a military family? Future RAND research aims to answer these questions.

Sacrificing personal interests for the greater good is one of the military's proudest traditions, but it seems clear that this sacrifice goes beyond the soldiers themselves. Providing caregivers with the skills and tools they need to survive and thrive should be as important as providing medical care to veterans. All quotes are from two focus groups conducted by RAND researchers and presented in the Military Caregivers report.