Supporting Military and Veteran Caregivers: Effective Strategies to Improve Mental Health and Reduce Caregiver Burden

At the Elizabeth Dole Foundation’s Ninth Annual National Convening on Military Caregiving, the RAND Corporation presented new insights from its nationwide study on the significant financial and emotional burdens faced by military and veteran caregivers.¹

"America has largely left the care of its service members and veterans in the hands of their family members and friends, without ensuring that they are prepared or adequately supported," said Steve Schwab, CEO, Elizabeth Dole Foundation, in a statement.² "RAND's findings are a wake-up call for the nation and force us to confront the consequences of continuing to thrust these tremendous responsibilities upon millions of selfless caregivers and their families."

Military and Veteran Caregiver Population

Military and veteran caregivers play a critical role in supporting the health and well-being of wounded, ill, or injured service members and veterans, with approximately 14.3 million military and veteran caregivers in the US, representing 5.5% of the adult population, according to the report.³ These individuals provide a range of caregiving services, often involving complex medical tasks and long hours of support.

Caregiving Experience Depends on Age of Care Recipient

Caregiving experiences were found to differ depending on the age of the care recipient. Military and veteran caregivers for those over age 60 often manage age-related conditions, while those caring for younger individuals tend to assist with injuries or illnesses specific to military service. Regardless of the age group, caregivers providing help with activities of daily living (ADLs), such as bathing and dressing, tend to spend significantly more time in caregiving roles.

Mental and Physical Health

A striking 43% of military and veteran caregivers for those age 60 and younger were found to suffer from depression, with about 20% experiencing suicidal thoughts within the past year. This mental health impact extends beyond the caregivers themselves, as the report also found a high number of caregiver children in need of mental health support, though many are not receiving adequate care. About 40% of these caregivers are "sandwich caregivers," who also care for a child under age 18 years, and many of these children are struggling.²

The Economic Toll of Caregiving

The report revealed substantial economic challenges faced by military and veteran caregivers.³ On average, these caregivers incur $8583 in annual out-of-pocket costs due to their caregiving duties. Additionally, military and veteran caregivers forgo an estimated $4522 in annual household income.

The economic value of the unpaid labor provided by military and veteran caregivers is substantial, ranging from $119 billion to $485 billion annually. This wide range depends on the nature of caregiving tasks, some of which are equivalent to the work of licensed nurses, while others could be compensated at minimum wage. Despite the value they provide, 35% of military and veteran caregiver households live below 130% of the federal poverty level, with many not utilizing benefits like the Supplemental Nutrition Assistance Program (SNAP) or the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC). Food insecurity is also more common among caregivers, particularly those caring for a veteran or service member 60 years or younger, 40% of whom are food insecure.²

Moreover, 63% of uninsured military caregivers live in Southern states, 59% are non-White, and 47% live below the 100% poverty line. Among those caring for a service member or veteran 60 years or younger, 39% lack health care coverage, which is 15 percentage points higher than civilian caregivers in the same age demographic.

Caregiver Settings and Support

Workplace accommodations remain a critical issue, as fewer than half of military and veteran caregivers have access to flexible work options or paid leave, leading to workplace disruptions and further income losses.³

Additionally, limited support networks are available to military and veteran caregivers, particularly those caring for individuals under age 60 years. About half of these caregivers report having no one else to rely on for caregiving help, and over half feel they lack emotional support. Military and veteran caregivers of individuals under age 60 years were found to be more likely to use support services like in-person and online support groups, respite care, wellness programs, and case management. In contrast, caregivers for those over age 60 years report lower engagement with these services, with nearly half not participating in any support programs.

However, across all caregivers, programs that reduce stress are highly desired, and religion plays a positive role in reducing caregiver burden for some.

Health Care Resources

The report noted that more than 70% of military and veteran caregivers feel unvalued and frustrated by health care providers. Only about one-third of military, veteran, or civilian caregivers feel that health care providers consistently seek their input or listen to their concerns regarding the care recipient. Additionally, a third of military and veteran caregivers report experiencing hassles in health care settings, such as delays in paperwork and having to remind staff to attend to the care recipient. Among younger caregivers aged 18 to 44 years, 25% to 30% attributed these hassles to age discrimination.

Caregivers in Veterans Affairs (VA) settings report higher rates of staff delays, exclusion from care decisions, and difficulties interacting with physicians. The report attributed these differences to the unique characteristics of VA care recipients, who are typically younger, have mental health and substance use disorders, and receive higher disability ratings. Therefore, the researchers of the study noted that this population may require more complex care coordination, contributing to these challenges.

Recommendations

The report offers 9 key recommendations to address the challenges faced by military and veteran caregivers. First, the authors suggest expanding access to mental health and substance use treatment for caregivers and their children, especially through telehealth, mobile apps, and other novel mental health delivery models.

Second, financial support is a major concern. Military and veteran caregivers face significant out-of-pocket costs and income losses due to caregiving; yet many do not access available financial assistance. Policy makers are encouraged to explore options like tax credits, while organizations should increase outreach to inform caregivers about existing programs.

“Organizations that serve caregivers should acknowledge which caregivers may be struggling financially, which caregivers may be eligible for certain programs that offset financial burdens, and then help them identify those programs and apply for them,” said Ramchand in a phone interview with The American Journal of Managed Care^®. “I think that’s the type of outreach that’s needed. At the same time, I think there’s still room for policy makers to explore more options.”

Third, the report stresses the need to tailor caregiver support programs to reflect the diversity of caregivers’ preferences. Programs should adjust their outreach to better identify caregivers and provide services that meet their specific needs, especially through a combination of in-person and tech-driven options like telehealth. The researchers also recommend promoting home health care services, which may reduce caregiver burden but require careful planning to avoid adding stress to the caregiver.

Other recommendations focus on integrating caregivers into health care teams, supporting work environments, and ensuring that program evaluations and further research capture the full scope of caregiving responsibilities.

Together, these initiatives aim to improve caregiver well-being and reduce the significant burdens they face in caring for military and veteran individuals.

References

1. RAND and Elizabeth Dole Foundation to unveil findings on state of military and veteran caregiving in America. News release. Elizabeth Dole Foundation. September 13, 2024. Accessed September 24, 2024. https://www.elizabethdolefoundation.org/news/elizabeth-dole-foundation-and-wounded-warrior-project-launch-online-resource-hub-for-caregiving-families

2. RAND announces stunning update to size of military caregiver population as financial insecurity, mental health, family strain reach concerning levels. News release. RAND. September 24, 2024. Accessed September 24, 2024. https://www.prnewswire.com/news-releases/rand-announces-stunning-update-to-size-of-military-caregiver-population-as-financial-insecurity-mental-health-family-strain-reach-concerning-levels-302257443.html

3. Ramchand R, Dalton S, Dubowitz T, et al. America's military and veteran caregivers: hidden heroes emerging from the shadows. RAND. September 24, 2024. https://www.rand.org/pubs/research_reports/RRA3212-1.html