More than 14 million Americans now provide daily care to wounded, ill, or injured military service members or veterans, with the burden falling heaviest on the 26 percent who assist people aged 60 and under, according to a new RAND report commissioned by the Elizabeth Dole Foundation.
More than 40 percent of caregivers for those 60 and under met criteria for probable depression. About one-third thought they need mental health care but don’t receive it, mainly because they don’t have the time.
Seventy percent of caregivers for those 60 and under reported some difficulty paying bills, and 40 percent met criteria for being food insecure.
Among all military/veteran caregivers, individuals reported spending $8,583 out-of-pocket each year on delivering care and forgoing more than $4,000 in annual income. These costs may be one reason that one-third of military/veteran caregivers report incomes below 130 percent of the federal poverty level.
Military/veteran caregivers often help others eat and walk, help manage mental health symptoms and memory deficits, and administer medications and prepare meals. They also may provide transportation to medical appointments, pharmacies, and grocery stores.
The study updates RAND work from 2014 that was the first to provide meaningful estimates of the number military/veteran caregivers in the United States and highlight the many challenges they face. It includes recommendations about how to improve services for these “hidden heroes.”
“Military and veteran caregivers are family members who do this out of love and obligation, but they are also friends and neighbors who are taking on these duties out of caring and kindness,” said Rajeev Ramchand, lead author of the research and a senior behavioral scientist at RAND, a nonprofit research organization. “Care recipients benefit from the work these caregivers do, and caregivers benefit as well. But caregiving is not without its costs, both financial and emotional.”
The RAND project estimates there are many more caregivers across the United States than highlighted by previous research. The study used a new approach for identifying caregivers that asked those surveyed whether they conducted specific caregiving activities instead of whether they identified as a caregiver. Using these measures, researchers found that more than 40 percent of American adults provide some type of caregiving to wounded, ill, or injured adults.
Military/veteran caregivers tend to live in areas where most Americans live, with more than half residing in either Southern or Western states and in urban areas. Texas, California, and Florida each have more than 1 million military/veteran caregivers.
Of the 14.3 million military/veteran caregivers identified by the study (5.5 percent of American adults), three-quarters care for people over age 60. Primarily they are children caring for aging fathers or spouses caring for a husband (most veteran care recipients over 60 are men).
Many of these veteran care recipients have chronic conditions such as diabetes or cardiovascular conditions, and hearing or vision impairments. Half of their caregivers help with at least one activity of daily living such as dressing or eating, and an additional 25 percent help provide cognitive or emotional support exclusively.
Caregivers to wounded, ill, or injured service members or veterans over 60 generally fare comparably to non-caregivers, but this does not suggest that they do not also have unmet needs. For example, 15 percent met criteria for probable depression, and 16 percent wanted, but did not access, mental health care—largely due to concerns about the cost. Around half reported some difficulty paying their bills.
The remaining quarter of military/veteran caregivers help individuals 60 and under, and they look very different from those providing care to older veterans. They also are different from their peers caring for civilians 60 and under.
These military/veteran caregivers include more friends, siblings, and aunts and uncles. They also provide care to individuals with chronic conditions and vision or hearing impairments, but two-thirds care for someone with a diagnosed mental health and/or substance use disorder. One-fifth care for someone with a traumatic brain injury.
Around 40 percent of military/veteran caregivers also are caring for a child. Many of these children help with caregiving tasks and also take on more household chores than children in non-caregiving households. Children of military/veteran caregivers also experience greater emotional and behavioral problems than non-caregivers.
Among working military/veteran caregivers, fewer than half are offered workplace accommodations that could help them more easily perform their caregiving responsibilities. Perhaps because of the lack of workplace accommodations, 27 percent of these military/veteran caregivers experience workplace disruptions, such as cutting back on their work hours or thinking they are being discriminated against.
Half of military/veteran caregivers to those 60 and under had no one else to turn to in their caregiving network or to call for emotional support. Those caring for someone over 60 fared slightly better, with 40 percent feeling like that they were going it alone.
Since RAND’s original research on military and veteran caregivers was released in 2014, many policies and programs have been enacted to better support military/veteran caregivers. Between half and two-thirds of military/veteran caregivers use common support programs like caregiving training programs, support groups, respite, or structured wellness programs.
The report outlines several ways policymakers can pursue reforms to further improve the health and wellness of military caregivers and their veterans.
“Just as the report RAND conducted in 2014 guided the Elizabeth Dole Foundation’s efforts for the last decade, we will use the information RAND provided in this report to shape the nation’s strategy for supporting military and veteran caregivers moving forward,” said Steve Schwab, CEO of the Elizabeth Dole Foundation.
The report recommends expanding access to mental health and substance use treatment for caregivers and mental health support for their children. These programs should explore alternative ways to offer care, including delivering services during non-traditional hours, telehealth, and asynchronous counseling such as texting therapy for those with lower acuity needs.
Additional efforts should increase opportunities for caregivers to receive financial support and offer financial compensation for the work they perform. This should include increasing efforts by programs to help caregivers apply for existing financial assistance programs.
Caregiver support programs should be tailored to reflect caregivers’ diverse preferences and needs. This might include different types of programs based on the age of person receiving care, as well as efforts adapted to the caregivers’ local conditions.
Care providers also should better integrate caregivers into health care teams. Thirty-nine percent of military/veteran caregivers reported having experienced a hassle in health care, such as needing to remind staff to do things for the care recipient or delays in paperwork.
The report is based on two different sets of surveys conducted by RAND. In the first, researchers administered the 2023 RAND Caregiving Survey, a probabilistic survey of U.S. households that collected detailed information from caregivers and non-caregivers alike.
RAND researchers also administered the 2022 RAND Veterans Survey, a survey of 1,100 veterans residing in the United States. Data from this survey were exclusively used to produce state-level estimates of the numbers of military and veteran caregivers.
The report, “America’s Military and Veteran Caregivers: Hidden Heroes Emerging from the Shadows,” is available at www.rand.org. There also are five related documents that detail the project’s findings from different perspectives. Other authors of the studies are Sarah Dalton, Tamara Dubowitz, Priya Gandhi, Kelly Hyde, Nipher Malika, Andrew R. Morral, Elie Ohana, Vanessa Parks, Michael W. Robbins, Terry L. Schell, Gretchen Swabe, Thomas E. Trail, and Kayla M. Williams.
