Increasingly, Disabled Veterans Count on Nontraditional Helpers
U.S. Marine Corps Sgt. Maj. Jose A. Acero, the incoming Wounded Warrior Regiment (WWR) sergeant major, attends the WWR relief and appointment ceremony with his family at the National Museum of the Marine Corps, Triangle, VA, last month. A new report discussed caregiving for military wounded warriors and how it is changing. (U.S. Marine Corps photo by Lance Cpl. Anthony Ramsey)
WASHINGTON, DC — More than 14 million Americans now provide daily care to wounded, ill or injured military servicemembers or veterans, according to a new RAND report commissioned by the Elizabeth Dole Foundation.
The report, “America’s Military and Veteran Caregivers: Hidden Heroes Emerging from the Shadows,” was based on surveys of 2,946 respondents—513 military and veteran caregivers, 1,205 civilian caregivers and 1,228 noncaregivers—along with a separate survey of 1,100 U.S. veterans. It was released a decade after RAND’s initial study on military and veteran caregivers.1
The updated report presents new data and highlights significant changes since the original study, according to Rajeev Ramchand, PhD, co-director of the RAND Epstein Family Veterans Policy Research Institute and senior behavioral scientist at RAND.
The most notable change from the original study was the shift in caregiver relationships, said Ramchand, who led both reports. “In the previous study, a lot of the servicemembers and veterans were younger, and many of them had their parents caring for them. But over 10 years their parents have gotten older, so we are seeing fewer parents caring for them and more siblings, cousins, nephews, nieces, uncles and aunts,” Ramchand explained in an interview with U.S. Medicine.
In fact, the report found that among military/veteran caregivers to individuals age 60 and under, more than half were nontraditional caregivers. Among caregivers for those over 60, however, between 65% and 75% are children for a parent or an individual caring for a spouse, but more than 20% of caregivers for that group are friends and neighbors.
Among other findings, most caregivers (78% to 81%) provide between 1 and 30 hours of care per week. Fewer than 10% offer less than an hour of care, while 11 to 16% dedicate over 31 hours each week. On average, caregiving costs about $13,000 per caregiver, factoring in both out-of-pocket expenses and lost income due to caregiving duties, according to Ramchand.
Most care recipients had at least one chronic illness or limitation in daily activities, but the report revealed a notable prevalence of substance abuse and mental health conditions, especially among younger care recipients, he noted. Among those over 60, 40% had been diagnosed with a mental health condition or substance-use disorder, while the figure rose to 62% for those aged 60 and under.
“That is a very different type of care giving,” Ramchand pointed out. “It is not the typical caregiving of helping people into and out of chairs, helping arrange medical appointments, helping with transportation. Caring for somebody with mental health and substance-use issue requires different activities—helping them manage their moods, helping them avoid crowds and helping manage their anger, emotions and triggers of antisocial behavior—so it’s really a different type of caregiving that these men and women need to do.”
The report further underscores the emotional strain on caregivers, with about one-third reporting that they need mental health support but don’t receive it—largely due to lack of time. In fact, 20% of military/veteran caregivers to those 60 or under had thought about taking their own lives (four times the rate of noncaregivers).
To better support caregivers, the report offers several recommendations, including improving access to mental health and substance-use treatments for both caregivers and their children, promoting caregiver-friendly workplaces and increasing financial support for caregiving responsibilities. It also encourages further research to fully capture the wide range of caregiving experiences and the diverse individuals serving in these roles.
For clinicians treating veterans or military personnel, the report highlights the importance of involving caregivers in the patient’s care process. According to Ramchand, most caregivers in the study said they were not being involved in the care being provided.
When a patient comes to an appointment with a caregiver, he recommends having the caregiver “really involved in the conversation, because it is going to be that person that helps ensure the patient is compliant with their medications, who helps ensure they come back for their next medical appointment, who helps ensure that forms are filled out appropriately and that everything that is being recommended can be adhered to,” he said.
If a patient comes into the exam room alone, doctors might ask, “Hey, is there anyone taking care of you? Does anyone cook your meals? Does anyone help with your injections? Does anyone drive you to and from your appointments? Tell me a little bit about that person. Maybe they should come in with you next time.”
There are strategies and ways to get caregivers involved, Ramchand said. “Ensuring that providers are not only talking to patients but also kind of including their caregivers in discussions is really critical.”
- Ramchand R, Dalton S, Dubowitz T, Hyde K, Malika N, Morral AR, et al. America’s Military and Veteran Caregivers: Hidden Heroes Emerging from the Shadows. Santa Monica, CA: RAND Corporation; 2024. Report No.: RR-A3212-1. Available from: https://www.rand.org/pubs/research_reports/RRA3212-1.html