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Hidden Heroes

America's Military Caregivers — Executive Summary

by Rajeev Ramchand, Terri Tanielian, Michael P. Fisher, Christine Anne Vaughan, Thomas E. Trail, Caroline Batka, Phoenix Voorhies, Michael W. Robbins, Eric Robinson, Bonnie Ghosh-Dastidar

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Research Questions

  1. What is the magnitude of military caregiving in the United States?
  2. How does caregiving affect individuals, their families, and society?
  3. How do these effects differ across cohorts of veterans and their caregivers?
  4. What are the current policies, programs, and other initiatives designed to support military caregivers?
  5. Do these efforts align with the needs of military caregivers?
  6. How can gaps be filled and the well-being of military caregivers ensured?

While much has been written about the role of caregiving for the elderly and chronically ill and for children with special needs, little is known about "military caregivers" — the population of those who care for wounded, ill, and injured military personnel and veterans. These caregivers play an essential role in caring for injured or wounded service members and veterans. This enables those for whom they are caring to live better quality lives, and can result in faster and improved rehabilitation and recovery. Yet playing this role can impose a substantial physical, emotional, and financial toll on caregivers. This summary distills a longer report, Hidden Heroes: America's Military Caregivers, which describes the results of a study designed to describe the magnitude of military caregiving in the United States today, as well as to identify gaps in the array of programs, policies, and initiatives designed to support military caregivers. Improving military caregivers' well-being and ensuring their continued ability to provide care will require multifaceted approaches to reducing the current burdens caregiving may impose, and bolstering their ability to serve as caregivers more effectively. Given the systematic differences among military caregiver groups, it is also important that tailored approaches meet the unique needs and characteristics of post-9/11 caregivers.

Key Findings

  • There are an estimated 5.5 million military caregivers in the United States. Of these, 1.1 million (19.6 percent) are caring for post-9/11 veterans.
  • Military caregivers helping veterans from earlier eras tend to resemble civilian caregivers in many ways.
  • Post-9/11 military caregivers differ from the other two groups. They tend to be younger, caring for a younger individual with a mental health or substance use condition, employed, and not connected to a support network. They are more likely to use mental health resources and services, and to use them more often.
  • Post-9/11 military caregivers typically help those for whom they are caring cope with stressful situations or other emotional and behavioral challenges.
  • Seventeen percent of civilian caregivers reported spending more than 40 hours per week providing care (8 percent reported spending more than 80 hours per week); 12 percent of post-9/11 military caregivers and 10 percent of pre-9/11 military caregivers spent more than 40 hours per week.
  • Military caregivers consistently experience worse health outcomes, greater strains in family relationships, and more workplace problems than non-caregivers, and post-9/11 military caregivers fare worst in these areas.
  • The need for long-term planning is likely more pronounced for post-9/11 military care recipients, who are younger and may be more vulnerable than pre-9/11 and civilian care recipients, particularly those relying on aging parents and in new marriages. Critical aspects of planning include financial, legal, residential, and vocational/educational planning.
  • Post-9/11 caregiver duties can be estimated as worth close to $3 billion (in 2011 dollars); the costs of lost productivity among post-9/11 caregivers are $5.9 billion (in 2011 dollars).
  • Most programs offering services to military caregivers tend to be targeted toward the care recipient, with his or her family invited to participate, or toward military and/or veteran families, of whom caregivers are a subset. These programs either make services available for family caregivers or they serve military families and within that group offer services for the caregiver subset.

Recommendations

  • Efforts are needed to help empower military caregivers, and should include ways to build their skills and confidences in caregiving, mitigate the potential stress and strain of caregiving, and raise public awareness of the caregivers' value.
  • Creating contexts that acknowledge caregivers' special needs and status — particularly in health care and workplace settings — will help caregivers play their roles more effectively and balance the potentially competing demands of caregiving and their own lives.
  • Programs relevant to the needs of military caregivers are typically focused on the service member or veteran, and only incidentally related to the caregiver's role, and there are specific gaps in needed programs, particularly for programs that help reduce the time spent performing caregiving duties, provide health care to caregivers, and offset lost income. Therefore, eligibility issues and these specific programmatic needs should be addressed.
  • Ensuring the long-term wellbeing of caregivers and the agencies that aim to support them may each require efforts to plan strategically for the future, not only to serve the dynamic and evolving needs of current military caregivers, but to anticipate the needs of future military caregivers in a changing political and fiscal environment.

Research conducted by

This report was prepared as part of a research study funded by Caring for Military Families: The Elizabeth Dole Foundation. The research was conducted within RAND Health in coordination with the RAND National Security Research Division, divisions of the RAND Corporation.

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