More than 20% of the U.S. population will be aged ≥ 65 years by 2030, an increase from 13% in 2012. 1 The likelihood of needing assistance with activities of daily living (ADLs) increases with age. 2 People who need such assistance often depend on informal and unpaid assistance from friends and family. In 2009, about 65.7 million Americans (28.5%) provided informal care for people with an illness or disability, and that number only is expected to rise. 3 These informal caregivers provide up to 80% of the total care hours needed by community-dwelling older adults—an estimated economic value of $450 billion in unpaid contributions in 2009. 4,5
Caregiving can lead to significant physical, psychological, social, and financial burdens. 6 The caregiving burden is associated with a host of adverse health behaviors and outcomes such as poor diet, lack of exercise and sleep, smoking, decreased participation in preventive health care, anxiety, depression, relationship difficulties, employment disruption, financial hardship, suicide, and higher mortality compared with that of noncaregivers. 6-10 Additionally, care recipients are at increased risk for abuse or neglect when the caregiver is experiencing a significant burden. 11 Therefore, efforts to improve caregiver support are important for both partners in the caregiver/care recipient dyad.
Caregiver support is beneficial to the health of caregivers and care recipients. 10,12 For example, the Resources for Enhancing Alzheimer’s Caregiver Health (REACH) program has been shown to reduce the stress of informal caregiving and the risk of depression in caregivers. 13,14 This program showed similar effects when implemented within the VHA. 14 In the Partners in Dementia Care project, the VHA and Alzheimer’s Association coordinated care and support for veterans with dementia and their family and friends. This intervention resulted in lower caregiver strain and depression scores among participants. 15
With a growing medical literature that shows the benefits of caregiver support interventions, the VHA developed a robust support program for informal caregivers of veterans. The VA caregiver support website (www.caregiver.va.gov) provides information and resources targeted to caregivers for veterans, including psychosocial and functional support for caregivers. The psychosocial support provided by the VA includes caregiver education, counseling, access to caregiver support coordinators, a caregiver support line, support groups, and referral to community support organizations. 16 Functional support on the site includes financial assistance toward skilled home care, home hospice care, adult day care, home-based primary care, homemaker and home health aide services, telehealth, and respite care. 16 Veterans who are caregiving for nonveterans have access to VHA psychosocial support but not to functional support services. For these veterans, functional caregiver support must come from family or referral to community organizations.
Background
In the U.S., about 11% of caregivers are veterans, but the availability of data about these caregivers is limited to veteran subgroups. 3 For example, a 2011 study reported that 20% of veterans aged ≥ 60 years are caregivers. 17 However, this estimate included child care for unimpaired children, which is not commonly included in other caregiving estimates. In another study, 30% of middle-aged active-duty officers reported helping their parents with instrumental ADLs (IADLs). 18 These data suggest a significant proportion of veterans may be caregivers; however, the estimates do not identify prevalence of caregiving among a population of VHA enrolled veterans.