Table of Contents
Preface iii
Figures ix
Tables xi
Summary xiii
Acknowledgments xxvii
Abbreviations xxix
Chapter 1 Introduction 1
A Social Ecological Framework of Military Caregiving 3
Terms and Definitions 4
Organization of This Report 5
Study Overview 6
Cornerstones of Support: A Review 7
Past Surveys of Military Caregivers 8
RAND Survey of Military Caregivers 11
Limitations of Our Survey Approach 15
Past Environmental Scans of Caregiver Support Programs 17
RAND's Environmental Scan of Caregiver Support Programs 18
Limitations of Our Approach to the Environmental Scan 25
Review of Federal and State Policies to Support Caregivers 26
Chapter 2 Critical Lifelines: The Role and Contributions of Military Caregivers 29
Introduction 29
Estimating the Number of Caregivers in the United States 29
Care Recipients' Era of Service 31
Impact of Era of Service on Program Eligibility 32
Characteristics of Military Caregivers 33
Relationship of Caregivers to Care Recipients 33
The Impact of Relationship Status on Program Eligibiliry 35
Demographics and Military Characteristics of Caregivers 36
Duration of Caregiving 40
Caregiving Network 40
The People Military Caregivers Care For 42
Demographics 42
VA Disability Rating 42
Veteran Characteristics That Affect Program Eligibility 45
Types of Conditions and Relation to Military Service 46
Disease-Specific Programs 49
Functional Impairment 52
What Military Caregivers Do 53
The Tasks Military Caregivers Perform 53
Programs and Resources for Training Caregivers 57
The Time Military Caregiving Takes 64
Summary 66
Chapter 3 Understanding and Addressing Caregiver Needs: The Risks and Consequences of Caregiving and Programs to Mitigate Them 69
Introduction 69
Health and Well-Being of Military Caregivers 70
Physical Health 70
Health Care Coverage and Utilization 72
Programs That Offer Nonstandard Health Care for Caregivers 73
Mental Health 75
Mental Health Care Utilization 81
Programs That Offer Nonstandard Mental Health Care for Caregivers 82
Self-Reported Effects of Caregiving 84
Other Programs to Address Caregiver Health and Weil-Being 86
Family Relationships and Roles of Military Caregivers 95
Relationship Quality 95
Patenting 99
Programs to Address Caregiver Family Well-Being 100
Employment and Financial Well-Being of Military Caregivers 103
Financial Strain 104
Work Absenteeism 106
Programs to Address Income Loss 107
Service and Resource Utilization Among Caregivers 108
Sources of Help Specifically for Military Caregivers 110
Governmental and Nongovernmental Programs Supporting All Caregivers 112
Formal and Informal Social Network Sources of Help 113
Summary 114
Chapter 4 Evolving Needs: Sustaining Caregiver and Care Recipient Well-Being Now and in the Future 115
Aging Parents and Fragile Marriages 117
Future Planning for Caregivers 119
Sustainability for Programs Serving Caregivers 120
Potential Benefits and Costs to Society 122
Summary 123
Chapter 5 Closing Gaps: Conclusions and Recommendations 125
Conclusions 125
1 Relative to Non-Caregivers, Caregivers Have Consistently Worse Health Outcomes and More Strained Family Relationships 127
2 Military Caregivers Caring for Service Members and Veterans Who Served After September 11, 2001, Differ Systematically from Caregivers for Those Who Served in Prior Eras, as Well as from Civilian Caregivers 127
3 Though They Serve Military Caregivers, Most Programs for This Group Serve Them Incidentally-The Focus Is Typically on the 111, Injured, or Wounded Service Member or His or Her Family 129
4 Noticeably Lacking in the Array of Services Offered to Military Caregivers Are Both Standard and Nonstandard Health Care Coverage and Programs to Offset the Income Loss Associated with Caregiving 130
5 The Need for Military Caregivers Is Not Going Away, and This Demand May Actually Increase Over Time, and Have an Economic Impact on Society 132
6 While Notable Federal Policies Have Been Expanded or Created to Cater to Post-9/11 Military Caregivers, State-Run and State-Level Policies Focus Caregiving Resources on Those Providing Care to the Elderly 132
Recommendations 133
Objective 1 Empower Caregivers 133
Objective 2 Create Caregiver-Friendly Environments 136
Objective 3 Fill Gaps in Programs and Services to Meet Needs 139
Objective 4 Plan for the Future 141
Final Thoughts 145
Appendixes
A Survey Methods 147
B Survey Analysis 169
C Enumeration of Military Caregivers 179
D Environmental Scan Methods 183
E Environmental Scan Organizational Characteristics 191
F Federal and State Policies and Programs to Support Military Caregivers 211
G Programs and Organizations Excluded from the Environmental Scan 227
H Military Support Programs and Organizations Included in the Environmental Scan 245
References 247
