Post War Needs

Post War Needs Veterans, Family members and Caregivers

Unfortunately, in a nation where less than 1 percent of the citizenry wears a military uniform and just 13 percent are veterans, there is widespread misunderstanding — and even ignorance — about what service really means.

Too often, troops are seen as trained killing machines eager to engage in that singular objective, only to later return to the civilian world unskilled, uneducated, angry, damaged and dangerous.

Over the past 13 years of combat, popular media — books, movies, video games and, yes, newspapers — often have fed such misperceptions, peddling combat violence as entertainment that fills the vacuum of knowledge about the truth of who serves in uniform and how that experience shapes them.

that while the war in Afghanistan winds down and all US troops are home by 31 December 2014, the after affects of the war in Afghanistan and Iraq will be “forever” for those who lost their legs, for those families who have lost a loved one, for those vets with mental and physical problems, and for those with PTSD, TBI, and various other mental issues, and for those who have thought of suicide. And for those who have to cope with a suicide of a service member, there might be a lifetime of sorrow after US troops leave December 31, 2014.

After the cameras are turned off, will that father find a job once he leaves the service — a job that allows him to support his family? Will he have the support he needs to deal with any mental or physical challenges that he may face? And what about the families — will that spouse finally be able to pursue his or her own career when the family is transferred across the country again? How are the kids going to adjust to yet another new home, another new school, and another new set of friends?

These questions come at a pivotal moment for our military families — and for our country. By the end of this year, after 13 long years, our war in Afghanistan will finally be over. More and more of our newest veterans — the 9/11 After the cameras are turned off, will that father find a job once he leaves the service — a job that allows him to support his family? Will he have the support he needs to deal with any mental or physical challenges that he may face? And what about the families — will that spouse finally be able to pursue his or her own career when the family is transferred across the country again? How are the kids going to adjust to yet another new home, another new school, and another new set of friends?

These questions come at a pivotal moment for our military families — and for our country. By the end of this year, after 13 long years, our war in Afghanistan will finally be over. More and more of our newest veterans — the 9/11 generation — will be hanging up their uniforms and transitioning to civilian life.

So in the years ahead, that will mean fewer news stories and homecoming videos about our military families. And without these celebrations and reminders, it would be easy for us to forget the burden they’ve shouldered after more than a decade of war.

So in the years ahead, that will mean fewer news stories and homecoming videos about our military families. And without these celebrations and reminders, it would be easy for us to forget the burden they’ve shouldered after more than a decade of war.

Researchers estimate there are between 275,000 and 1 million women and men who are providing care or have provided care for military members or veterans who served in Iraq or Afghanistan. Caregivers include spouses, children and parents of military members and veterans.

Military caregivers are spouses with young children, parents with full- and part-time jobs, and sometimes even young children helping shoulder some of the burden. Government services available to this population are in their infancy; community service organizations offer diverse services but they are generally uncoordinated.

Military caregivers tend to differ from civilian informal caregivers in several ways. Military caregivers are younger and tend to live with the individual they care for, relative to civilian caregivers who tend to be older adults caring for elderly parents, often with age-associated illnesses like Alzheimer’s disease. Military caregivers must navigate multiple systems of health care and benefit providers for individuals who often face complex injuries and illnesses. The typical military caregiver is a younger woman with dependent-age children.

Caregivers help provide a broad assortment of aid, assisting with the normal activities of daily life such as bathing, dressing and eating, serving as mental health counsellors, advocating for better treatment, and even overseeing a family’s legal and financial needs.

In addition to general physical strain, caregivers may experience a greater incidence of disease and other health problems than the general population. Prior research on the general caregiver population found that they are at greater risk for coronary heart disease, hypertension, compromised immune function and reduced sleep. It also found that they suffer disproportionately from mental health problems and experience emotional distress associated with caregiving. However, studies on how these conditions compare in the military caregiver population are lacking.

This preliminary RAND study included two focus groups of military caregivers organized to provide insight about the challenges they face. Many of the wounded veterans cared for by participants had experienced a traumatic brain injury, the signature wound of the Iraq and Afghanistan conflicts. These service members and veterans also suffered from multiple health conditions, including musculoskeletal problems, hearing loss, respiratory problems and PTSD.

Many members of the focus groups reported having insufficient time or energy to devote to parenting and feared those circumstances would have negative consequences for their children.

In a 2010 survey of military caregivers done by the National Alliance for Caregiving, more than two-thirds of caregivers reported devoting more than 20 hours per week toward providing care. More than 20 percent reported providing more than 80 hours of care per week.

Military caregivers must navigate a bewildering maze of service providers that may have different eligibility requirements. Community-based efforts to serve the population are scattered and largely uncoordinated. Caregivers reported a need for training and assistance with tracking appointments and medication schedules.

Military Caregivers Differ From the General Caregiving Population

• While most of the focus on caregivers tends to be on older populations caring for persons with chronic conditions or dementia, military caregivers tend to be younger mothers with dependent-age children who are dealing with a different set of patient variables, including physical and mental trauma.

They Face Unique Challenges

• Along with providing assistance and assuming responsibilities typically conducted by nurses, orderlies and attendants, military caregivers also act as case managers who coordinate care, sometimes across multiple health systems, advocates for new treatment and better care, and financial and legal representatives for their loved one. Many of them are also parenting children and holding down jobs outside the home.

They Put Themselves Last

• General studies on caregivers indicate that caregivers suffer from physical strain and a general decline in physical and mental health. They tend to put their own concerns last, citing a lack of time and ability to get the hours needed for their own care. Military caregivers also suffer disproportionately from mental health problems and emotional distress.

Available Resources are of Limited Help

• Although there are programs offering information, training, assistance and support, many are government programs still in their infancy and community resources are scattered and uncoordinated. Difficulties are presented by differing eligibility criteria, lack of access, and the way caregivers’ needs change over time.

Recommendations

• Research is recommended to explore how caregiving needs of veterans and wounded service members change over time, how these changes will be met in the long-term, how decades of serving as caregivers affect military spouses, what happens when the care giver can no longer meet their loved one’s needs, and the long-term effects on child caregivers.

• Proposed research includes a comprehensive needs assessment of military caregivers, a formal environmental scan of resources available to military caregivers, and a gap analysis to identify where there are sufficient resources and where there is opportunity for improvement.