Caregiver Support in the Veterans Health Administration: Caring for Those Who Care

By Sheets, Carol J.; Mahoney-Gleason, Heather | Generations, Summer 2010 | Go to article overview

Caregiver Support in the Veterans Health Administration: Caring for Those Who Care


Sheets, Carol J., Mahoney-Gleason, Heather, Generations


The VA recognizes that caregivers play a vital role in the successful health outcomes of veterans.

On October 14, 2009, Eric K. Shinseki, Secretary of Veterans Affairs, told the House Committee on Veterans Affairs in his "State of the VA" address that the Department of Veteran Affair's (VA) mission is "to care for our nation's veterans, wherever they live, by providing them the highest quality benefits and services possible." Of the nation's 23.4 million veterans, 7.8 million choose the VA as their provider of healthcare services and benefits. (Shinseki, 2009).

Veterans and families have made sacrifices on behalf of the American people. Veterans from World War II, the Korean War, and the Vietnam War are aging, which brings with it physical and psychological changes that often require a caregiver to provide support and to meet the care needs of the veteran. In some cases, caregivers anticipate taking on the caregiver role and know in advance what will be expected of them. On other occasions, family caregivers have little or no notice that their lives are about to drastically change, as when veterans severely injured during combat in Iraq or Afghanistan require lifelong care.

The Veterans Health Administration (VHA) currently has limited statutory authority to use appropriated funds to provide services to family members of veterans or those individuals who live with or who take a veteran into their home for care. The VA's mission is to provide the best healthcare to veterans; supportive services are provided to caregivers only when those services are directly related to the veteran's healthcare. For example, if a veteran is receiving rehabilitation for a new spinal cord injury, VHA staff can provide education and training to the spouse who will become the veteran's caregiver. But, the VHA cannot provide healthcare or mental health services solely to caregivers separate from the veterans treatment plan.

Who Are the Caregivers of Veterans?

The VA recognizes that caregivers play a vital role in the successful health outcomes of veterans. Since 2008, the VHA has been developing a comprehensive national caregiver support program. Through this program, national caregiver support points of contact have been identified at all VA medical centers throughout the United States. The VHA implemented a national caregiver support advisory board and has implemented five national work groups to provide expert clinical input into the development of the program.

The VA is focusing on eight major areas of caregiver support: respite care, education and training, VA supportive services, community resources, caregiver wellness, emotional and spiritual health, emergency preparedness, and home safety.

In the 1990s the VA was reorganized, impacting healthcare delivery services and implementing managed care principles to shift from inpatient-based care to an outpatient system focused on primary care and preventive services. Kenneth Kizer, the VA's Under Secretary for Health during this period, stated: "VA care is an organized approach to reducing variations so that the right care is provided in the right way at the right time in the right place for the right cost each and every time" (Kizer, 1999).

The changes decreased inpatient stays and offered more services at home and in the community. But the changes also resulted in greater demands on veteran's families, who often provide caregiving services in the home.

Typically, there are two kinds of caregivers: informal and formal. Informal caregivers provide care without being paid, such as family members, partners, friends, or neighbors; formal caregivers are paid or are volunteers through a service delivery system, such as home healthcare or nursing home employees (Fradkin and Heath, 1992; McConnell and Riggs, 1994). This article will focus on the needs of informal caregivers.

According to the National Alliance for Caregiving and AARP (2009), there are an estimated 65. …

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