For the Wounded Vet, an Overworked Caregiver

Former senator Elizabeth Dole (fourth from right) and a group of fellows from her foundation were in Washington yesterday for the inaugural Military and Veterans Caregivers Week. The fellows were among those who shared stories about caring for wounded veterans as part of a new study on post-combat life. Photo courtesy of Lynn Dykstra, Focused Images, and The Elizabeth Dole Foundation.

In a decade of war, the United States deployed more than 2.4 million military service members. In Afghanistan and Iraq, more than 63,000 of them suffered injuries severe enough that they had to be medically evacuated. And 720,000 may have experienced a traumatic brain injury or met the criteria for post-traumatic stress disorder. 

We know a lot about the wounded. We know much less about the people who care for them. 

She–the primary caregiver for a combat veteran is almost always a woman, often a spouse–is younger than those caring for veterans of older wars. She still has dependent-age children. The wounded veteran in her care is likely to have multiple injuries, requiring the attention of different medical specialists, sometimes as many as a dozen. She is often the keeper of doctor visit schedules, as well as the person processing insurance claims; through the Defense Department, the Veterans Affairs Department, or private health insurance, and sometimes all three. How many of these caregivers there are experts can’t say. There are only crude estimates, ranging from about 275,000 to as many as 1.1 million. 

These are the sobering findings of a new study on so-called “military caregivers,” which was released yesterday by the Rand Corporation. The study finds that the burden placed on spouses and family members caring for wounded veterans is likely to have ripple effects. In general, caregivers get sicker faster than the general population, and often faster than the people they’re caring for. 

And yet the size of the caregiver population cannot be easily estimated or well understood because so few studies have been made. What the researchers have discovered comes from those, but also from interviews with caregivers themselves.  

They are “an overlooked and under-appreciated” group, said Adm. James Winnefeld, the Vice Chairman of the Joint Chiefs of Staff, at a luncheon yesterday at the Army and Navy Club, where the report was unveiled. Rand researchers said they plan new studies to better understand how many caregivers there are and what additional support they might require. The study was commissioned by the Elizabeth Dole Foundation, which also awarded three grants to non-profit organizations that focus on caregivers and their families. 

The foundation has also selected a class of fellows, which includes military spouses who now find themselves juggling their loved ones’ physical therapy and counseling sessions with their kids’ soccer games. They were among those who gave personal stories to the Rand researchers. 

I spoke with the wife of one Army veteran, Betty Easley, whose husband Greg was injured in an IED explosion in Iraq in 2003. Betty said she keeps a master calendar for all his doctor appointments, as well as the school and extracurricular activities for their six kids.  The big book travels with her wherever they go, she said. Greg ping pongs back and forth between different government health care programs depending on which specialist he’s seeing.  

Logistics are only part of the work. Betty said she has had to learn what will set her husband off–crowds and loud noises are the usual triggers. She knows now, sometimes with just a look, when it’s time to leave the store or the shopping mall, get him back to the car, and to go home. She said Greg is in counseling for PTSD and enjoys it. But she’s also beginning to see the signs of emotional strain on their kids. 

Talking to Betty, I was struck by the similar stories I’ve heard from people caring for an elderly parent or spouse. Last year, I wrote a story about a Washington couple, George and Trish Vradenburg, who are trying to find a cure for Alzheimer’s Disease. They told me about a common saying among caregivers: “Look at the person pushing the wheelchair. That’s who dies first.” 

The initial Rand report jibes with many of the stories I heard reporting on Alzheimer’s patients and their families. This is the first phase in what the researchers said will be a more concerted and focused effort to better understand how many caregivers there are, the range of their problems, and whether the existing health care system can support them better. It’s being led by one of the researches who worked on an influential study about PTSD. Several people at the luncheon were hopeful that the new study would shed light on the caregivers’ dilemma the way the earlier one did on vets suffering emotional trauma.