Wellbeing Among Caregivers of Veterans Who Applied for Comprehensive Caregiver Support Through the VA

In 2011, the Department of Veterans Affairs established the most comprehensive caregiver support services in the United States (US): the Program of Comprehensive Assistance for Family Caregivers (PCAFC). Eligible caregivers receive a stipend, mental health care, self-care classes, peer mentoring, caregiver skills training, health care coverage, and travel benefits among other supports. In 2020, VA substantially expanded program access and services, yet no studies have examined PCAFC applicant characteristics since expansion.

To characterize the well-being, quality of life, and health status of PCAFC application since 2020.

A cross-sectional, descriptive study using VA administrative data and surveys from caregivers of veterans at the time of application to PCAFC.

Veterans and their caregivers who recently applied to PCAFC between January 1, 2022, and December 31, 2023.

Caregiver well-being was assessed via the 12-item Zarit Burden Scale, the CESD-10 Scale, the Caregiver Reaction Assessment subscale of perceived financial strain, and care-related quality of life. Veteran health status was assessed using activities of daily living/instrumental activities of daily living and the Jen Frailty Index Score (risk of institutionalization).

The sample includes 1522 caregiver/veteran dyads. Nineteen percent of caregivers screened positive for depression, 27% reported clinically significant subjective burden, and nearly 50% of caregivers reported some level of financial difficulty. However, caregiver quality of life was 75.9 out of 100. Nearly 90% of the veterans were rated as having severe or total ADL/IADL problems and, on average, veterans had a moderate risk of long-term institutionalization.

Prior to enrollment in the program, caregivers provided intensive caregiving and a substantial proportion reported clinically significant levels of depression and burden and high financial strain. However, quality of life was rated highly. While improvements in the health and well-being of this cohort are needed, caregivers demonstrate substantial resilience despite intensive caregiving experiences.