Study Shows Significant Financial Burden for Caregivers of Veterans with Polytrauma and Traumatic Brain Injury

BACKGROUND:
The Caregivers and Veterans Omnibus Health Services Act of 2010 aims to reduce financial strain for caregivers by providing financial stipends to those who care for severely injured OEF/OIF Veterans. However, it is not yet known whether caregiver stipends will be sufficient to cover the costs of caregiving for Veterans with polytraumatic injuries. This study (conducted prior to the implementation of stipends from the Caregivers and Veterans Omnibus Health Services Act) evaluated the prevalence of financial strain as measured by asset depletion and/or debt accumulation, and labor force exit among caregivers of Veterans with polytrauma and traumatic brain injury (TBI). Factors associated with financial strain also were examined. Using data from the Family and Caregiver Experience Survey (FACES), investigators identified 1,045 Veterans with polytrauma, including TBI, who had received inpatient rehabilitation care at any of the four VA Polytrauma Rehabilitation Centers between 9/01 and 2/09 and received completed surveys from 538 caregivers (survey conducted from 6/09-12/09). In addition to queries about caregiving tasks and time spent caregiving, caregivers were asked about financial stability, work and income history, changes in work status after becoming caregivers, asset depletion, debt accumulation, and out-of-pocket costs associated with caregiving.

FINDINGS:

• Financial strain is common for caregivers: 62% reported depleted assets and/or accumulated debt, and 41% reported leaving the labor force. The latter finding stands in sharp contrast to studies in other populations internationally, where between 2% to 27% of caregivers left the labor force.
• If a severely injured Veteran needed intensive help with activities of daily living, the primary caregiver faced 4.6 higher odds of leaving the labor force, and used $27,576 more assets and/or debt to help care for the Veteran compared to caregivers of Veterans needing little or no help.
• Male caregivers, those providing care since the time of injury, and those providing care to Veterans with high-intensity needs and with the lowest overall functioning at time of discharge experienced significantly higher amounts of asset depletion and/or debt accumulation compared to female caregivers, caregivers relatively new to their role, and those providing care to higher functioning Veterans with low-intensity care needs.
• Spouses did not face higher financial strain compared to parents; financial strain was no higher for caregivers of those injured in Iraq, Afghanistan or the Middle East compared to those injured in the U.S., and the timing of injury was not associated with greater financial strain.

LIMITATIONS:

• Because asset and debt amounts are self-reported, the true amounts may be higher or lower, or the amount may have been misattributed to caring for the Veteran rather than other reasons, such as the economic downturn or other factors that affected household finances.

AUTHOR/FUNDING INFORMATION:
This study was funded by VA/HSR&D's Quality Enhancement Research Initiative (SDR 07-044). Dr. Van Houtven also was supported by an HSR&D Career Development Award (MRP 05-311), and she is part of HSR&D's Center for Health Services Research in Primary Care, Durham, NC.

Van Houtven C, Friedemann-Sanchez G, Clothier B, et al. Is Policy Well-Targeted to Remedy Financial Strain among Caregivers of Severely Injured U.S. Service Members? Inquiry Winter 2012/13;49(4):339-51.