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Lyles TA, Cowper Ripley DC, Shorr RI, Tillman C, Coffeen-Carly M. Women Veterans and Their Caregivers: Implications for Assessing Potential Gaps in Providing Health Care in Rural Areas. Poster session presented at: VA HSR&D Rural Health / VA Office of Rural Health Field-Based Meeting; 2010 May 5; Portland, ME.
BACKGROUND:There are currently close to 2 million women veterans nationawide. The younger population of women veterans are more diverse group economically and ethnically, and more live in rural and highly rural areas. In addition, a growing population of older women Veterans are using the VA for the first time. OBJECTIVES:The overall objective of this study is to discover how women veterans and their caregivers, in rural settings, access the VA healthcare system and determine potential barriers encountered in access healthcare gaps, identify caregiver dynamics with the veteran, and capture the experiences of caregivers as they cope with stressors (burden) in caring for women veterans. METHODS:This was a non-funded, mixed methods pilot study with institutional approval (IRB#446-2009). Three dyads (N = 6) of women vets and their caregivers, all of which were spouses/partners and also veterans, were interviewed and asked to complete a short questionnaire. All participants were interviewed in their home. STATUS:From this study, it was noted that the transportation problem was not a "one size does not fit all" issue. Even though some veterans lived close to a VA facility, transportation problems arose. Being able to have "alternative" transportation methods to health care services was important. Some suggestions included providing free bus passes to veterans, reimbursing for taxi services (if their vehicle is inoperable), and engaging community transport services in addition to VA transports. The women were also concerned with how their spouse/partner's health impacted the lives of their family. Providing "house sitting" services for a spouse, if needed, or perhaps a system of scheduling appointments for a couple if they are both veterans, would reduce stress, time, and expense. FINDINGS:Women veterans ranged in age from 40 to 79, with spouses/partners' age ranging from 48 to 86. All dyads lived in the same home. Two of the couples lived within 10 miles of a VA facility and only one couple lived more than 20 miles from a VA facility. Women veterans, in general, tended to have higher resiliency scores than and also had higher confidence levels (self-efficacy) their partners/spouses. From the qualitative interviews, the women veterans had as many health issues/disabilities as their caregivers/partners. Regardless of the age group, all participants expressed strong concern with key issues: 1) transportation to a VA facility for appointments, 2) better communication between veteran and health care provider (i.e., having a "voice"), 3) lack of education provided to the veteran ("being aware," "I didn't know about my veteran eligibility"), and 4) underutilization of technology for patient care/management. Although the three women vets in this study were fairly highly functioning, those who had mild to severe health issues became "caregivers to the caregivers." The women were concerned about the health of their spouses/partners with little to no regard for their own health. IMPACT:Women veterans are the fastest growing population of health care users at the VA. Many are married, but younger women vets may depend on other family members for care, and many women veterans are first time VA users. A better centralized method of transportation, perhaps combining a technology with community partners, providing more opportunities for veterans to voice their concerns and opinions about their care, providing more opportunities for education (through their providers or other veterans), and finding alternatives for spousal care in the home if there is a need.