Veterans’ Families: Caring for those who care

August 16, 2016 - Ottawa, ON

---

• The impact of a Veteran’s illness or injury is felt by the whole family and they should be supported.
• Veterans Affairs Canada (VAC) provides some support to families and I encourage them to better promote the VAC Assistance Service to those needing support.
• I would also encourage VAC to address two gaps by providing mental health treatment benefits to families in their own right and by considering a caregiver benefit for informal Veterans’ caregivers.
• Please share your thoughts on what supports families need by letting VAC know directly through their online consultation.

---

I have often said that the well-being of the Veteran is inextricably linked to the well-being of the family. When a member serves in the military, the entire family serves as well. The impact of a member’s illness or injury is, similarly, felt by the whole family.

As part of the Office of the Veterans Ombudsman’s (OVO) work on transition, we have been consulting with Veterans and with family members in order to better understand their challenges and their needs. We recently published a review on the role of families and the challenges they face during transition. We followed that up with a Twitter chat on families in transition where we heard directly from family members on what works for them and what they need.

We know that family members often act as informal caregivers for their ill or injured Veteran. Research shows that caring for our most seriously injured Veterans can take a physical and emotional toll on family members and that they may require more support as a result of the care they provide. It is crucial to acknowledge the important role these caregivers play and to compensate them fairly for the work they provide in terms of caring for the Veteran.

Research shows that:

• Informal caregivers to modern-day veterans tend to be younger, employed and likely have children but they can also be adult children, parents, other family members or even non-relatives.[i]
• Caregivers support the most seriously ill and injured Veterans by doing basic functional tasks such as bathing and managing medications. But they also assist by coordinating and arranging care, advocacy, coordinating household tasks and helping to cope with stressful situations and other emotional and behavioural challenges.[ii]
• The presence of an informal caregiver can improve the care recipient’s well-being and recovery, and reduce medical costs by enabling home-based or community living for the disabled.[iii]
• Caregivers face strain on family relationships, may experience worse health outcomes, and more workplace problems than non-caregivers, as well as higher levels of burden, distress, stress, physical and mental health problems (such as anxiety and depression) and lower levels of life satisfaction.[iv]

In our family review, we compiled a comprehensive list of the programs currently available for families. The review noted that families receive substantially more support now than in the past, but there are still a number of gaps in the support provided to families including a lack of communication about services available to them; a lack of outreach – especially to those in crisis –; a lack of treatment benefits for family members in their own right; a lack of compensation for caregivers; and lack of access to a dental plan. 

Recently, VAC has made some improvements in the support they provide to families, including:

• a pilot project that expands access to certain Military Family Resource Centres to medically-released Veterans and their families for up to two years post release;
• increased support and counselling available through the VAC Assistance Service to 20 sessions per year (increased from 6 in December 2014);
• an online tool developed in partnership with the Royal Ottawa Hospital designed for caregivers and families of Veterans living with an operational stress injury (OSI); and
• an announcement of a contract to deliver online education for caregivers, beginning in 2017.

These improvements are a step in the right direction, and we will continue to monitor their progress. That being said, there is still an urgent need to provide better support to families who may be vulnerable. The two improvements that I believe could have the greatest impact are:

1. enhanced mental health treatment benefits to families in their own right; and
2. a modern caregiver benefit.

Treatment Benefits

Where a family member suffers from an illness or injury that is related to the unique conditions and challenges of military service, we have a responsibility to provide that family member with the care they need. For example, in those exceptional cases where the child of Veteran suffers from clinical anxiety or vicarious Post Traumatic Stress Disorder as a consequence of the challenges a Veteran is struggling with, they should be able to get help in their own right. Their eligibility for services should be based on their need for treatment, not on the needs of or impact on the Veteran.

The primary provision of support to family members in their own right is the VAC Assistance Service which provides counselling and referral services free of charge. Those accessing the service can receive up to 20 counselling sessions with a trained professional. This is a valuable service, and based on referral stats, the evidence suggests that clients are happy with the service they receive. The uptake overall, however, is surprisingly low with a utilization rate of just 0.38 percent. In my outreach, I have often met Veterans and family members who were unaware of the availability of this program. I would encourage VAC to better promote the availability and details of this program so that more Veterans and their family members may benefit.

However, the VAC Assistance Service does not provide diagnosis or treatment services. Research has found that families and Veterans both benefit from and should have access to mental health treatment in their own right. VAC provides diagnosis and treatment services through OSI Clinics across the country. This service, however, is only available to family members if the treatment is related to the needs of the Veteran. I would propose that family members would benefit from access to diagnosis and treatment benefits in their own right.

Caregiver Benefit

In 2015, VAC acknowledged that informal caregivers make a vital contribution to the health and well-being of ill and injured Veterans. They created a new benefit, the Family Caregiver Relief Benefit, to ensure that the Veteran gets the needed support while his / her informal caregiver takes a much-needed break. This benefit does not recognize or compensate the caregiver themselves for the work that they do to care for the Veteran. 

Several of our Allies, including the United States, the United Kingdom and Australia, already provide some form of compensation for caregiving. The United States has a program, specifically targeting Veterans’ caregivers, which provides a monthly financial stipend as well as training and other support services for family caregivers of post-9/11 Veterans.

Past and present VAC programs, including the Attendance Allowance, the Veterans Independence Program, the Family Caregiver Relief Benefit, and the Canadian Armed Forces (CAF) Attendant Care Benefit, have all been used to address caregiving, but they do not directly compensate the caregiver for the work they do (see table). As a result, I have been consistently recommending that a new benefit be developed that recognizes and compensates the caregiver directly for the care that they provide to the Veteran. 

The intent of this benefit should be to recognize informal caregivers and compensate them for the increased responsibility and workload they bear in providing care to an ill or injured Veteran. Some key aspects the benefit should include: 

• Needs-based (i.e. level of care required and being provided);
• Compensation based on various levels of support that may be required and that may change over time;
• Eligibility that takes into account the unique support required for mental health needs and the advocacy/co-ordination role family caregivers are often required to fill; and
• Adequate training for the level of care required.

VAC has taken steps to better support families, and we would encourage them to rigorously evaluate the uptake and effectiveness of these programs, including the expanded access to Military Family Resource Centres, increased sessions through the VAC Assistance Service, and online tools for caregivers. My office will also continue to monitor recent initiatives.