Advocates for veterans with traumatic brain injuries are calling for a sunsetted assisted living program for them to be relaunched or replaced with a similar program, a new RAND report notes.
The report, “America’s Military & Veteran Caregivers: Hidden Heroes Emerging from the Shadows,” was released Tuesday. It highlights the now-defunct Department of Veterans Affairs’ Assisted Living for Veterans with Traumatic Brain Injury, or AL-TBI, pilot program, which began in 2009 and placed eligible veterans in specialized private-sector residential care facilities for neurobehavioral rehabilitation.
“Although much caregiving is done in people’s homes and, in fact, is performed to keep care recipients out of residential facilities, some families may decide that residential placement is the best way to keep individuals safe,” the report authors stated.
The Veterans Access, Choice and Accountability Act of 2014 extended the program through October 2017, but it was not renewed. Although the pilot program was to be evaluated, the report authors were unable to find an evaluation to determine the program’s effects on care recipients or their caregivers.
Expanding HCBS
The report authors also noted the recent expansion of home- and community-based healthcare options, including assisted living options, home health aides and adult day programs, many of which are offered to eligible veterans in recognition of most older Americans’ desires to age in place.
The optimal suite of home- and community-based services for veterans living with dementia, depression or posttraumatic stress disorder remains unclear, they said, adding that some veterans may need the higher levels of care and services found in residential care communities such as assisted living communities.
“Though HCBS hold promise, they will not entirely eliminate the need for long-term residential care facilities,” the authors wrote. “Policymakers need to plan carefully to ensure the appropriate mix of services to better care for current wounded, ill and injured vets, as well as the projected needs as the veteran population ages.”
In addition, the report recommends that employers create more caregiver-friendly workplaces and communities. Among the authors’ suggestions are educating current caregivers and employees about Medicare and Medicaid coverage for long-term care, home care and other community-based services, including identifying gaps in coverage and options for addressing those gaps.
More than 14 million adults (14.3 million), representing 5.5% of the adult population, are caring for wounded, ill or injured service members or veterans, according to the report.
The publication documents the diversity of caregivers, their contributions to society and the challenges many still face. It is an update to a 2014 “Hidden Heroes; America’s Military Caregivers” report documenting how many American adults were providing care to wounded, ill and injured service members and veterans; how their experiences compared with those of other caregivers; the effects that caregiving had on their lives; and support services available to them.
The updated report includes data from the 2023 RAND Caregiving Survey, with new estimates and insights on the potential consequences of caregiving on caregivers’ health, economic security and well-being. The 2023 survey found that 14% of military/veteran caregivers cared for someone “currently staying in a medical center, nursing home or some other care facility.”
