While some of the elderly population that receives home care includes veterans who have served our country, not all of the veterans who require home care services are elderly.
And for these younger veterans there are often different types of care needed for issues like post-traumatic stress disorder, traumatic brain injuries and loss of limbs.
There are 23 million veterans and three million of them live with service-related disabilities, according to the Veterans Administration. Of the veterans returning from the conflicts in Iraq and Afghanistan, 43,000 are living with the effects of traumatic brain injuries; 16,000 suffered catastrophic or devastating physical injuries; 8,400 live with amputated or badly mangled limbs; there are 4,000 new cases of post-traumatic stress disorder (PTSD) diagnosed each month.
“The veterans are harder to care for than the typical population in home care,” said Ramona Streit, owner of Homewatch CareGivers serving Torrance, South Bay and Los Angeles Harbor in California. Streit has a contract with the local Veterans’ Administration and nearly half of her business involves caring for veterans.
Often what makes caring for veterans so difficult, Streit said, is the problems for which there are no veteran statistics: hoarding and combative anger, to name a couple. In addition, these veterans are more likely to switch caregivers—she has one client who has gone through 10 caregivers in one year. “The difference between caring for veterans and the aging population is that veterans are still cognitively there,” she said. “They want to get out and be active.”
One of Streit’s clients is John F., a 50-something Vietnam veteran who is blind and has PTSD (both of which he attributes to exposure to Agent Orange, an herbicide sprayed on forested land during the Vietnam War to defoliate trees and expose enemy fighters). He also has diabetes, kidney ailments, experiences sleeplessness and restlessness. “He’s a very pleasant person on his good days,” said Streit. “On his bad days he won’t even open the door.”
Although John F. is married, he needs in home care to assist him with bathing, housekeeping, meal preparation, and transportation to and from the V.A. for doctor’s appointments. “Not only are the veterans themselves more difficult, but then you add in dealing with their spouses and family members and their frustration,” explained Streit. John F.’s wife is on dialysis and Streit said that often caregivers are helping the whole family of veterans, not just the veteran. John has cycled through four caregivers in 10 months, but Streit calmly explains that he is not one of their most challenging cases.
To help prepare her caregivers for these special circumstances with veterans, she provided additional training on hoarding and PTSD that she got from the V.A. Home Care Training Specialist Nicole Brackett recommends courses from Homewatch CareGivers University that address with depression, which is often an underlying cause of hoarding, and behavior management for caregivers who have veteran clients.
“These deal with, ‘how do we help them when they don’t want us to clean their home?’,” explained Streit, who described home settings so filled with clutter that they bordered on unsafe with rotting food left out for weeks and narrow paths between ceiling-high stacks of personal belongings.
As overwhelming as some of these cases may seem, it is part of the process for both caregivers and the clients to adapt to in home care for veterans. “We are actually supplementing V.A. care with private pay care once they get used to us,” said Streit. “They want us to be there more often. The care turns into respite care when the wife or husband needs to get out.” She cites one client whose wife needed time alone so the caregiver took the client to a train station that he enjoys visiting.
Statistics from a study by the United Health Foundation show that care for a veteran with service-related health conditions is a longer-term challenge with a higher burden of care. These veterans tend to need assistance with activities for daily living such as bathing, dressing and feeding as well as help with housework, transportation and grocery shopping. As a result of this great need, their family caregivers report higher emotional stress and physical strain along with financial hardship.
Given all of these variables, Streit and her staff of caregivers remain sympathetic to these veterans. “I always tell my caregivers, ‘You haven’t walked in their shoes. You don’t know what has happened to them’,” she said. “It’s a privilege to serve them in their time of need because they served our country.”