The Impact of the COVID-19 Pandemic on Veteran Caregivers: A Mixed Methods Study to inform the VA Caregiver Support System

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Background: The COVID-19 pandemic has had cascading impacts for families and communities. Concerns have been raised for potential negative physical and mental health consequences due to the immediate risk of COVID-19 and the secondary social and economic effects. Family caregivers may be especially vulnerable to short- and long-term impacts. • Significance/Impact: Informal caregivers provide the majority of home and community-based long-term care. A majority of functionally impaired Veterans rely on informal care for daily support and condition management. Negative impacts from the pandemic have the potential to reduce the capacity of informal caregivers to support Veterans choosing to remain at home. • Innovation: There are no known studies of how the pandemic has impacted Veteran caregivers. This study provides a unique opportunity to learn about an essential ally in the care of Veterans, and the ways in which the VA system can enhance their support for Veterans experiencing functional and clinical impairment. We uniquely combine an ecological systems framework and the concept of “cascading effects” from disaster research to help us frame and understand the different complex short- and long-term effects caregivers may experience. • Specific Aims: Aim 1. To describe both positive and negative caregiver experiences during the COVID-19 pandemic and to identify threats to long-term caregiver resiliency. We will conduct surveys with Veteran caregivers from each of our 5 sites (San Antonio, Palo Alto, Miami, Salt Lake City, Durham), to describe variability of impacts and to purposively sample caregivers for in-depth, semi-structured interviews. We will triangulate findings from interviews with local VA caregiver stakeholders. Aim 2. To feedback preliminary data and debrief with VISN and national level VA stakeholders to understand how these issues are perceived and responded to at a regional and national level, and their priorities for caregiver services and research. Aim 3. To engage Veteran caregivers in a participatory, deliberative process to identify top priorities for future research and intervention. • Methodology: We will conduct a 15-month, multi-sited, mixed methods study, utilizing a brief Veteran caregiver survey, semi-structured interviews with caregivers and VA stakeholders, and virtual focus groups with caregivers. We will focus on how caregivers have been impacted and responded, VA organizational responses, and identifying priority areas for future research and intervention. Implementation/Next Steps: This pilot is a first step toward developing a long term understanding of how Veteran caregivers and their capacity for caregiving have been and will be impacted by the pandemic. It is an entry point for developing more tailored and sensitive (e.g., to inequities) VA Veteran caregiver system supports. Our design includes feedback loops to VA stakeholders and partners so that our findings may be actionable and inform ongoing research and caregiver-centered, operations work.