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Director's Letter

VA’s original mission is reflected in our motto taken from Lincoln’s second inaugural address: “to care for him who shall have borne the battle and for his widow, and his orphan.” This motto, however, is no longer sufficient. Due to the increasing number of Veterans who suffer from dementia, other problems of aging, or severe wartime injuries, and who need extensive home support, VA recognizes that Veterans’ caregivers are also in need of support. As outlined by Meg Kabat in the lead commentary article, efforts began with programs to assist caregivers of patients with dementia, then got a significant boost with the creation of the comprehensive caregiver support program in 2011 in response to legislation allowing VA to support caregivers for Veterans wounded in conflicts in Iraq and Afghanistan. The logic of supporting caregivers seemed straightforward: Veterans prefer care at home, yet care takes significant economic, emotional, and physical tolls on family caregivers. Few family members know how to handle the complex medical and psychological needs of ill Veterans. But because institutional care is costly, investing in caregiver support could be cost-neutral if it even modestly reduced the need for institutionalization. The economics and logistics of delivering effective caregiving support has proven complicated. Providing caregiver support involves determining the unique needs of patients and their families and developing effective education or training programs to meet those needs.

The innovation, testing, and revision needed to create effective programs would not be possible without the careful qualitative and quantitative information produced by our research community. Because of their efforts, we have a clearer picture of how to deliver high quality, Veteran- and caregiver-centered support. The work described in this issue is a testament to the power of an embedded research program with strong program partnerships. VA leads the nation not only in our caregiver support programs but in research on caregiving. This research will not only improve the lives of Veterans and their caregivers, it will also help pave the way for health systems across the country to do the same.

David Atkins, MD, MPH, Director, HSR&D