As the wars rage on in Iraq, Afghanistan and beyond, our Armed Forces continue to be prepared for lengthy overseas deployments, often serving multiple or extended tours of duty. This has created unparalleled stress and trauma; not only on those who serve, but also on their families during these deployments and upon their returns. Families make tremendous sacrifices so that these men and women in uniform can provide military service and advance the cause of freedom throughout the world. Families are also a vital support system to these service members and their roles can not be underestimated.
 
When service members go to war, the nuclear and extended families also “go to war” and are impacted by the outcomes. Unfortunately, combat can result in severe injuries, disabilities and casualties. Many veterans have now returned home to thousands of families who face daunting challenges and may be unprepared to care for them. Lives are altered and rearranged at all levels to care for the physical injuries and emotional needs of loved ones. Many of these family members, including children, experience a change in their roles and have become “caregivers.”
 
Fortunately, in this day and age, caring for our military members also includes tending to the well-being of their families and caregivers. A multitude of programs and resources are now available or are being developed to assist our Armed Forces members as they return to duty or civilian life and to assist their family members as they face new roles and expand their capacity to provide care.

Family Transitions and Support:
Upon a veteran’s return from the battlefield, the entire family will go through a period of transition that includes restoring trust and wholeness in the family circle. This is the most important time frame to seek support and gain knowledge about the changes and difficulties that may be present.
 
In recent years, the VA (Veterans Administration) identified a six-phase “Cycle of Reintegration.” The phases also directly involve and impact caregivers and family members as the veteran reunites with them.

Phase One: “The Honeymoon”: elation and joy, relief and celebration
Phase Two: “Disillusionment”: role changes, life at home doesn’t feel the same, pace of life is different, new stresses may emerge
Phase Three: “Alienation”: no one “gets it,” “I want to go back,” risk of drug/alcohol abuse, frustration, boredom, feels distanced from the military routine and comrades
Phase Four: “Engagement”: intervention by the family, motivation to change, counseling/support groups, return to work, seek new routines and connections
Phase Five: “Acceptance”: realization that life is different, “I am different,” “you are different,” relearning takes place, negativity is replaced by gratitude
Phase Six: “Finding a New Normal”: aiming for stability and lifestyle balance, prioritizing life issues, working together to set new goals
 
Understanding these phases and utilizing counseling support services through the military or local programs will be a key to a positive adjustment for the veteran and the entire family system.
 
The need for family support during times of deployment and upon the return of service members has always existed. Family Readiness Groups (FRGs) and support groups are available through each branch of the Armed Forces to provide social and emotional support, outreach services, and information prior to, during, and in the aftermath of military separations. The camaraderie and strength that develops between military families that face uncertain times together is priceless.
 
Military family retreats, provided through many military branches, are another example of support for families and caregivers. They provide combat veterans and their families with the education, training and skills needed to manage their lives after serving in a war. The retreats are often held in a rural, private area, are staffed by trained volunteers and counselors, and are usually free. Youth and children’s activities are provided along with educational and support sessions for veterans and their spouses. These topics may include: self care, relaxation techniques, stress reduction, sleep solutions, problem-solving skills, money management, intimacy issues, communication, VA services and more.
 
Positive results have come from these retreats as families have attested: “This experience has pulled our family from the brink of destruction,” “The retreat gave our family a boost of self-worth,” and “Everybody faces challenges with the aftermath of war. It is good to know, see and feel that it is normal.”

Taking Care of the Caregiver:
Family members may face the prospect of starting a new chapter in their own lives if their loved one returns from military service with an injury or disability. Many have had to put life on hold, leave jobs or change residences to care for a spouse, adult child or significant other. Caregiving can be overwhelming as one tries to meet all of the emotional, physical and medical needs of a veteran. Mourning the loss of a “normal” life and relationship prior to the war may also occur. At this point, it’s important for caregivers to accept that things have changed and to surround themselves with their own spiritual, emotional and physical resources.
 
The health and emotional well-being of the veteran’s caregiver also needs to be a priority. If not addressed, caregiver fatigue, illness and impatience can directly reflect on and impact the quality of care that one is able to give. An important analogy can be found in our airline industry. Just as the flight attendant instructs passengers to use the oxygen mask on themselves first and then assist the person next to them, so must the caregiver follow the same important instructions.
 
Caregivers who learn what help is available to veterans and how to access that help will feel more in control of a complex situation. Some ideas are:
 
Become educated about the veteran’s medical condition, whether physical or emotional.
 
Learn to communicate with members of the health care profession. Write down questions prior to appointments and, if needed, have an additional person attend appointments to gather important information.
 
Keep good medical records and summaries of office visits. Bring identification and health insurance cards, plus names and doses of the veteran’s medications to the appointments.

Learn the routines and points of access with the medical facilities used by the veteran. This includes office hours and how to reach health care providers, schedule appointments and transportation.
 
Inquire about assistive technology devices and utilize home care and skilled-care services.
 
Find out about benefits that are available through the military and Department of Veterans Affairs.

Additional Caregiver Keys Include:
Asking for help (it is a sign of strength)
 
Taking breaks to restore energy
 
Making one’s own health needs and medical appointments a priority
 
Learning proper caregiving techniques such as lifting, transferring, or wound care from medical professionals at the VA or other medical facilities 
 
Connecting or reconnecting with a faith-based community for support
 
Establishing a circle of support around the family that includes professionals, relatives and (military) friends who are able to share the care and reduce stress

Community Support is Priceless:
Fostering community support for veterans and military families is essential to their readjustment and stability. If the community is committed to helping and supporting them, the period of readjustment will be more successful. This support can take many forms, and state governments and citizens across the nation are proposing new initiatives and partnerships to help speed up and expand services to veterans and their families.
 
The Minnesota National Guard, for example, has been heralded for a program that hopes to change how soldiers and airmen are reconnected to their families and communities. “Beyond the Yellow Ribbon” is named as a reminder that the support of soldiers and their families must not end when they return from their deployment and the yellow ribbons are removed. The program offers a roadmap of important steps to take care of the soldier’s physical and emotional health, personal business/benefits, health, education, legal issues, employment, and family needs including marriage enrichment and parenting.
 
Chaplain Major John Morris of the Minnesota “Beyond the Yellow Ribbon” campaign made this analogy.  “Going into combat is a little like canoeing across the lake of life. When you leave for war, it’s like standing up in the canoe and upsetting the balance of family life. While you’re gone, your family takes over the paddling and tries to survive. When you return, you climb back into the canoe, and flip it, swamping it. Many families have been faced with bailing out that canoe, and they suffer extreme duress over something they thought would be joyful. A lot of families can become exhausted from paddling that canoe through life.”
 
Chaplain Morris encourages returning veterans to seek whatever help they need to make a successful adjustment back into their families, relationships and community lives.
 
Another example is a program developed by Mary Pawlenty, wife of Governor Tim Pawlenty of Minnesota, called the “First Lady’s Military Family Care Initiative.” She has brought together service groups, community organizations and faith-based groups throughout the state, all of whom have expressed a strong desire to provide a wide selection of volunteer services to military families. A simple task like mowing the grass, assisting with chores or preparing a meal can go a long way toward helping a family in their time of need.
 
“Homes for our Troops” (part of the Defense Department’s “America Supports You” program) is yet another option available to wounded service members and their families. The program builds or remodels homes (at no cost) to accommodate the specific needs of the severely wounded soldiers who are returning from Afghanistan and Iraq. Their goal is to adapt, build and remove obstacles in the homes to meet the needs of a veteran who is in a wheelchair or who faces injuries that hinder mobility. The organization provides services specifically to troops who are double amputees, paraplegic, quadriplegic, have severe post-traumatic stress disorder, or are severely burned. “Homes for Our Troops” has successfully partnered with the communities where veterans live to help fund the projects by holding benefits/fundraisers, donating materials and utilizing local professionals.

Veterans Administration Role:
The VA supports caregivers as they support our veterans, including those who care for recently wounded or ill veterans as well as aging veterans. Although the VA system has been inundated with requests for care and is often criticized for their service limitations, strides continue to be made toward greater care options and contracts with existing programs.
 
For example, in December of 2007, the VA announced that $4.7 million was allocated to help caregivers. Since family caregivers are on the front lines to care for veterans, the goal of the VA is to form a partnership between family caregivers, the VA itself and community-based agencies.

The VA is now funding “caregiver assistance pilot programs” to expand and improve health care education and provide needed training and resources for caregivers who sacrifice to care and assist disabled and aging veterans in their homes. The eight pilot programs across the nation will explore opportunities for providing social work services, extended care, home safety evaluations and volunteer support. The VA plans to contract with local programs such as home health agencies, medical equipment companies and adult day programs for respite care. Many of the projects will also use technology to offer support through computers, video conferencing, and teleconferencing, especially for caregivers that live in remote areas or are unable to leave home to participate in support activities.

The majority of our service members are extremely strong and resilient; however, the emotional battering and stress of war can ultimately lead to mental health consequences. Veterans from Operations Enduring and Iraqi Freedom, who have accessed VA health care, have reported mental health concerns including PTSD (post traumatic stress disorder), substance abuse and mood disorders. Living with and caring for veterans with these issues is difficult and can change the way that family members relate to one another. That’s why it is crucial for those who care for our veterans to become educated about these obstacles and learn how to recognize when help or an intervention is needed.
 
Veterans’ Centers around the country offer support for mental health needs, readjustment issues, marriage and family problems, and medical caregiving. Support groups are also offered at many of these centers to help caregivers understand the veteran’s personal challenges such as anxiety, depression, difficulties with their work/life balance, and grief and loss issues. For those who reside in rural areas, the VA is now networking with county and private human service providers to offer education and counseling, including bereavement support for families of fallen service members.
 
Military OneSource is yet another support option. This free 24-hour service, provided by the Department of Defense, is available to all Guard, Reserve and active duty members and their families. Consultants provide information on a wide range of issues that affect daily life and offer counseling. The program can be reached by telephone at 1-800-342-9647 or through the Web site at www.militaryonesource.com.
 
Providing care and support to our veterans can be challenging, yet options and solutions are more readily available than ever before. The VA and communities across the nation are forming partnerships and working diligently to support veterans, their families and caregivers. Military institutions recognize the sacrifices made on the home front while we are at war and pledge to support family programs while keeping the well-being of our servicemen and women at the forefront.
 
This article is written in honor of my husband, Col. Patrick Dwyer who served in the Gulf War, and all members of our military who serve bravely and make personal sacrifices for peace and freedom.
 
Helpful Websites:

www.militaryonesource.com
www.aarp.org
www.guardfamily.org
www.disability.gov
www.operationmilitarykids.org
www.pva.org
www.va.org
www.usa.gov
www.tricare.osd.mil/cap
www.dma.state.mn.us
www.remind.org

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