Editor’s note: This article by Patricia Kime originally appeared on Military.com, a leading source of news for the military and veteran community.

The 14 million Americans who care for a chronically ill or injured veteran face challenges such as financial insecurity, stress and a lack of support that warrant attention by advocacy groups and the federal government, a new report has found.

Roughly 5.5% of the U.S. adult population provides daily care and medical support for a veteran, services worth an estimated $199 billion to $485 billion annually, according to the report "America's Military and Veteran Caregivers: Hidden Heroes Emerging from the Shadows," which was released Tuesday.

The research, conducted by Rand Corp.'s Epstein Family Veterans Policy Research Institute, found that about three-fourths of veteran caregivers supported a loved one age 60 or older, with the remainder caring for younger veterans below age 60.

But the caregivers of the younger veterans appear to be shouldering a particularly heavy burden, sacrificing careers to take care of their veterans, taking on the lion's share of parenting children, or supporting aging parents while also caregiving.

[TAKE ACTION: Urge Your Lawmakers to Support Caregiver Program Reforms and Other VA Upgrades by Passing the Dole Act]  

According to the report, about half those caring for a younger veteran had not seen a doctor in the past year, and 42% met the criteria for depression. Roughly 20% said they had considered suicide in the past year.

When asked why they hadn't sought mental health treatment or care for themselves, "they simply didn't have the time," said Rajeev Ramchand, a behavioral scientist and co-director of the Rand Epstein Family Veterans Policy Research Institute.

"This was very surprising for us because we were expecting to see what we heard ... among those over age 60 where they reported cost concerns as the primary barrier to care," Ramchand said during a presentation on the report Wednesday in Washington, D.C.

Military and veterans caregivers reported spending $8,583 out of pocket each year on delivering care and forgoing $4,500 in annual income. Roughly one-third reported incomes below 130% of the federal poverty level.

Approximately 50% to 70% of military and veteran caregivers said they face difficulty paying bills, and 22% to 40% reported food insecurity.

"Approximately one-quarter of caregivers have experienced work disruptions, which may cause economic strain for these caregivers as they forgo employment opportunities," the authors wrote.

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Rand based its findings on two primary sources: a 2023 survey of 2,946, including 513 military and veteran caregivers, 1,205 civilian caregivers and 1,228 non-caregivers, as well as the 2022 Rand veterans survey of 1,100 former service members.

Just a fraction of the nation's veteran caregivers receive assistance from the Department of Veterans Affairs, according to the report, presenting opportunities for the VA and for advocacy groups to help those bearing much of the burden alone. 

According to VA data, 62,570 family caregivers are enrolled in the VA's Program for Comprehensive Assistance for Family Caregiving, an initiative that provides health care and financial compensation to veterans with combat injuries or related illnesses, while 25,000 receive support through the VA's Program of General Caregiver Support Services.

Given the small number of those served by the VA, the Rand researchers made recommendations designed to address the needs of all the the nation's military and veterans caregivers, to include increasing family access to mental health care, expanding work opportunities for caregivers or providing compensation for caregiving, expanding home health care and promoting work environments supportive of caregivers.

During a House Veterans Affairs Committee hearing Wednesday on the VA's programs for caregivers, advocates and lawmakers discussed the possibilities of additional assistance, in the form of tax breaks for caregiver families, credits for Social Security for caregiving, and broader education on respite care services provided by the VA.

"A tax credit ... is a really good idea. I think it should be a tax credit that we did in the Rescue Plan, which gives folks the money up front and not having to wait or be required to do their taxes," said Rep. Julia Brownley, D-Calif.

Earlier this month, a dozen veterans organizations wrote to President Joe Biden asking him to accelerate the process for determining new eligibility criteria for the VA's Program for Comprehensive Assistance for Family Caregiving, a process that is now into its second year.

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According to advocates, roughly 14,000 families face dismissal from the program by October 2025 depending on the final eligibility rules. During the hearing, Committee Chairman Rep. Mike Bost, R-Ill., questioned why the process has taken so long.

"The administration has dragged its feet on these changes, leaving thousands of caregivers in limbo," Bost said.

Colleen Richardson, executive director for the VA caregiver support program, said the proposed rule is with the Office of Management and Budget and should be released sometime this fall.

"When we opened this program up the first time in Oct. 1, 2020, we didn't get it quite right, and I don't want that to happen again," Richardson said. "Now that I'm leading the caregiver support program, I feel that it is my duty and obligation ... to get it right."

Lawmakers pledged to consider the recommendations, and advocates said that many of the suggestions could help the more than 91 million Americans who are caregivers, in addition to the 14 million supporting a military member or veteran.

"The reality is, without family caregivers, more Americans would have to rely on government programs for their care. We estimate that value of care being provided is about $600 billion a year," said AARP Kentucky State Director Troy Broussard, who testified at the hearing.

"I did not need to see a study to know how bad this problem is, but America needs to see it," Wounded Warrior Project CEO and retired Army Lt. Gen. Walter Piatt said during the conference announcing the Rand report.