Injured vet Tammy Duckworth

We’ve long been warned how unprepared this country is for the number of young men and women who will return home from the Iraq War with mental and physical disabilities.

American military casualties in Iraq and Afghanistan have exceeded 28,000. Statistics show that 80 percent of the wounded are in the 18-30 age range and face an entire lifetime of recovery, adding to an already strained long-term care system that lacks a stable, well-trained workforce.

It’s a strange outcome of improved battlefield medicine, which has saved many combatants, but has left many with brain and spinal cord injuries and other long-term care needs.

Injured Iraq War veterans like Tammy Duckworth of Illinois, whose severe combat wounds cost her both her legs, have criticized the Bush Administration for being unprepared for the number of veterans who require long-term care.

The hardest hit by it, perhaps, is the family caregiver, whose life is also forever changed. Last week, the New York Times profiled a young woman in Colorado who is now caring for her 27-year-old husband, who was shot in Iraq six weeks after their wedding and is now quadriplegic.

Tracy Keil quit her job to care for her husband. She hired home-care workers to help her from a service paid for by the government, but after going through four workers in nine months, she is looking for a different solution.

She joins other veterans’ families who want to be paid for caregiving. Proposed legislation would allow families of soldiers with traumatic brain injuries to be paid for their caretaking after training and certification by the Veterans Affairs Department.

The Veterans Affairs Department, however, opposed the legislation, saying it would be liable if a veteran was injured by a family member trained by the department.

But that’s not the real issue, says Henry Claypool, ICS policy director. The VA knows that families will provide this care whether they get paid or not.

“Saying liability is a workman’s comp issue is disingenuous. They know they would do the work anyway,” says Claypool.

If the VA would give families of veterans the money, says Claypool, people like Keil will have more control over hiring and will give themselves a much-needed break from caregiving by handpicking workers.

But the situation is more complex than just handing over money, says Claypool. The VA also needs to make services available in the future, should a family’s situation change.

Keil gave up her job and clearly wants to be taking care of her husband. But, Claypool points out, “the reality is she’s young. The reality is that this is new. This stuff changes an awful lot. They were married in 2007. Six weeks later, this guy was paralyzed.”

The questions remain: In ten years, is this arrangement going to be stable? Is she still going to be able to play this role as care coordinator? What’s going to be there to support them?

To address the changing needs of people with disabilities and their family members, PHI advocates for a comprehensive system of supports that includes paying family caregivers when appropriate and ensuring access to well-trained, professional direct-care workers. For more information, see PHI National Policy Agenda: Consumer Direction & Family Caregiving (pdf) .