“Caregivers are hidden heroes.” Each November, during Warrior Care Month and National Family Caregivers Month, that truth comes into sharper focus. Millions of Americans quietly provide care for veterans and their family members each day. Their work sustains quality of life, preserves family stability, and equates to billions of dollars’ worth of unpaid labor each year. Their efforts are indispensable, yet too often invisible.

This year, there is something new to recognize alongside their sacrifices. In January 2025, after years of relentless advocacy from veterans’ organizations and families, the Senator Elizabeth Dole 21st Century Veterans Healthcare and Benefits Improvement Act – better known as the Dole Act – was signed into law. For caregivers, it represents a turning point, expanding access to resources, reducing barriers, and strengthening the systems designed to support them.

To understand why this milestone matters, and where caregivers stand today, we must look at the scale of veteran caregiving, the hurdles caregivers face, how support systems have evolved over the last decade, and what work is still needed for the future. 

The Scale of Caregiving

A 2024 RAND study found that 14.3 million Americans – about 5.5% of adults – serve as military or veteran caregivers. Most provide between one and thirty hours of care per week, while 11 to 16% provide more than thirty. This labor is unpaid but has an estimated annual value between $119 and $485 billion.

The costs to caregivers themselves are significant. Families spend an average of $8,583 out of pocket each year and lose another $4,522 in household income. Among caregivers to veterans aged 60 and under, 61% assist with at least one activity of daily living (ADL), such as bathing, dressing, or feeding. Additionally, 40% of these caregivers help manage mental health conditions or substance use disorders. 

But caregiving in military families goes beyond supporting former service members. Oftentimes, parents in active duty households are taking care of a child or family member with acute needs without the ability to pay for support or receive compensation for their labor. Approximately half of military spouses report having at least one child with a physical, developmental, emotional, or behavioral condition. Many of these caregivers are providing intensive support while also managing the day-to-day needs of other family members, with 44% caring for more than one dependent at the same time. 

The toll on caregivers themselves is significant. Balancing the needs of children with special requirements alongside the demands of military life can lead to heightened stress, sleep disruption, and mental health challenges. Caregivers in military families tend to be younger and more likely to be female and married compared with caregivers in the general population, yet they navigate complex responsibilities without the financial support or resources often available to other families. Their contributions are vital to the well-being of the service member and family alike, yet they remain an often invisible pillar of the military community.

Behind these statistics are parents, spouses, children, and friends whose contributions are both irreplaceable and exhausting. Forty-two percent of caregivers for younger veterans meet the criteria for depression, and one in five has considered suicide, a rate four times higher than the general population. The picture is clear: caregiving is profoundly meaningful, but it comes at a steep cost.

The Burden Caregivers Carry

The challenges of caregiving go beyond medical support. Many families find themselves giving up jobs, withdrawing from social circles, or shouldering overwhelming financial stress. They face bureaucratic complexity as they try to access programs, and they struggle with the uncertainty of whether they even qualify for benefits. 

These struggles are particularly stark for military families with children who have complex medical needs. In just one example, Mission Roll Call highlighted the Carrigg family on our blog last year. Military family Austin and Joshua Carrigg adopted their daughter Melanie knowing that she would need extra care. But they could not predict the additional diagnoses, medical crises, and surgeries that would follow. Over the years, Melanie’s conditions – including moyamoya disease and the effects of a catastrophic stroke – required her family to navigate countless appointments, relocations, and hospital stays.

Like so many caregivers, Austin found herself advocating for resources across multiple systems while managing the demands of military life. Her older son even stepped into the role of youth caregiver, putting his own life on hold to help. 

The Carriggs’ journey reflects what millions of veteran and military caregivers know well: caregiving is often a lifelong role, shaped by love, tested by stress and sustained by resilience.

Building a System of Support

Over the past 15 years, caregiver policy has slowly evolved. The Caregivers and Veterans Omnibus Health Services Act of 2010 expanded the VA’s Caregiver Support Program, including a support line, website and two key initiatives: the Program of General Caregiver Support Services (PGCSS), which provides education and resources for caregivers of veterans from all eras; and the Program of Comprehensive Assistance for Family Caregivers (PCAFC), which provides stipends, health coverage, counseling, respite care and training to veterans, though it was initially limited to post-9/11 veterans with severe injuries.

The need was far greater than expected. By 2020, more than 40,000 caregivers were enrolled in PCAFC, five times the original projection. To address this demand, the VA Mission Act of 2018 expanded PCAFC eligibility to earlier generations. Still, implementation challenges remained: inconsistent access, confusing rules, and limitations on home- and community-based services.

Meanwhile, the Veteran-Directed Care (VDC) program—launched in 2008—allowed veterans to design their own care plans, such as hiring family or non-family caregivers, purchasing assistive technology, or funding home modifications. This veteran-led approach gave them discretion over what best supports their road to recovery and greater independence, but access was uneven across the country.

These programs laid the groundwork, but gaps persisted. The Dole Act was designed to close them.

What the Dole Act Changes

Signed in January 2025, the Dole Act strengthens caregiver support in several important ways:

• Expansion of Veteran-Directed Care: Requires every VA medical center in the U.S. and its territories to offer VDC, ensuring consistent nationwide access. 

• Full coverage of home nursing care: Raises the VA’s share of home nursing costs from 65% to 100%, making non-institutional care a more viable alternative to nursing homes. 

• Respite care for resident caregivers: Guarantees at least 30 days of covered respite care annually, with extensions allowed if medically necessary.

• Mental Health counseling grants: Funds providers who offer counseling services to caregivers enrolled in PCAFC.  

• Streamlined application processes: Simplifies how caregivers apply, access benefits and transition between programs.

• Expanded training and resources: Extends training, financial aid and mental health services to caregivers not covered under PCAFC. 

• Pilot programs in underserved communities: Funds the hiring of nursing assistants to deliver in-home care.

In addition, the Act mandates clearer eligibility criteria, requires annual Congressional reporting on application approvals and denials, and directs improved coordination of services when caregivers are denied or discharged. 

While it does not establish direct salaries for caregivers like PCAFC, the Dole Act improves access, reduces bureaucratic barriers and strengthens both financial and mental health support. Its overarching mission is to expand eligibility and make existing services more accessible. 

Why It Matters

The value of caregiving is both moral and fiscal. On average, PCAFC costs about $18,300 per veteran annually. Compare that to more than $56,000 in state veterans’ homes, over $100,000 in community nursing homes, and nearly $380,000 in VA community living centers. Supporting care at home saves the nation billions while delivering what veterans themselves say they want most: the dignity of living with family.

But the numbers only tell part of the story. Caregivers sustain the health and stability of veterans, preserve family bonds, and strengthen entire communities. Their voices – supported by the advocacy of organizations like the Elizabeth Dole Foundation, Exceptional Families of the Military, and Mission Roll Call – drive the policies we see today.

Looking Ahead

The Dole Act is a meaningful step, but caregivers and veterans alike have said the work must continue. According to an August 2025 poll by Mission Roll Call, our veterans believe caregivers still need support, most notably in three key areas: training and resources specific to caregiving, financial compensation, and mental and emotional wellness support. Whether these responses are due to a lack of awareness to recent benefits, lack of access or simply point to a need for even greater expansions, it’s clear that our work is far from finished. 

Caregivers are America’s hidden heroes. They hold families together, sustain veterans’ quality of life, and save the nation billions. Their work is irreplaceable, and the systems designed to support them must reflect that truth.

Recognition months remind us to honor our caregivers. But truly showing our appreciation for these caregivers means more than giving thanks – it means taking action. It means listening to their voices, advocating for the policies that sustain them, and ensuring resources remain accessible for every generation of veterans and families. By doing so, we honor not only the caregivers themselves, but also the veterans whose lives they transform every day.

For caregivers in need of support: 

• Call the Caregiver Support Line: (1-855-260-3274) or check out MRC’s own Resource Directory.  
• Do you have your own veteran caregiver story to share? Tell us here.