Characterizing Key Drivers of Respite Use Among Veteran Caregivers

TL;DR

This study identifies factors influencing respite care use among Veteran caregivers, aiming to improve access and reduce caregiver burden.

Contribution

The study combines machine learning and qualitative analysis to identify key drivers of respite use among VHA caregivers.

Findings

Veteran functional limitations and caregiver age were top predictors of respite use.

Qualitative data highlighted psychosocial and system-level barriers like lack of awareness and scheduling issues.

VHA’s respite payment model was found to alleviate financial strain for caregivers.

Abstract

Respite care has been shown to reduce caregiver burden and may delay long-term care placement, yet it remains underutilized, with only 12-15% of US caregivers reporting use of these services. Understanding drivers of respite use is critical to informing initiatives to improve access. This convergent mixed-methods study aimed to characterize factors influencing respite use among caregivers and Veterans enrolled in the Veterans Health Administration’s (VHA) Caregiver Support Program. A retrospective analysis used machine learning (random forests) to analyze caregiver survey data (2018–2021) linked to Veteran electronic health records (N = 1,727), ranking Veteran and caregiver factors associated with respite use. Semi-structured interviews were conducted with a separate sample of caregivers (N = 20) in 2024, with transcripts analyzed using directed content analysis. Data were integrated using Andersen’s Behavioral Model for Health Service Use. Top predictors included Veteran’s functional limitations, age, health risk, and caregiver’s age and caregiver perceived integration of care with the clinical team. Enabling factors included in-home care support and financial resources; need factors encompassed caregiver burden, depression, loneliness, and Veteran’s chronic conditions, dementia, and frailty. Qualitative findings reinforced the importance of Veteran and caregiver needs while highlighting how VHA’s respite payment model alleviates financial strain. Caregivers described psychosocial and system-level factors, including lack of awareness, concerns about access and quality, and scheduling barriers as reasons not to use respite. Findings provide actionable insights for improving respite uptake by enhancing caregiver-clinician communication, tailoring services, and increasing outreach. Future research should examine how these factors impact respite use in non-VHA settings.