Characterizing Key Drivers of Respite Use Among Veteran Caregivers

TL;DR

This study explores why only a small percentage of Veteran caregivers use respite care services, identifying key factors that influence their use.

Contribution

The study combines quantitative and qualitative methods to identify novel predictors of respite use among Veteran caregivers.

Findings

Veteran's functional limitations and health risk are top predictors of respite use.

Caregiver's age and perceived integration with the clinical team also strongly influence use.

Qualitative findings highlight psychosocial and system-level barriers like lack of awareness and scheduling issues.

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.