With an aging population and rural workforce shortages, family caregivers face growing demands. Caregivers’ ability to continue providing care depends on their own underlying health and access to home- and community-based services (HCBS). This study examines rural caregiver needs within the Veterans Health Administration.
Methods
We conducted a qualitative study using data from family caregivers (N = 19). Content analysis was used to identify key themes.
Results
Key emergent themes included (1) Dyadic health: significant health concerns for both caregiver and Veteran; (2) Tension of pride vs. support needs as a caregiver; and (3) Patchwork of community supports: limited access to healthcare, respite, and transportation.
Discussion
This study highlights challenges in supporting rural family caregivers of older Veterans with complex health needs. Addressing transportation burdens, dual caregiver–care recipient needs require innovative, dyad-focused approaches. Future research using dyadic data can deepen understanding and guide community-based, caregiver-informed solutions.
AARP and National Alliance for Caregiving. (2020). Caregiving in the United States 2020. Washington, DC: AARP. May. https://doi.org/10.26419/ppi.00103.001
2.
AndersenR. M. (1995). Revisiting the behavioral model and access to medical care: Does it matter?Journal of Health and Social Behavior, 36(1), 1–10.
BradleyE. H.McGrawS. A.CurryL.BuckserA.KingK. L.KaslS. V.AndersenR. (2002). Expanding the andersen model: The role of psychosocial factors in long‐term care use. Health Services Research, 37(5), 1221–1242. https://doi.org/10.1111/1475-6773.01053
5.
BrennerR. J.HansenJ.BrintzB. J.BouldinE. D.PughM. J.RupperR.MunozR.Garcia‐DavisS.DangS. (2023). Association between specific unmet functional needs and desire to institutionalize among caregivers of older veterans. Journal of the American Geriatrics Society, 71(7), 2264–2270. https://doi.org/10.1111/jgs.18307
6.
BrueningR.SperberN.MillerK.AndrewsS.SteinhauserK.WielandG. D.LindquistJ.Shepherd-BaniganM.RamosK.HeniusJ.KabatM.Van HoutvenC. (2020). Connecting caregivers to support: Lessons learned from the VA caregiver support program. Journal of Applied Gerontology, 39(4), 368–376. https://doi.org/10.1177/0733464818825050
7.
GatelyM. E.MucciniS.EgglestonB. A.McLarenJ. E. (2022). Program evaluation of my life, my story: Virtual storytelling in the COVID-19 age. Clinical Gerontologist, 45(1), 195–203. https://doi.org/10.1080/07317115.2021.1931610
8.
GatelyM. E.QuachE. D.ShirkS. D.TrudeauS. A. (2022). Understanding variation in adoption of video telehealth and implications for health care systems. Medical Research Archives, 10(5). https://doi.org/10.18103/mra.v10i5.2751
9.
HarvathT. A.MongovenJ. M.BidwellJ. T.CothranF. A.SexsonK. E.MasonD. J.BuckwalterK. (2020). Research priorities in family caregiving: Process and outcomes of a conference on family-centered care across the trajectory of serious illness. The Gerontologist, 60(Supplement_1), S5–S13. https://doi.org/10.1093/geront/gnz138
10.
HollidayA. M.QuinlanC. M.SchwartzA. W. (2022). The hidden patient: The CARE framework to care for caregivers. Journal of Family Medicine and Primary Care, 11(1), 5–9. https://doi.org/10.4103/jfmpc.jfmpc_719_21
11.
LahiriA.JhaS. S.ChakrabortyA.DeyA.DobeM. (2023). Home-isolation care in newly COVID-19-Positive elderly patients: A caregiver-centric explanatory framework. International Journal of Public Health, 68(1), Article 1606060. https://doi.org/10.3389/ijph.2023.1606060
12.
LederleM.TempesJ.BitzerE. M. (2021). Application of Andersen’s behavioural model of health services use: A scoping review with a focus on qualitative health services research. BMJ Open, 11(5), Article e045018. https://doi.org/10.1136/bmjopen-2020-045018
13.
LumH. D.NearingK.PimentelC. B.LevyC. R.HungW. W. (2020). Anywhere to anywhere: Use of telehealth to increase health care access for older, rural veterans. Public Policy & Aging Report, 30(1), 12–18. https://doi.org/10.1093/ppar/prz030
14.
NgoV.ShirkS. D.ChamberlinE. S.MarfeoE.MooL. R. (2025). A visit-associated logistics framework describing challenges faced by caregivers of older adults. The Gerontologist, 65(6), gnaf090. https://doi.org/10.1093/geront/gnaf090
15.
ParkS. S. (2021). Caregivers’ mental health and somatic symptoms during COVID-19. The Journals of Gerontology: Series B, 76(4), e235–e240. https://doi.org/10.1093/geronb/gbaa121
16.
PatzelM.BarnesC.RamalingamN.GunnR.KenzieE. S.OnoS. S.DavisM. M. (2023). Jumping through hoops: Community care clinician and staff experiences providing primary care to rural veterans. Journal of General Internal Medicine, 38(Suppl 3), 821–828. https://doi.org/10.1007/s11606-023-08126-2
17.
PharrJ. R.Dodge FrancisC.TerryC.ClarkM. C. (2014). Culture, caregiving, and health: Exploring the influence of culture on family caregiver experiences. International Scholarly Research Notices, 2014(1), 689826–689828. https://doi.org/10.1155/2014/689826
18.
RainaP.O'DonnellM.SchwellnusH.RosenbaumP.KingG.BrehautJ.RussellD.SwintonM.KingS.WongM.WalterS. D.WoodE. (2004). Caregiving process and caregiver burden: Conceptual models to guide research and practice. BMC Pediatrics, 4(2), 1–13. https://doi.org/10.1186/1471-2431-4-1
19.
SchulzR.BeachS. R. (1999). Caregiving as a risk factor for mortality: The caregiver health effects Study. Jama, 282(23), 2215–2219. https://doi.org/10.1001/jama.282.23.2215
20.
Shepherd‐BaniganM.ShermanS. R.LindquistJ. H.MillerK. E.TuckerM.SmithV. A.Van HoutvenC. H. (2020). Family caregivers of veterans experience high levels of burden, distress, and financial strain. Journal of the American Geriatrics Society, 68(11), 2675–2683. https://doi.org/10.1111/jgs.16767
21.
SolankeB. L.YinusaR. A.OyeleyeO. J.OluwatopeO. B.IlesanmiB. B.OniT. O. (2023). Using Andersen’s behavioral model of health care use for intermittent preventive treatment of malaria in pregnancy in Nigeria. BMC Pregnancy and Childbirth, 23(1), 315. https://doi.org/10.1186/s12884-023-05648-9
22.
TraversJ. L.HirschmanK. B.NaylorM. D. (2020). Adapting Andersen’s expanded behavioral model of health services use to include older adults receiving long-term services and supports. BMC Geriatrics, 20(1), 1–16. https://doi.org/10.1186/s12877-019-1405-7
23.
von LengerkeT.GohlD.BabitschB. (2014). Re-revisiting the Behavioral Model of Health Care Utilization by Andersen: A Review on Theoretical Advances and Perspectives. In JanssenC.SwartE.von LengerkeT. (Eds.), Health Care Utilization in Germany. New York, NY: Springer. https://doi.org/10.1007/978-1-4614-9191-0_2
24.
WolcottM. D.LobczowskiN. G. (2021). Using cognitive interviews and think-aloud protocols to understand thought processes. Currents in Pharmacy Teaching and Learning, 13(2), 181–188. https://doi.org/10.1016/j.cptl.2020.09.005
25.
YoungH. M.BellJ. F.WhitneyR. L.RidbergR. A.ReedS. C.VitalianoP. P. (2020). Social determinants of health: Underreported heterogeneity in systematic reviews of caregiver interventions. The Gerontologist, 60(Supplement_1), S14–S28. https://doi.org/10.1093/geront/gnz148
