Veterans with Overburdened Caregivers: A Stark Reminder of the Toll on Families and the Urgency of Proactive Planning

A new study reveals a heartbreaking reality for many military families: Veterans with overburdened caregivers are 2.5 times more likely to end up in nursing homes, highlighting the devastating impact of caregiver fatigue on aging in place. Published in Journal of the American Geriatrics Society (October 2025) and reported by McKnight's Home Care, the research analyzed data from 1,200 veterans aged 65 and over in the VA's Health and Retirement Study cohort, finding that 40% of caregivers reported high burden levels (averaging 31 or more hours weekly), correlating with a 150% increased odds of institutionalization within two years. 

For readers of the Aging-in-Place Planning and Elderlaw Blog, this isn't just a statistic—it's a call to action amid a crisis where 53 million U.S. caregivers (including at least 5 million for veterans) face burnout, depression, and health decline. As we've delved into recent articles like "Parenting a Parent: Rethinking the Role Reversal Myth to Empower Aging in Place" and "Smart Home Technology: A Lifeline for Aging in Place Amid Caregiver Burnout," the strain is real, but solutions exist. This piece unpacks the study, its implications for families, and strategies to prevent nursing home placement, emphasizing proactive tools like supported decision-making (SDM) and trusts to safeguard autonomy and keep loved ones at home.

The Study: Caregiver Burden as a Tipping Point for Veterans' Independence
The study, led by researchers from the University of Michigan and the VA Ann Arbor Healthcare System, followed 1,200 community-dwelling veterans aged 65 and older from 2016 to 2022, tracking caregiver burden using the Zarit scale (measuring stress, health impacts, and time demands). Key findings:

• High Burden Prevalence: 40% of caregivers (mostly spouses or adult children) scored "high burden," juggling 31 or more hours weekly amid veterans' needs like mobility aids or dementia support.
• Nursing Home Risk: Veterans with burdened caregivers had 2.5 times higher odds of admission within two years, even after controlling for veteran health factors like frailty or comorbidities.
• Why It Happens: Burdened caregivers reported 25% higher depression rates and 15% more health issues, leading to "breakdowns" where home care becomes unsustainable—echoing the 2025 EY study's 31-hour average and burnout's role in 30% of institutionalizations.

Lead author Dr. Katherine Berger noted, "Caregiver burden isn't just emotional; it's a predictor of system failure, pushing veterans from homes to facilities." This ties directly to our recent piece on "parenting a parent," where we debunked the role-reversal myth, stressing that eldercare isn't about control but about partnership.  Without planning, however, it collapses under its own weight.Consequences for Families: A Cascade from Burnout to Betrayal
For veteran families, the stakes are higher amid a 25% higher PTSD rate and complex needs from service-related injuries. Burdened caregivers, often spouses, and frequently age 65 or over themselves, face physical tolls like hypertension (up 18%) and emotional strain, leading to resentment or "abandonment" guilt when placement becomes inevitable. The study found that 35% of burdened caregivers reported "crisis points," such as mishandled falls or infections due to exhaustion. Financially, nursing home costs average $8,000/month, draining VA benefits and savings, while heirs lose inheritance to "spend-down." With many facilities understaffed and inadequately equipped, placement isn't relief; it's a new risk of neglect and new burdens and fears for the caregiver, as they relinquish control while holding on to a responsibility they have less power to discharge. 
Proactive Strategies: Beyond Burnout to Home-Centered Protection
The study recommends "caregiver support programs," but aging-in-place planning and elder law offer deeper shields. Here's how to protect veterans (or any senior) from the cascade:

1. Build SDM Networks: Formalize family as supporters in an SDM agreement, sharing decisions to lighten the load—e.g., one child handles meds, another drives. This prevents "sole burden" and guardianship, as in our "SDM-Driven Supplemental Advanced Directive."
2. Leverage VA Resources: Enroll in the VA's Program of Comprehensive Assistance for Family Caregivers (PCAFC), providing stipends ($2,000/month) and respite care. Pair with HCBS waivers for home aides, preserving benefits for heirs.
3. Use Trusts for Financial Buffer: Create a Medicaid Asset Protection Trust to shield $100K+ for home mods or tech, avoiding spend-down. Include "caregiver compensation" clauses to pay family without tax pitfalls.
4. Incorporate Tech for Relief: As in our "Smart Home" piece, devices like Amazon Echo reminders or Apple Watch fall detection reduce oversight by 15-20 hours weekly, easing burnout without sacrificing autonomy.
5. Draft Joint Directives: Spouses should co-sign supplemental directives specifying "home care regardless of cost," shielding the survivor from liability like in Burris. Nominate each other as primary agents in POAs.
6. Seek Respite and Counseling: Use AARP's caregiver resources or VA's peer support groups to combat depression, averaging 25% higher amid burden.

These steps transform "parenting" into partnership, keeping families united and veterans at home.Conclusion: From Burden to Shared Strength
The Tennessee study isn't a verdict on caregivers; it's a signal that burden breaks even the strongest bonds, pushing veterans toward homes they don't want. By reframing care as collaboration, you honor service and love. While this article has provided a thorough examination of the risks and solutions of caregiver burden, it is by no means comprehensive. The landscape of veteran care evolves rapidly, influenced by VA policies and family dynamics. Readers must remain vigilant, consulting sources like AARP, VA.gov, and local elder law attorneys, while evaluating their situations to identify risks. By combining awareness with tools such as SDM agreements, trusts, and technology, seniors and families can better safeguard independence and thrive while aging in place. For ongoing support, consult a professional and stay informed—your security depends on proactive engagement.

Ohio's 'What's Done in the Dark' Initiative: A Spotlight on Elder Abuse and Exploitation

In a state where 1 in 10 adults over 60 faces abuse or exploitation, yet only 1 in 5 cases is reported, Ohio Attorney General Dave Yost has launched a statewide campaign to raise awareness and encourage reporting. Announced on October 27, 2025, the initiative features a compelling video titled “What’s Done in the Dark,” aimed at destigmatizing victimization and educating families on signs of financial scams, neglect, and emotional abuse. Unveiled at the Attorney General's Elder Abuse Commission meeting, the video and accompanying resources on Yost's Elder Justice Unit webpages are designed to spark conversations and empower Ohioans to spot and stop the "invisible crime" affecting over 100 daily referrals to Adult Protective Services (APS). 

For readers of the Aging-in-Place Planning and Elderlaw Blog, this effort is timely amid a 27% rise in elder abuse reports since 2020, but it raises a key question: Does it represent genuine reform, or is it more window dressing for a system in need of structural overhaul? As we've explored in "Rethinking Elder Abuse Strategies: How Prophylactic Planning Can Safeguard Autonomy and Aging in Place," tangible protection lies in proactive tools such as advance directives, supported decision-making (SDM) agreements, powers of attorney, and trusts.  While awareness videos can increase reporting after the fact, proper planning and proactive measures can help avoid problems altogether. This article reviews the initiative, analyzes its potential impact, and whether it addresses root causes.

The Initiative: A Video and Resources to Shine Light on the 'Dark'
At its core, Yost's campaign is a public education push, partnering with the Ohio Pharmacists Association to train professionals in spotting abuse. The video  features survivors sharing stories of financial scams and isolation, emphasizing "the shame belongs only to those who harm." Key elements include:

• Warning Signs: Unexplained financial changes, unpaid bills, or sudden account alterations.
• Reporting Tools: Hotline (855-OHIO-APS) and online portals for APS referrals, and filing an Elder Justice Unit Complaint; Elder Justice Unit at 800-282-0515 for legal aid.
• Pharmacist Training: Pharmacies serve as frontline sentinels to flag suspicious prescriptions or behavior.
• Website Resources: ag.state.oh.us/elderjustice for guides, videos, and protections like the Ohio Consumer Sales Practices Act.

Yost stated: "There is an epidemic of underreporting...Our elders need to know there is no shame in being victimized." The campaign launches amid a 38,000-case surge in 2024, targeting Ohio's 2.5 million seniors amid a "graying" population projected to hit 36% of the total population in key counties by 2040.Critical Analysis: Awareness or Actual Reform?It's unquestionably a positive step; videos humanize victims, and pharmacist training could catch more cases of financial exploitation or abuse. Ohio's legal protections, though, already rank high (4th nationally, according to WalletHub 2025), with mandatory APS reporting and Elder Justice Unit prosecutions averaging 200 cases annually. In other words, at least compared to other states, there's not much more the state can offer to meaningfully reduce the risk of abuse.  Increasing reporting is an undeniably laudable goal.  
The video is compelling, recounting raw stories of scams and isolation.  It is not "required viewing," for example, in guardianship training or courts, or even for pharmacists. It's promotional, not mandatory. Ohio's Supreme Court offers elder abuse resources for attorneys; however, there is no statewide mandate that ties this video to probate or guardianship education, or any other event beyond pharmacists, pharmacies, and the public education associated with the campaign.  The video is also likely to miss the most vulnerable, seniors who are homebound or must rely on third parties to run errands. Regardless, however, laudable these efforts are, they focus on reporting abuse after the fact, rather than preventing abuse.   The Funnel of Failure: From Report to Resolution
Even if reporting dramatically increases, the extent of elder abuse and exploitation is unlikely to drop in a meaningful way. Enforcement is even less likely than reporting (possibly explaining some of the underreporting- why report a crime when you know that no one is going to be able to do anything about it?).  The journey from “I was scammed” to “Justice served” is a gauntlet most never finish. Below are the cold, hard numbers that show why the system feels broken, and what families can do tonight to slam the door on predators. 

Step	% That Make It Through	Real-World Meaning
Reported	1 in 5 (20%)	80% of victims never tell anyone—shame, fear, or dementia                    silence them.
Investigated	1 in 25 (4%)	Local Adult Protective Services (APS) is swamped: 1 worker per 1,000 cases in many states.
Prosecuted	1 in 100 (1%)	Only financial crimes over $100k usually cross a DA’s desk.
Convicted	1 in 250 (<0.4%)	Plea deals or jury sympathy for “family” abusers drop most charges.

Sources:

• National Adult Maltreatment Reporting System (NAMRS) 2024: 1.2 million reports translate to 48,000 investigations leading to 12,000 prosecutions.
• U.S. Senate Special Committee on Aging, 2025: “Of 38,000 financial-exploitation reports, 98% closed without arrest.”
• DOJ Elder Justice Initiative, 2025: “Telephone/internet scams comprise 72% of reports, with a 0.3% conviction rate.”

This means that only 1 in 1,250 actual elder-abuse victims (1 out of every 1,250 seniors who are abused) ever sees the abuser convicted. That’s 0.08% of the true total.  Enforcement is made nearly impossible by the nature of modern crime.  Most scams are borderless, cashless, and anonymous.  A Romanian call-center spoofing U.S. numbers can’t be extradited for a $2,000 wire fraud.  Crypto “pig-butchering” scams (DOJ seized $15 billion from just one Cambodian scammer in 2025) vanish into untraceable wallets. Grandparent scams evolve weekly, with AI voice clones now mimicking your “grandson in jail.”  The tragic reality is that even a dramatic increase in reporting is unlikely to result in a meaningful decrease in either identification of or enforcement actions against abuse and exploitation.   

Protecting Yourself or a Loved One

While the odds of catching an abuser are slim, you can drastically increase your odds of safety by taking prophylactic measures tonight.  Prevention is undeniably the best tool.  After reading our article, Rethinking Elder Abuse Strategies, read and implement the strategies outlined in Safeguarding Seniors: Comprehensive Strategies to Prevent Elder Fraud and Financial Abuses; it is full of tips, tricks, tools, and information.  

 

How You Can Help Drive Real Change

If you want to help: 

• Share the Video: Post on social media to destigmatize reporting.
• Advocate Locally: Contact your local Adult Protective Services, senior center, probate judge, church, or charitable organization to volunteer or help spread the word. 

 Your voice amplifies the campaign.
Conclusion: From Awareness to Action

Prevention beats reaction every time.  Build the fence at the top of the cliff, rather than relying on the ambulance at the bottom. While this article has provided a thorough analysis of the campaign and reform gaps, it is by no means comprehensive. The landscape evolves rapidly. Readers must remain vigilant.