Though caregiving can be rewarding, the U.S. Department of Veterans Affairs (VA) understands that caregivers often face difficult challenges ranging from financial and employment concerns to the neglect of their own care, depression, and the repercussions of the trauma some veterans experienced. To address some of these needs, the VA's Desert Pacific Healthcare Network and Sierra Pacific Healthcare Network received $1.1 million in funding from the VA Office of Care Management and Social Work Service to develop a pilot program to help caregivers access support services and education and navigate complex health care and community systems. In this effort, the networks have joined forces with the California Caregiver Resource Centers and Family Caregiver Alliance, Stanford University, and Legacy Health System in a federal, state, and community partnership known as Caring for Those Who Care. The program is designed to enhance the support that is provided to veterans' caregivers in California.

The VA's California Offices on Caregiving wants to reinforce the significant value that informal and family caregivers have for our health care system (including VA staff and the caregivers themselves). In addition to the considerable time and energy caregivers dedicate to veterans, the VA depends upon caregivers to provide its professionals with important information about the veterans they care for. Caregivers are often the first to identify potential problems, sometimes even before the care recipient realizes something is wrong. Early identification, communication, and education can help to prevent or ameliorate future problems and exacerbated conditions and help control stress or anxiety for the caregiver.

One goal of the program is to better link the VA and caregivers by providing a resource center and point of contact. We hope to give caregivers a familiar place to call, to educate caregivers about available services, to help caregivers learn stress-management and self-care techniques, and to teach caregivers how to better communicate with health care professionals, care recipients, and family or friends. Through this program, we hope to identify and support those who would benefit from assistance and to fill some of the gaps in services that have been identified by caregivers and by VA staff. We have established central locations and toll-free telephone lines for caregivers of veterans in California, as well as a number of telephone support groups, telephone educational groups, and Web-based and community training programs for caregivers. If they can't come to us, we look for other vehicles that will help us support them.

This is a large project with many pieces. In addition to our telephone support systems, we are working with a team from Stanford University to develop an Internet caregiver self-management program. This is a six-week course for caregivers that will be available online. We are initially focusing on caregivers for veterans with traumatic brain injury and other neurological diagnoses. Some of the resources will be available to the general public, but veterans and their caregivers will be served first.

The VA is developing a number of programs that support the needs of caregivers around the country. The VA also has in place services such as location-specific, nonemergency nurse advice lines that patients and caregivers can call with specific concerns or general questions about a patient's health. Also available is My HealtheVet (http://www.myhealth.va.gov)-"the gateway to veteran health benefits and services"-which provides user-specific information such as medications, copayments, and health care appointments and links to VA and other important resources. This program also enables veterans to view some of their VA records, create a personal health journal, track their health history, and order prescriptions. A caregiver section at My HealtheVet is under development.