Supporting America's Veterans: A Conversation with Carrie Farmer

Evan Banks

You are listening to Policy Minded. I'm Evan Banks. Today is Veterans Day, and our guest is Carrie Farmer, Co-Director of the RAND Epstein Family Veterans Policy Research Institute. Carrie will share insights on some of the many policy issues that are important to America's veterans, from transitioning into civilian jobs to the role of VA health care to the importance of family support. You can find our research on these topics and more at www.rand.org/veterans. Ok. Here's the show.

Hi, Carrie. Thanks for joining us on the show.

Carrie Farmer

Thanks for having me.

Evan Banks

What got you into researching veterans and sort of dedicating your your life to studying this one topic?

Carrie Farmer

Yeah, it's a great question 'cause it's somewhat unexpected. I'm not a veteran myself. I didn't grow up in a military family. My father served in the Massachusetts National Guard, but I was young at the time and didn't, wasn't really aware of that service and he never, he never deployed or activated in any way. So, my understanding of the military when I came to RAND was really very limited. And I came to RAND as a health policy researcher and I honestly thought, well, I know RAND does all this national defense research and I won't be involved in any of that because I'm a health researcher.

And the very first project I worked on when I came to RAND was a congressionally-mandated study of the quality of VA mental health care. And that opened the door to my understanding of veterans' health care and VA health care. And my second project was a DoD-funded project on all of these programs that have been implemented to address the needs of service members with psychological health problems and traumatic brain injuries. And so, that was another introduction, and I came to be really passionate and fascinated by how can we best meet the needs of this population. And that's what I've been doing ever since.

Evan Banks

We're gonna focus on just a few topics today that highlight the experiences of veterans and their families. Let's start with jobs. So, paint a picture for us. What's it like for veterans after they leave the military and enter the civilian workforce?

Carrie Farmer

This can be an incredibly challenging time for veterans who are sort of making this transition both emotionally, professionally, personally, changing from their identity as a service member to a new identity as a veteran. Many transitioning service members or separating service members feel like they might be prepared to re-enter the civilian workforce and find that it's much harder to find a job than they expected. It is challenging to translate military skills and experience into the needs of a civilian workforce. So, some of that is how a resume is prepared, what types of skills are emphasized in, and thinking about like what are the skills that civilian jobs are offering and how do you translate that and how do you think about what you have to offer to that job as a veteran. And it depends on lots of different characteristics.

So, people who are separating from the military because they're retiring, so they've served at least 20 years, and might be officers, are in a different position in terms of their experience and expertise and transitioning to the workforce than people who are separating from the military after serving, you know, three or four years. And these people might be still relatively young, new to the workforce in general, along with their similarly aged peers. But may not have gone to college, might not have a degree that would help with finding a job. So, it can be a really challenging time and there are a lot of organizations out there that are working to support transitioning service members into the workforce after the military.

Evan Banks

Let's talk a little bit about some of those skills that service members acquire in their training and in their service. I think that there might be a a misconception because the U.S. military is so big and so broad and there's so many different jobs that are done. How well in general do these skills acquired in military training and service translate to skills that civilian employers are looking for? And, and on the flip side, are there ways that these skills don't translate?

Carrie Farmer

I think you're right. It really depends, right, on what jobs someone held while in the military. So, if you were someone who was working on cyber defense, that is a easily translatable skill into the civilian workplace. If you are in the infantry and you know, most of your job is related to combat preparedness, and that is something that is more difficult to translate to the civilian workforce. We don't have a lot of similar jobs. But within that, there are skills that are transferable.

So, leadership skills are always in demand in any workplace. And the military offers a lot of opportunities for people to learn and develop leadership skills. There's many examples of people who are only 19 or 20 years old who are responsible for a large number of other service members and having to make quick, really high critical decisions. And being able to translate that experience and that skill to the civilian workplace is a real benefit to civilian workplaces to have that leadership training available to them with new veterans.

Evan Banks

The way that the military works is also in general very different from the civilian workforce. I'm thinking of orders and duty stations and a chain of command. What are some of the biggest challenges veterans face in navigating that transition to the civilian workforce?

Carrie Farmer

Yeah, I think a lot about like even at RAND, we hire a lot of people who formerly served in the military. And if we think about officers who come in and they're used to being Colonel so and so and everybody reporting to them, they come into a place like RAND where we call everybody by their first name and have a much a flatter hierarchy. That can be a really difficult emotional transition to trying to fit into a environment and a new culture that is extremely different than the military. And there are reasons why the military is very hierarchical in terms of ensuring that the mission is accomplished. And there's a different way of accomplishing a mission and a different type of mission outside the military. So, I think that can be a big learning curve for new veterans as they're adjusting to the civilian workforce.

Evan Banks

What kinds of resources are available to help veterans as they make this transition away from military service and into the civilian workforce?

Carrie Farmer

Every separating service member goes through the transition assistance program, which is a federally run program that is mandated for all separating service members to be completed ideally a year before separation. And this is a program that is jointly run by the Department of Defense or Department of War, Department of Labor, and the Department of Veterans Affairs. And as part of that transition assistance program, separating service members are introduced to the idea of finding a job. There is some assistance with thinking about some of these issues that we've discussed around cultural transitions, preparing a resume, things like that. But it's generally not sufficient. It is sort of an introduction to the concept.

After separation, there are a lot of nonprofits that are working in this space that are really dedicated to supporting separating service members. An organization that we work a lot with is Hire Heroes USA, which provides individualized counseling and advice to new veterans who are seeking civilian jobs. The Chamber of Commerce has Hiring Our Heroes, which is another organization that provides this type of resource, as well. And there's a there's a large number of these organizations, both operating at the national level and at more local levels.

Evan Banks

You've studied programs like the transition assistance program. What can be done to provide more support and help improve these job outcomes for veterans?

Carrie Farmer

The transition assistance program, as I mentioned, is sort of a good first step, but it's not really sufficient. So, one thing that we could do is think about how to provide more support prior to separation, have there be a longer period of this transition process while someone is still employed with the military, to be connecting to new jobs, to be thinking about what that next step looks like, what the job possibilities are. But this is also really challenging because doing that takes away from time spent meeting the mission for the military. And so, that's this is a real balance and something that's really challenging. And so, alternatively, it is really providing structured resources after separation or at the point of separation.

So, there is a role here for Department of Labor and Department of Veterans Affairs to have even a bigger programming and opportunities to support veterans. There is a program that is through the Department of Labor, it's called the Employment Navigator Pilot Program, that is aiming to connect new veterans to some of these nonprofits that are working to help with veteran employment. But there's a lot across all of these programs that we don't understand. And I would be remiss as a researcher if I didn't emphasize also the need to evaluate the effectiveness of these programs and ensure that any programs that we're investing in have excellent outcomes and that there's opportunities to continue to improve and understand which new veterans are most supported by which types of interventions and supports.

Evan Banks

Let's change gears a little bit and talk about health care. Veterans often face some serious health challenges and increased health risks. There's substance use disorder, PTSD, depression, even risk of suicide, to name just a few. You and your colleagues at RAND have studied these issues, and we could probably do an entire episode on each one of them. But today we're going to focus on how veterans receive the care they need for these health issues. Let's start at a high level. So, what's the health care experience like for veterans right now?

Carrie Farmer

That's a bit of a complicated question. So there's a misperception that all veterans are getting their care from the Department of Veterans Affairs or VA. And the reality is that there's about 18 million veterans in the United States. About half of those, about 9 million veterans, are enrolled to get care from VA, and about 6 million get care from VA in any given year. So, that's about a third of all veterans are getting care from VA each year.

Veterans who are not getting care from VA are getting care from other places. So, some might be old enough to be eligible for Medicare and are receiving their care from Medicare providers. Many are getting care from employers through employer-sponsored insurance, and a mix of other sources, as well. So, it's a real mix, although VA is what we think of most commonly when we think about veterans' health care.

Evan Banks

Do we have good data on exactly what their health care needs are? And and are there any gaps in the data that we have?

Carrie Farmer

We have good data. We can always have better data. I think that's that's that's always the case, right? So, we have we do have a relatively good sense of how veterans' health needs are different from non-veterans, and we know that this has some to do with military experiences and some to do with differences in the demographic makeup of the veteran population compared to the non-veteran population.

So overall, veterans tend to be older and more male than the non-veteran population. So, we always have to take that into consideration when we think about the differences between veterans and non-veterans on an average level. And it's true that while veterans are more likely to have some types of health conditions and particularly mental health conditions, it's still a minority of the veteran population that experience things like PTSD. Most veterans are healthy, have a easy transition to civilian life. And so where we're most concerned are for those that don't and that do need extra support and need access to health care more quickly.

Evan Banks

I think I'm jumping ahead a little bit, but my understanding is, and and feel free to correct me if I'm wrong, that we that we actually do have very good data from the VA on how veterans use the VA health care. Correct?

Carrie Farmer

That's right. And VA really has a robust internal research infrastructure that makes use of all of the data that VA collects about veterans and their health care experiences, really aiming to provide coordinated care and understand the needs of the veterans they serve. We have much less information about the health care experiences and health care needs of veterans who don't use VA health care. It's an area that it's difficult to find information about because most health systems don't ask whether or not someone is a veteran. And so, we don't have that that type of the equal type of data.

Evan Banks

Right. I suppose this is rewinding a little bit. Could you explain more about how veterans receive care from the VA or from the private sector? How does how does that work? I know that there's a program where they can receive private sector care. How did their experiences differ depending on where they received this care?

Carrie Farmer

So, that's another area where we actually don't have enough data and understanding about that. So, VA provides care directly through VA facilities, through VA-employed providers. Increasingly, VA is turning to the private sector to meet the needs of some veterans, and this is something that has been legislatively required over the past decade. VA has long partnered with the private sector to provide care to veterans when it is unable to meet the needs of veterans. But with the passage of legislation in 2014 and again in 2018, has turned to this much it's much more common for veterans to receive care that VA is paying for that's outside, provided by outside providers.

And so, VA refers to this as the community care network. And so, veterans are enrolled with VA, are getting some care from VA, and then are referred to the private sector, to this community care network to receive some of their care. And this often happens when veterans aren't able to get an appointment in a timely way at a VA facility or when they live far from VA care or there's a specific type of care that's more easily accessible outside VA than within VA.

Evan Banks

Do you find that this model works for for veterans?

Carrie Farmer

I think it depends on who you ask. So, for some veterans, yes, this is this has been a real improvement in their experience of care from VA, that they're able to go to providers in their communities. They might be able to they might be seeing the same providers that the rest of their family is seeing and their neighbors, especially for veterans who live far from a VA facility, this is a real benefit. Other veterans, it hasn't met their needs. This is where we need much more information. We don't know a lot about the care that's being provided through the community care network to these veterans, whether it is the same quality that's being provided by VA, whether it's better, whether it's worse, and for whom.

Most non-VA providers don't really know very much about veterans and their unique health care needs, don't really know anything about the military. And sometimes this matters and sometimes this doesn't matter. If you're treating a heart condition, it might not appear to matter whether or not someone is a veteran that the same type of care would be provided. But it could matter if there are aspects of that heart condition that are due to military service or that might be exacerbated by being exposed to some type of toxic substance that's important to know. And if a provider is not asking whether someone is a veteran and not asking about their military experiences, they might not be addressing the whole health of that veteran.

Evan Banks

Health care costs are generally one of the biggest issues facing this country. How do veterans' costs fit into that discussion? Are costs for veterans also rising?

Carrie Farmer

The VA budget has definitely been increasing. And part of that is the increased costs of care provided through this community care network. So those costs have been increasing quite a bit, and the overall budget for VA, as well. And so, why that is is a complicated question. Some of it, of course, is health care costs overall in the United States. Some of it is is that the veteran population is aging, their health care needs are increasing. And this is true for all aging populations.

And so, just the general costs of care are increasing with an aging veteran population. But we don't have good comparisons of the cost of care delivered by VA compared to the cost of care delivered outside of VA because health care systems are really different. So, VA is an integrated health care system with its own facilities and salaried providers, and it's much more difficult to compare on a procedure by procedure basis the cost of care between VA and outside of VA.

Evan Banks

Switching gears once more, let's talk about veteran families. I think we hear a lot about military families and the challenges they face, but veteran families represent a whole different area of policy needs, right?

Carrie Farmer

Yeah, we really don't know very much about veteran families. We recently conducted a study where we were examining the characteristics of veteran families and realized something surprising to us, which is also something that's obvious, which is that not all veteran families were military families. So, about half of veteran families were formed after the veteran had separated from the military. And so, what this means is that spouses of veterans may really have no or very little understanding of that veteran's experience in the military. They didn't live through it with them the same way that a military spouse lived through the experience with them. And so may have a lack of context for what the veteran is experiencing, and may also have fewer access to resources, just not tapped into the same network that people who are military spouses are part of.

Evan Banks

What do we know about the experiences of these veteran families?

Carrie Farmer

We really know hardly anything about what it's like for for veteran families and as you know, especially for this type of veteran family that was formed after military service. You know, there are kids in these families, and these kids might not have been military kids, either. So, they were born after their parent served in the military. And I think it it varies, right? It depends on that person's military experience, whether it is a huge part of their identity that they talk to their family a lot about, and the family therefore can learn about the military experience, or something that is something that they don't talk about, but may still affect their life and the family doesn't know very much about.

In our analyses, you know, veteran families don't look that much different from non-veteran families. Veteran families, in fact, often look economically slightly better than non-veteran families in terms of wages, in terms of the extent to which they're have a high housing cost burden or the extent to which they're spending a lot of their income on housing. Veterans tend to have a lower housing cost burden than non-veteran families. So, in many ways, veteran families are doing well, but there's not a lot we know about them in general.

Evan Banks

Would you say that these veteran families are largely overlooked, and if so, what might change that?

Carrie Farmer

I wouldn't say that they're overlooked so much as I think there's an assumption that they're part of this broader military community and the families themselves may not feel that they're part of this broader military community. So, I think it is important to be thinking about how can we connect to those families and ensure that they're aware of resources available to their family and available to the veteran in their family. Through outreach, there are some wonderful organizations that serve military families and also serve veteran families. And I think our research really helps to shed light on the fact that there may be families out there that aren't aware, don't feel part of this broader community.

Evan Banks

How important is family support to veterans' success in civilian life?

Carrie Farmer

I think family support is important for all of us, right? And so one of the things that we often say is that veterans are people, too. And so, but I wouldn't say that it's it's more important than for non-veteran families. I think having the support for veterans who are struggling or who have high health care needs, they may be in a unique situation where they have their spouse or family member is acting as a caregiver to them. These are people that are really not only providing the emotional support, but also logistical support and in some cases medical support to wounded, ill, or injured veterans.

Evan Banks

Ok. Let's change gears one more time. Are there any misconceptions or misperceptions about veterans that you want to highlight for our listeners?

Carrie Farmer

I think one of the biggest misperceptions about veterans is that veterans are wounded in some way, that all veterans experience a toll of military service that is leading them to suffer in some way. And the reality is that for most veterans, their military experience has been a very positive aspect of their lives. And veterans are contributing in all ways to our communities, to our workplaces, to our country. So, if there's one thing I would change is this perception of the the broken veteran. That's not to diminish the concerns we have for those veterans who are suffering and who do need additional support and additional programs and additional resources to ensure that they have a healthy and happy life. But it is not the majority of veterans. So, I think that's one that's one big misperception.

Evan Banks

Yeah. So, we're releasing this episode on Veterans Day. I wanna close by asking you what does Veterans Day mean to you and and what would you say to any veterans listening?

Carrie Farmer

To me, Veterans Day is an opportunity to really be grateful for the role that those who have served in the military have played in helping to strengthen our country. It is not an easy thing to volunteer to serve the country, and we ask an awful lot of these individuals. So, I am a grateful American. I am not a veteran myself, and I really admire the service of those who have volunteered to serve our country. And I think Veterans Day is an opportunity for us to thank those people who have volunteered in this way and for us to think about how we as a country have benefited from that service.

Evan Banks

Ok. Thanks, Carrie. Really appreciate having you on the show and really appreciate your work.

Carrie Farmer

Thank you so much for having me.

Evan Banks

You can learn more about the research we discussed on this episode at rand.org/veterans. This episode was produced by Deanna Lee. It was recorded by Deanna and me, Evan Banks. It was edited by Emily Ashenfelter. RAND's director of Digital Outreach is Pete Wilmoth. On a personal note, today's episode will be my last appearance on the podcast. But don't worry, Policy Minded will continue and you're in good hands. Thanks for listening to Policy Minded. RAND is a nonprofit institution that helps improve policy and decisionmaking through research and analysis.