Mona Pearl Treyball has experienced all sides of veteran health care and caregiving.

She’s a veteran, a retired colonel in the United States Air Force who served on active duty and as a reserve officer. She’s a trained trauma nurse and a former government administrator who helped shape veteran’s health policy.

Currently, she’s a professor at the University of Colorado College of Nursing who was an architect of the college’s groundbreaking masters-level Veteran and Military Health Care program.

But ask her about her toughest job, and she points to caring for her former husband, a veteran who experienced post-traumatic stress disorder (PTSD).

“I had a lot of experience. I was in the military. I am a nurse. And it was still tough,’’ Pearl Treyball says. “It is rough caring for someone with PTSD.”

Their marriage did not survive. “It broke my heart at the time, but we all figured it out eventually.”

Veteran Care is Complex, Requires Commitment

PTSD is a psychiatric disorder that can occur following the experience of witnessing of a life-threatening event such as military combat, according to the Department of Veterans Affairs (VA). Those who experience PTSD may have nightmares or flashbacks, difficulty sleeping and may feel estranged from the larger society. Depression, anxiety and substance abuse may develop from PTSD. They can experience bouts of anger or can retreat into periods of isolation, making caring for them tricky, requiring a high level of patience and understanding for professional caregivers.

And veterans have a higher incidence of PTSD. Nearly 8 percent of the U.S. population will experience PTSD at some point in their lives. But about 30 percent of women and men who have spent time in war zones will experience it, according to the VA.

Depending on when they served and in what war or conflict, those percentages change. Hence, Treyball says, the complexity of caring for veterans.

“Veteran caregiving requires the special kind of compassionate rigor steeped in the insatiable quest for finding out as much as a professional caregiver can about a veteran’s service,” she said. Each war and conflict have specific injuries - invisible as well as the visible wounds of war - that a caregiver should work to understand to provide holistic care.

The odds that a professional caregiver will encounter a veteran are relatively high.

Consider, she says:

• 10% of patients have served in the military
• One in four dying patients is a veteran
• Half the dying men in America are vetera­­ns

Reflection Can Surface Good, Bad Memories

It is a population that has unique needs. Aging veterans, the everyone, become reflective, and some memories that may have been stifled may rise to the surface, according to Treyball. Not all memories are bad. For many, their service defined them as women and men and catapulted their future. There is often pride. But sometimes there is guilt or the need to process events that, perhaps, some have never shared.

"It brings that identity back to the surface,'' she says. "It's unique to them, to their family and other vets." And understanding that not all veterans are the same is paramount in their care, she argues.

“Every conflict has a hallmark’’ that impacts veterans differently, she says. Nuclear warfare in World War II, Agent Orange in Vietnam, the Gulf War Syndrome in the conflict in the Persian Gulf in 1991, blast injuries in more recent conflicts in Afghanistan and elsewhere – every conflict has its own fallout.

‘I Don’t Know What I Don’t Know’

For a veteran loved one, finding a professional caregiver with military experience is best. But finding one with training and education in the care of the veteran population may be more realistic, she said. Family caregivers can, and should, seek out supplemental help, either in peer-to-peer groups or with volunteer groups who can support their care. The VA, for example, offers advice and toolkits for family caregivers to help on its website. Officials there can provide experts or volunteers to assist.

There is no specific certification required for caregivers when it comes to the companion care of veterans, Treyball says. That’s why hiring a professional caregiver can make a significant difference.

“I think it’s important for caregivers to have an understanding of a veterans’ service,’’ she says, adding that some of her students, many of whom have been vets themselves don’t fully understand the complexity of care needed.

“I’ve had so many tell me: ‘I didn’t know what I didn’t know.’’’

Companion care for veterans is also rooted in core behaviors that all professional caregivers provide:

• Be willing to understand the person
• Understand their age, condition and needs
• Be culturally sensitive
• Be patient and responsive to their unique needs
• Show compassion and understanding
• Listen

Treyball says it is vital for professional caregivers to have a sincere appreciation for the veteran for whom they are caring.

“These are amazing people, they have sometimes sacrificed so much for us,’’ she says. “We need to have a truly compassionate understanding of that.”

Get more information on how veterans can finance home care services by clicking here.