ENSURING QUALITY END OF LIFE CARE FOR VETERANS
This past Veteran's Day we celebrated our nation's veterans. But how many of us have really considered what post-military life is like for them and their families?
Mr. C is an 86-year-old veteran with end-stage heart failure and moderate dementia. After surviving some of the toughest fighting in World War II, he went on to earn a law degree and establish a successful practice. Mr. C never talked about the war with his family. They never thought to mention it to his doctors or the nursing home staff. Mr. C is haunted by memories from more than half a lifetime ago. Observing his frequent tears and periods of profound depression, his family and the nursing home staff realize something is wrong but they don't know how to comfort him.
Mrs. J is a 67-year-old veteran who served as a nurse in Vietnam. She has been told by her doctor that she has less than six months to live. For the past two years, Mrs. J has been receiving treatment at a Department of Veterans Affairs (VA) Medical Center an hour away. Although she still wants to maintain contact with VA staff, she is no longer able to make the trip to the VA Medical Center and wishes to spend her remaining time in the comfort of her home.
Mr. L is a 56-year-old veteran with end-stage liver disease and a limited prognosis. He lost a leg in Vietnam and has struggled with alcohol abuse and depression since returning to the United States. Now homeless and with no income or family support, he is in a VA hospital after collapsing outside an office building.
These stories represent just a few of the more than 600,000 veterans who are expected to die each year well into the next decade. Many of these veterans could benefit from hospice care, an end-of-life care choice that provides patients and their loved ones with comfort, compassion and dignity. Hospice care involves a patient-centered, team-oriented approach to expert medical care, pain management, and emotional and spiritual support. Care can be provided in a number of settings including patients' homes, inpatient hospice units, hospitals, nursing homes, and assisted living facilities. At the center of hospice care is the belief that everyone has the right to die pain-free and with dignity. The emotional and spiritual components of hospice care can be especially meaningful to veterans who often face issues near the end of life relating to their military experiences.
We Honor Veterans, a project of the National Hospice and Palliative Care Organization (NHPCO) in collaboration with the Department of Veterans Affairs (VA) has invited hospices, state hospice organizations and VA partners to join a pioneering program focused on respectful inquiry, compassionate listening and grateful acknowledgment. By recognizing their unique needs, community providers like Niagara Hospice, in partnership with VA staff, help guide America's veterans and their families through their life stories toward a more peaceful ending.
A Fragmented System
Anyone who has tried to navigate the health care system in America knows that often there is fragmented communication and coordination of services among health care providers, public and private insurance companies, and patients and families. Even though the Department of Veterans Affairs (VA) is the largest integrated health care system in the country there are still issues. So how can we ensure veterans receive quality end-of-life care? It's an important question to answer--particularly when considering these facts from the VA:
- More than 1,800 veterans die every day, representing a quarter of all deaths in America.
- Approximately 85% of veterans do not receive care through the VA health care system.
- Most veterans still die in the community; only 4% of veteran deaths occur in VA facilities.
These statistics highlight the importance of partnerships among VA and community health providers as well as organizations that serve veterans. There is a great need for education about hospice care and how it can be accessed.
Hospice care is part of the basic eligibility package for veterans enrolled in the Veterans Health Administration (VHA). If hospice care is appropriate for enrolled veterans and has been approved by a VA physician, VA medical centers will either provide hospice care directly in their facilities or purchase it from community hospices. All Medicare-eligible veterans, whether or not they are enrolled in VHA, have access to hospice care through Medicare. Veterans not eligible for Medicare may have hospice benefits through Medicaid or other private insurance.However, like 90% of all Americans, most veterans simply don't know that these options exist.
Niagara Hospice has established a partnership with the Veteran's Administration in Buffalo to ensure quality end-of-life care is available to all Niagara County veterans. Goals of the partnership include educating veterans and the community about the hospice benefit that every veteran is entitled to; customizing hospice care plans specific to the special needs of veterans; and recruiting community veterans to serve as hospice volunteers who are paired with Niagara Hospice patients who are also veterans.
One of those volunteers is Gene Brayley of Lockport. Gene often shares a special camaraderie with the veteran patients he has the privilege to meet. For many of those patients, that camaraderie and sharing of military experiences help provide necessary closure. Gene shares that during a home visit with a veteran patient, the daughter stopped him on his way out to leave. She said she learned a lot about her dad by listening in on their conversation, stating that her dad never spoke to family about his military experience. Ralph Bishop was a resident at Niagara Hospice House when Gene would visit with him. Ralph was a retired Army man, and Gene retired Navy. You know there's some competition there, but there were no fisticuffs during their visits. In fact, during one of their visits Ralph and Gene learned they were both at the Inauguration of President Eisenhower: Gene played in the Navy Band for the President and Howard served on the Presidential Guard.
Our nation's veterans have sacrificed something for the rest of us. They deserve our thanks, our compassion and our care - with dignity, especially at end-of-life. For more information about hospice care, call Niagara Hospice at 439-4417 or visit NiagaraHospice.org.