Scars unseen

The Unique Needs of VETERANS

AT

END OF LIFE

Objectives• Review Statistics of Veterans’ Illness and

Death in PA• Describe the Differences between VA Model

of Care and Community care• Develop an Understanding of the “WE Honor

Veterans” Campaign• Develop an Understanding of the “No Veteran

Dies alone” Mission

Pennsylvania Statistics

• Rank 5th in the nation for Percent of Veteran Population > 65 years

Pennsylvania Statistics

• Ranks 5th in the nation for Veteran Deaths

Pennsylvania StatisticsVeterans Enrolled in VA

• Total Veterans = 1,014,884– War Time = 708,200– Gulf War = 183,500– Vietnam = 320,400– Korean Conflict = 117,700– WWII = 109,800– Peacetime = 255, 900– OIF/OEF/OND = 51, 784

National Center for Veterans Analysis and Statistics, 2010 VISN 4 OIFOEF Dashboard, 2012

Demographic Imperative

Only 4% of Veterans die in VA (~21,000)

~642,370 Veterans will die in 2012

PTF file and VetPop for 2012

MANY with advanced serious illness

Selected Characteristics

Has a service connected disability

Uses VA Health care

Use VA only No Health Coverage

Below poverty

0

5

10

15

20

25

30

MaleFemale

Source: U.S. Census Bureau, American Community Survey PUMS, 2009Prepared by the National Center for Veterans Analysis and Statistics

VA Care vs. Community Care Veteran Affairs (VA) Community

Culture Quasi- Military Nurse-led Movement

Role Provider and Payer Provider

Funding Fixed appropriation and budget

Entitlement-Medicare/Medicaid hospice benefit: 3rd party reimbursement

Accountability Congress Governing body, CMS, Fiscal Intermediaries, and State

Location Large Medical CentersCBOC’s

Private Homes

VA Hospice and Palliative Care

Film clip

VA Palliative Care

• Holistic

• Interdisciplinary Model– Nursing – Spiritual– Psychosocial– Symptom Management– Medical Management

Palliative Care

• Even if a Veteran meets eligibility criteria for Hospice Care, he might not be mentally ready for Hospice care.

• Palliative care (skilled nursing care symptom management) is offered until the Veterans symptoms are managed to an acceptable level set by the veteran. Palliative Care continues until the skilled need or the goals of therapy are met or the veteran elects Hospice care.

Palliative care cont’

• Palliative care falls under the homecare umbrella of insurance coverage and can be offered through a home health and hospice agency. Not all homecare/hospice agencies have palliative care teams available.

• The Veteran must have a skilled need and be homebound in order for insurance to pay for it.

Veterans in Community Hospice / Palliative Care

Home Hospice Care is provided wherever the Veteran calls Home

The VA purchases Community Hospice Service as a Comprehensive Bundled per Diem Service for a Specific Period of Time.

If a Veteran has Medicare or Other Private insurance, he may elect to have the VA pay or his other insurance pay.

If a Veteran does not have insurance to pay for hospice care, the VA will pay through FEE basis, for the care the Veteran needs, through a community hospice agency.

Veterans in Community Hospice

The VA will pay for 3 levels of community hospice care

• Routine home care • Continuous care • Inpatient Care when indicated

For inpatient care, the hospice agency is to contact the VA for authorization prior to admission to an contracted facility.

Veterans in VA Health care

A VA Facility should be considered before a community facility

Reasons for Inpatient Admissions for Hospice and Palliative Care

• Uncontrolled Symptoms• Inadequate Care or No Caregiver• Caregiver Burden

What Influences Veteran Needs ?

• Cultural Impacts

• Fears

• Different War Eras

• Where They Served, How They Served

Cultural Impacts

• Military Service– Military Values– Stoicism

• Combat influences– Heroic Measures– Advance Directives– Pets

Fears 65% Veterans :

• Have Poor Support Systems

• Have Psychological Stress

• Prefer the “Strength of many and the power and

wisdom of the group”

• Oppose Institutionalization at End-of Life

• Desires Open Communication with Professionals

Different War Eras

• WWII–Cold Injuries–Mustard Gas Effects–PTSD vs. Delirium–Radiation Exposure

• Korean Conflict–Cold sensitivity–PTSD– Minimizing of Experiences

War Eras Con’t• Vietnam–Alcohol/Substance abuse–Agent Orange Exposure–Homelessness– Increased need for care

• Gulf war/OEF/OIF–Exposure to Toxins–Gulf war Syndrome–TBI–Chronic Fatigue Syndrome

PTSD- Post Traumatic Stress Disorder

• What is PTSD?• 3 Major Symptoms–Re-experiencing–Avoidance– Increased Arousal

• Management• Spiritual and Emotional Distress• Interdisciplinary Approach to Care

How can We IMPROVE Care to Veterans?

• We Honor Veterans• No Veteran Dies Alone

Designed to empower hospice professionals to meet the unique needs of dying Veterans :

• Military Check list• Honoring Veteran Medical Needs• PTSD & Psychosocial Needs• Veteran Healthcare Benefits

How to Become Involved…

• Enroll

• Learn

• Complete Activity Reports

• Network

VA Provides Tiered Recognition

• Level 1- Commit to Program

• Level 2- Provide Education to Staff

Identify Veterans

• Level 3- Strengthen Relationships with VA

• Level 4- Increase Access and Quality Care to

Veterans•

No Veteran Dies Alone

• “No one should die alone…. Each human should die with the site of a loving face”

-Mother Teresa of Calcutta

• What is it?• Who may help?• How to help?

No Veteran Dies Alone

• National initiative • The Department of Veterans Affairs says its

mission is "to fulfill President Lincoln's promise ... 'To care for him who shall have borne the battle.' “

• VA hospitals around the country, provide the special care that Veterans desire when their final battle is coming to an end.

A Veteran’s Story

Jim Cooper

• Navy Frogman

• Korean War Veteran

• Advanced COPD

Home Care Agencies’ Best Friends Federal Guide to Veteran & Dependent Benefits (on line & in print)

www.va.gov (VA benefits, especially healthcare)

www.vba.va.gov (general VA benefits)

VHA Handbook 1140.5 (Community Hospice Referral & Purchase Procedures)

Your local VA facility Hospice/ Palliative Care POC, Community Home Health Coordinator and Pre-registration staff

County Veteran Representatives – located usually in county courthouses

Summary

• Growing Numbers of Veterans• Unique Needs• How can WE honor Veterans?– Collaboration– Use of tools and Expertise– Partnerships