we honor veterans: honoring and caring for all veterans end of life care for veterans in their...
TRANSCRIPT
We Honor Veterans:Honoring and Caring for all Veterans
End of Life Care for Veterans
in their Community
How do you change a culture?
Jerry Sternin Story
Coming Home: Era of Service
• World War II: Heroes
* country worked together
• Korea: Ignored
* forgotten war
• Vietnam: Shamed
* country torn apart
Courtesy of Margaret Walkosz, MS, GNP-BC
Video clip
Hospice Foundation of America Living with Grief Series
Improving Care for Veterans Facing Illness and Death
https://youtu.be/77KuIEiL7VA
Demographic Imperative
Only ~3% of Veterans die in VA facilities (~20,000)
~632,931 Veterans died in 2014
PTF file and VetPop for 2012
Many more with advanced serious illness and dementia
(510,314 expected to die in 2025)Source: VetPop 2007
Collaborate (kuh-lab-uh-reyt)
1. To work, one with another; cooperate
2. To cooperate, usually willingly, with an enemy nation
It all begins with…
“Are you a Veteran?”
Can we work together to;
- ensure reliable access,
- to quality hospice and palliative care,
- for all Veterans?
www.WeHonorVeterans.org
• Hospice Veteran Partnerships
• Education• Partner Tools• Best Practices
(e.g., pinning ceremonies)
• Announcements• And more…
Mar-11
Jun-1
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Dec-11
Mar-12
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Sep-12
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Mar-14
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Sep-14
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0
500
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2500
3000 Level Four
Level Three
Level Two
Level One
Recruit
We Honor Veterans Partners (www.WeHonorVeterans.org)
Veteran-to-Veteran Volunteer Program
• Veterans often have a distinct culture• Common language and experience can
form strong bonds• Camaraderie among Veterans can provide
invaluable support• Identify Veterans in your Volunteer pool,
build on this resource and recruit others
Vision for VA’s Community Engagement
• Empower field leadership to develop and strengthen partnerships
• Communicate VA’s willingness to effectively partner
• Leverage partnerships to expand capacity, resources and access to services
Hospice Veteran Partnerships/ Veteran Community Partnerships
We Honor VeteransTop 10 Reasons to Participate
% of Veterans with CAN > 95 with Pall Care
3.4% got Pall Care
However, avg CAN score for Veterans that got Pall Care Consults is 98
Veterans “at risk” for needing palliative care
CAN- Care Assessment Need score
Goals of Care Conversations
Dr. Atul Gawande
How to have those end of life discussions?
https://www.youtube.com/watch?v=45b2QZxDd_o
A big question…
How would you make culture change happen across VA?
What indicators/measures would convince you VHA is moving towards improved care for Veterans with advanced illness?
% of Inpt Deaths in HospiceMore inpt deaths in hospice than in all of acute
and ICU combined
FY09 FY10 FY11 FY12 FY13 FY140
10
20
30
40
50
60
Funding support
When hospice is available, many will use it(absolute % change in inpatient deaths by venue nationally)
ICU Acute Nursing Home Hospice
Change 8% 17% 14% 39%
FY14 20% 22% 6% 52%
FY04 28% 39% 20% 13%
Note, inpt deaths declined over this period, ~5060 veterans impacted
Inpt Hospice Deaths by VISN(sorted)
20 7 17 19 2 5 9 22 8 3 18 11 1 15 16 12 21 6 4 10 23 Nat'l0%
10%
20%
30%
40%
50%
60%
70%
FY08 FY15 Q1
# of Palliative Care ConsultsLevel 3+ consults considered “comprehensive”
FY 2014
FY 2013
FY 2012
FY 2011
- 5,000 10,000 15,000 20,000 25,000 30,000 35,000 40,000
31,266
30,511
26,773
19,092
5142
4584
4487
4232
8005
6768
6878
6287
3477
2498
2625
2456
Palliative Care Consult Workload: 2011 - 2014
Inpatient Consults Level 3-5
Inpatient Consults Levels 1-2
Outpatient Consults Level 3-5
Outpatient Consults Levels 1-2
Days between Consult and Inpatient Death Trend
0-3 days 4-7 days 8-30 days > 30 days
FY 2015 Q1 20% 13% 25% 41%
FY 2014 21% 13% 26% 39%
FY 2013 23% 14% 26% 37%
FY 2012 25% 16% 29% 30%
National Average % of Families Rating Last Month of Care as “Excellent”
FY08 FY09 FY10 FY11 FY12 FY13 FY14 FY15 goal
20%
25%
30%
35%
40%
45%
50%
55%
60%
65%
70%
52%
56% 57% 58% 59%
63% 62%65%
Families of VA inpatient decedents, response rate ~56%, sample sizes ~11,000/yr
I CARE Initiative
Access Scandal
% of Families Rating End of Life Care as “Excellent” in Acute Units vs. Palliative care vs. Inpatient Hospice Unit Settings
P values< 0.001
N=4,222 N=3,494 N=4,072 FY2011 N=3,178 N=3,836 N=4,005 FY2012 N=2,122 N=3,523 N=3,090 FY20130%
10%
20%
30%
40%
50%
60%
70%
80%
48%50%
52%
61%59%
64%66% 67%
70%
Usual care Palliative Care Inpatient Hospice Unit
p<.001 p<.001
Confronting our “foes”
http://www.nbcnews.com/video/nightly-news/43433937#43433937
Healing can come decades later