1. The Unique Needs of VETERANS AT END OF LIFE
Scars unseen
The Unique Needs of VETERANS AT
END OF LIFE

2. 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

3. Pennsylvania Statistics
Rank 5th in the nation for Percent of Veteran Population > 65 years

4. Pennsylvania Statistics
Ranks 5th in the nation for Veteran Deaths

5. Pennsylvania Statistics Veterans 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

6. Demographic Imperative
Only 4% of Veterans die in VA (~21,000)
~642,370 Veterans will die in 2012
Open with slide and then back to Scott when he begins to talk about the 642,370 Veteran deaths
if you use Almanac to identify Veterans with just 4 serious illnesses, CHF, CRF, COPD and XX, you’ll get more a figure of more than 800,000 Veterans suffering from these illnesses. This is before we even add in ANY Veterans with serious cancers which likely numbers in the 100,000s as well. I applaud all the advances in coordinating cancer care. Many of these concepts, such as being evidence based, matching goals of care to appropriate services and improved care coordination are equally applicable to the care of non-cancer serious illness.
MANY with advanced serious illness
PTF file and VetPop for 2012

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

8. 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 Centers
CBOC’s
Private Homes

9. VA Hospice and Palliative Care
Film clip

10. VA Palliative Care Holistic Interdisciplinary Model Nursing Spiritual
Psychosocial
Symptom Management
Medical Management

11. 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.

12. 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.

13. 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.

14. 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.

15. 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

16. What Influences Veteran Needs ?
Cultural Impacts
Fears
Different War Eras
Where They Served, How They Served

17. Cultural Impacts Military Service Combat influences Military Values
Stoicism
Combat influences
Heroic Measures
Advance Directives
Pets

18. 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

19. Different War Eras WWII Cold Injuries Mustard Gas Effects
PTSD vs. Delirium
Radiation Exposure
Korean Conflict
Cold sensitivity
PTSD
Minimizing of Experiences

20. 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

21. 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

22. How can We IMPROVE Care to Veterans?
We Honor Veterans
No Veteran Dies Alone

23. 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

24. How to Become Involved…
Enroll
Learn
Complete Activity Reports
Network

25. 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

26. 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?
Many years ago friends and family surrounded dying loved ones as they reached the final stage of their life. Today many people are living longer due to medical advances and frequently outlive their family and friends. Working in a health care setting, hospital staff observe many patients are dying alone. For this reason a program called ‘No One Dies Alone’ was originated. The ‘No One Dies Alone” program is a volunteer Companion Program for Dying Hospital Patients. The program is designed to train volunteers in assisting with the care of veterans at the end of life.

27. 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.

28. A Veteran’s Story Jim Cooper Navy Frogman Korean War Veteran
Advanced COPD

29. Home Care Agencies’ Best Friends
Federal Guide to Veteran & Dependent Benefits (on line & in print)
(VA benefits, especially healthcare)
(general VA benefits)
VHA Handbook (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

30. Summary Growing Numbers of Veterans Unique Needs
How can WE honor Veterans?
Collaboration
Use of tools and Expertise
Partnerships