1. We Honor Veterans: Honoring and Caring for all Veterans End of Life Care for Veterans in their Community

2. How do you change a culture? Jerry Sternin Story

3. 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

4. Video clip Hospice Foundation of America Living with Grief Series Improving Care for Veterans Facing Illness and Death https://youtu.be/77KuIEiL7VA

6. 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

7. Collaborate (kuh-lab-uh-reyt) 1.To work, one with another; cooperate 2.To cooperate, usually willingly, with an enemy nation

8. 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?

9. www.WeHonorVeterans.org Hospice Veteran Partnerships Education Partner Tools Best Practices (e.g., pinning ceremonies) Announcements And more…

10. We Honor Veterans Partners (www.WeHonorVeterans.org)

11. 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

12. 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

13. We Honor Veterans Top 10 Reasons to Participate

15. % 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

16. Goals of Care Conversations Dr. Atul Gawande How to have those end of life discussions? https://www.youtube.com/watch?v=45b2QZxDd_o

17. 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?

18. % of Inpt Deaths in Hospice More inpt deaths in hospice than in all of acute and ICU combined Funding support

19. When hospice is available, many will use it (absolute % change in inpatient deaths by venue nationally) ICUAcute Nursing Home Hospice Change8%17%14% 39% FY1420%22%6%52% FY0428%39%20%13% Note, inpt deaths declined over this period, ~5060 veterans impacted

20. Inpt Hospice Deaths by VISN (sorted)

21. # of Palliative Care Consults Level 3+ consults considered “comprehensive”

22. Days between Consult and Inpatient Death Trend 0-3 days4-7 days8-30 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%

23. National Average % of Families Rating Last Month of Care as “Excellent” Families of VA inpatient decedents, response rate ~56%, sample sizes ~11,000/yr I CARE Initiative Access Scandal

24. % of Families Rating End of Life Care as “Excellent” in Acute Units vs. Palliative care vs. Inpatient Hospice Unit Settings P values< 0.001

25. Confronting our “foes” http://www.nbcnews.com/video/nightly- news/43433937#43433937 Healing can come decades later