The U.S. Department of Veterans Affairs (VA) is working to expand hospice and palliative care utilization among veterans, both in its own facilities and through collaborations with private health care providers.
Historically, hospice utilization among veterans has been lower than that of the general population. In 2000, 21.6 percent of all Medicare decedents enrolled in hospice, compared with only 5 percent of veterans. The department has been working behind the scenes to close this gap.
“The majority of enrolled Veterans are older than 65, and the VA has made strategic decisions to meet the growing needs of an aging and often seriously ill population,” a VA spokesperson told Hospice News. “This is an ongoing effort to expand Veterans’ access to palliative and hospice care as these services are a part of every enrolled Veterans’ benefit package.”
Unlike the Medicare Hospice Benefit, the VA does not require patients to end curative treatment in order to enroll in hospice. VA health benefits will cover both concurrently. This policy has helped increase utilization of hospice and palliative care in VA facilities and also helped improve performance on quality metrics.
Recent research has shown that providing hospice or palliative care concurrent with radiation or chemotherapy reduces intensive care admissions among veteran patients, reduces the likelihood that patients will seek more aggressive treatments, and reduces health care costs associated with those patients.
Currently, all VA medical centers have interdisciplinary palliative care teams for consultative services, and close to 100 have dedicated inpatient hospice units. However, like most patients, the majority of veterans choose to receive hospice care in their home, for which the VA relies on community providers. Currently, 94 percent of veterans in hospice care receive services outside the VA health system.
“The VA is both a purchaser and provider of hospice and palliative care, however, the VA does not directly provide comprehensive home hospice care using VA staff,” the VA spokesperson said. “The VA made a strategic decision years ago to purchase home hospice care for veterans choosing this care and not to duplicate the nationwide network of community hospices already in existence.”
As of 2017, 4,488 hospice providers were operating in the United States, according to the Medicare Payment Advisory Commission. Of those, 3,800 currently participate in We Honor Veterans, a VA program to promote hospice use among veterans, developed in collaboration with the National Hospice and Palliative Care Organization. The program also provides resources to help hospice providers train volunteers and clinicians to address needs specific to veterans.
Amedisys, Inc. (NASDAQ: AMED), the third largest provider of hospice care in the United States, is a participant in the We Honor Veterans program.
“We spend a lot of time educating our staff on how to talk to patients. Veterans have unique needs. For instance, when a patient suffers from dementia at the end of life, conditions such as post-traumatic stress disorder can become an issue even if it wasn’t before,” Karen Powell, volunteer coordinator for Amedisys, told Hospice News.
One component of their service is to connect veterans in hospice with support from other veterans, who are often volunteers. Though Amedisys provides its own training to volunteers, others volunteering to work with veterans receive training from the We Honor Veterans “No Veteran Dies Alone” program. Fellow veterans can provide a level of understanding that few others can, sometimes including the patient’s family.
“My dad was in the Korean War, and he never spoke to us about it,” Powell said. “Veterans often do not talk to their families about their experiences, what they saw or what they have done.They only have that kind of camaraderie with other veterans, with others who have experienced leaving their families and putting their boots down in a foreign land.”