As U.S. veterans age with the general population, hospices nationwide are designing programs and engaging in partnerships designed to meet the unique medical, psychological and emotional needs of veterans during the end of life.
Roughly 18.2 million military veterans live in the United States, according to the most recent numbers from the U.S. Census Bureau, and nearly 642,000 die each year, accounting for 1 in 4 deaths nationwide. Nearly 85% receive health care services, including hospice, outside of the U.S. Veteran’s Administration (VA), and only 4% die in a VA facility.
“It is so important that before we do anything, we ensure that our hospice caregivers have a basic understanding of the service-related illnesses, diseases, and conditions that impact our veterans,” said Courtney Butler, assistant vice president of clinical distinction at Amedisys (NASDAQ: AMED). “This includes understanding that some veterans may under-report pain and/or symptoms that impact their quality of life and overall well-being and, as such, we cannot always rely on self-report, but instead need to focus on non-verbal communication.”
Staff training is essential to effective treatment of terminally ill veterans, addressing military service-related illness and injuries, emotional trauma, spiritual uncertainties and creating safe and supporting environments.
Butler explained that she and her colleagues at Baton Rouge-based Amedisys also receive education on military culture.
“There is significant opportunity for all hospice providers to provide more advanced training to build competence and skill when delivering care for this unique population,” she said. “Developing veteran-specific programs helps reinforce an organization’s commitment to providing a stronger platform for quality outcomes and improved quality of life.”
Psychological issues among veterans can be particularly complex. Dementia patients for instance can re-experience old traumas or painful memories related to combat or other military service.
“At the end of life, feelings of intense guilt and responsibility, fear, anger, anxiety, and stress can rise to the surface, causing veterans to wrestle with profound emotions they may have buried for decades, Community Hospice & Palliative Care Chief Medical Director Ana Sanchez, M.D., told Hospice News. “These symptoms can be exacerbated in the setting of a neurologic disease.”
“Veterans often have unique clinical needs as a result of chemical exposures, including ALS (Lou Gehrig’s disease), leukemia, diabetes, lymphoma. They also exhibit psychosocial and spiritual needs, including [post-traumatic stress disorder], moral and ‘soul injuries,’ depression and anxiety, substance abuse and addiction, loss of faith, and many others,” said Kathy McDonough, hospice director, psychosocial, spiritual and volunteer services at Amedisys.
Many hospice agencies participate in national programs designed to support veteran patients, like the Hospice-Veteran Partnership Program, a collaboration between the VA and the National Hospice and Palliative Care Organization (NHPCO). Perhaps foremost among the network programs is We Honor Veterans, another VA/NHPCO alliance providing resources to help hospice providers train volunteers and clinicians to address veteran-specific needs.
Char Miller, director of marketing and communications for Community Hospice & Palliative Care, described one of the agency’s partnership programs as “A group of veterans, active duty and veteran advocates, who serve as brand ambassadors, ensuring veterans are aware of and have access to our services.”
Miller coordinates veteran’s programs in her organization.
Other agencies promote in-house and outreach volunteer programs with names like “Vet-to-Vet Café” and “Operation Adopt a Soldier.” Still others sponsor pinning ceremonies, distribute certificates, or recognize veterans in other public ways.
“By the time a veteran has entered the care of our hospice program, they have developed coping mechanisms that work for them. Our team works with and supports that individual’s coping strategies,” said Jennifer Martin, director of Community Hospice & Palliative Care. “Many of the veterans we serve are World War II, Korean War, and Vietnam War veterans. Some are more likely to discuss their service, while others minimize and deflect.”
Written by Robert A. Porché, Jr.