The National Hospice and Palliative Care Organization (NHPCO) and the U.S. Department of Veterans Affairs (VA) have expanded the scope of their We Honor Veterans partnership to enhance mental health services for traumatized veterans receiving hospice or palliative care.
The program is making grants to hospice and palliative care care providers to develop their capabilities in providing trauma-informed care, including mental health-oriented telemedicine services and a triage screening system for referrals to the VA’s PTSD consultation program.
“The Trauma-Informed Care for Veterans on Hospice Initiative will offer state-based hospice and palliative care organizations tools to help local VA facilities and community-based hospice providers collaborate and improve upon the person-centered, interdisciplinary care Veterans and their families receive at the end of life,” said NHPCO President and CEO Edo Banach.
Grant recipients will work with VA medical centers to promote access to the VA’s palliative tele-mental health services for veteran’s receiving care in their homes, develop care planning processes specific to veterans suffering from trauma, improve screenings for PTSD and moral injury, and provide training to hospice staff on the unique needs of veterans, in addition to some data collection activities. Thirteen organizations nationwide have been selected to participate in the first round of the program.
Hospice utilization among veterans is rising faster than that for nonveterans, according to a 2017 study in Health Affairs. Veterans’ utilization saw a 6.9 to 7.9 percentage-point increase compared to a 5.6 percentage-point increase for nonveterans.
The number of veterans of the Vietnam conflict is the fastest rising group in terms of utilization.
“Vietnam-era Veterans are quickly becoming the largest Veteran population utilizing hospice services. Military service can change veterans in fundamental ways that may impact how hospice and palliative care should be delivered,” Katherine Kemp, director of veterans’ services for NHPCO, told Hospice News. “While many of our hospice partners and their volunteers recognize the uniqueness of Vietnam veterans, there is scant research on what is needed when providing care at the end of life to Vietnam veterans.”
The We Honor Veterans program in 2018 launched a pilot project was to perform qualitative research to shed light on the mindset of Vietnam veterans as then grapple with the question of electing hospice.
Among other findings, the NHPCO/VA partnership’s research showed that many Vietnam veterans were skeptical of health care and end-of-life care due to the unfortunate reception many of them received upon returning home from overseas, frustration with the VA, and a lack of support services. Despite this reluctance, these aging veterans tend to have complex medical and psychosocial needs unique to their population. Hospice staff can benefit from additional training to provide the necessary support.
“I would say probably 90% of Vietnam veterans have a hidden agenda stashed deep within their spirits because of their issues with Vietnam, and it only takes the severity of dying that smacks them in the face, so the nurses really need to be sensitive when life review is really coming to visibility with our veterans,” said one Air Force participant in a We Honor Veterans focus group. “That’s when we have to jump on the situation and lead that person through that experience so ultimately that they can have peace in their lives.”