Houston Hospice has augmented its veteran’s program, which is designed to address the specific end-of-life and serious illness needs of those who have served in the Armed Forces. The hospice, which launched veteran-specific services in 2014, now serves as a mentor to other providers seeking to improve their own programs for current and former military patients and families.

The Houston Hospice Veterans Program recently achieved the Level 5 designation within the We Honor Veterans initiative. To reach Level 5, providers must build on their previous work serving veterans by building partnerships with other community organizations and offering guidance to other providers on caring for that population.

During 2020, about 10% of the 2,400 patients Houston served were veterans, according to President and CEO Rana McClelland. 

“The program teaches hospice staff and volunteers about the best techniques for respectful inquiry, compassionate listening, and grateful acknowledgement for patients with a history of military service, and possibly physical or psychological trauma,” McClelland told Hospice News. “Our social workers and staff are trained to assist veterans with complex specific mental and mental health concerns. We also offer assistance in navigating veterans benefits.”

The National Hospice & Palliative Care Organization in 2018 launched We Honor Veterans in partnership with the U.S. Department of Veterans Affairs (VA) to improve access for veterans and help them grapple with the question of electing hospice.

Roughly 20.3 million military veterans live in the United States, according to the National Center for Veterans Analysis and Statistics. According to 2016 data from the U.S. Census Bureau,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.

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.

Veterans in hospice have a number of care needs that differ from those of the general population. 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.

“We need to determine their needs on an individual basis, whether those include clinical care, navigating VA benefits or bereavement services,” Monica James, community engagement and We Honor Veterans liaison for Houston Hospice, said. “We do a thorough psychosocial assessment, including the impact of a military service on both the veteran and the family members.”

A key aspect of the Houston Hospice program is connecting patients with volunteers who are also veterans. This gives the patient access to someone who may have had similar experiences in the military, which helps to foster trust.

For example, James cited an instance in which a veteran hospice patient experienced a flashback associated with post-traumatic stress disorder (PTSD). The patient had barricaded himself behind his door and refused to let anyone enter. The hospice called upon a veteran volunteer who appeared in uniform and addressed the patient using military language, including their respective ranks. The volunteer helped establish a rapport with the patient that allowed him to be more at ease and allow caregivers inside his room.

“Houston Hospice works very closely with each veteran and their families,” James said. “Our team of doctors, nurses, social workers, grieving specialists and volunteers take the time to get to know each veteran, their branch of service, and the war in which they fought so that they can customize their care plan for their unique needs.”