The U.S. Department of Veterans Affairs (VA) has designated Iowa-based Generations Hospice as part of its Community Care Network (CCN). The contract allows Generations to receive referrals directly from the VA and receive reimbursement if the patient is not covered by Medicare.

Though the VA has its own health system, the agency also contracts with non-government providers to give veterans’ access to a wider range of services. Congress established the CCN in 2018, which the VA has implemented in phases. As of 2021, CCN included five regional networks that include all U.S. states and territories. 

“The network is providers that have met certain requirements to which the VA can send referrals for services that they can’t necessarily handle,” Joshua Howell, director of marketing for Generations, told Hospice News. “The VA is working with local providers like us to fill that need. We’ve always served veterans in the past, but not in an official capacity with the VA. To have that kind of official status is a pretty big deal for us.”

Through CCN, the VA provides coverage of health care services via third-party administrators. In Generations’ region, the administrator is Optum Public Sector Solutions, a component of United Health Group (NYSE: UNH). Insurance provider TriWest Health Care Alliance is the agency’s second third-party administrator, covering Regions 4 and 5 of the CCN. 

For veterans who are Medicare beneficiaries, Generations will receive reimbursement through the traditional hospice benefit. For terminally ill veterans who are not Medicare eligible, hospices will receive payment through Optum or TriWest.

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.

“Military men and women often carry deep physical, emotional, and spiritual wounds from experiences during their service,” Michael Carney, ordained chaplain at Generations, said. “These wounds are often never spoken of during the veteran’s life, for fear that sharing them would shock and disturb the civilian listener.”

As veterans age with the rest of the population, the VA is paying closer attention to end-of-life care.

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 one in four deaths nationwide. Nearly 85% receive health care services, including hospice, outside of the VA. Only 4% die in a VA facility.

The VA began its Comprehensive End-of-Life Initiative in 2009 to improve the quality of end-of-life care among veterans and increase dying veterans’ enrollment in hospice for care more aligned with their goals. The initiative has led to a roughly 7% to 8% increase in hospice use among veterans.

Howell and Carney are two of three U.S. Air Force veterans working at Generations. The third is Medical Director Rebecca Wester, M.D.

“There may be some things that come up with a veteran towards the end of life that relate to what they went through while in the service,” Generations Executive Director Stephanie Kemerling told Hospice News. “We feel very qualified, having the staff that we do, to take care of any needs, including post traumatic stress syndrome, due to their serving our country.”