Presentation on theme: "The Unique Needs of VETERANS AT END OF LIFE"— Presentation transcript:
1The Unique Needs of VETERANS AT END OF LIFE Scars unseenThe Unique Needs of VETERANSATEND OF LIFE
2Objectives Review Statistics of Veterans’ Illness and Death in PA Describe the Differences between VA Model of Care and Community careDevelop an Understanding of the “WE Honor Veterans” CampaignDevelop an Understanding of the “No Veteran Dies alone” Mission
3Pennsylvania Statistics Rank 5th in the nation for Percent of Veteran Population > 65 years
4Pennsylvania Statistics Ranks 5th in the nation for Veteran Deaths
5Pennsylvania Statistics Veterans Enrolled in VA Total Veterans = 1,014,884War Time = 708,200Gulf War = 183,500Vietnam = 320,400Korean Conflict = 117,700WWII = 109,800Peacetime = 255, 900OIF/OEF/OND = 51, 784National Center for Veterans Analysis and Statistics, 2010VISN 4 OIFOEF Dashboard, 2012
6Demographic Imperative Only 4% of Veterans die in VA (~21,000)~642,370 Veterans will die in 2012Open with slide and then back to Scott when he begins to talk about the 642,370 Veteran deathsif you use Almanac to identify Veterans with just 4 serious illnesses, CHF, CRF, COPD and XX, you’ll get more a figure of more than 800,000 Veterans suffering from these illnesses. This is before we even add in ANY Veterans with serious cancers which likely numbers in the 100,000s as well. I applaud all the advances in coordinating cancer care. Many of these concepts, such as being evidence based, matching goals of care to appropriate services and improved care coordination are equally applicable to the care of non-cancer serious illness.MANY with advanced serious illnessPTF file and VetPop for 2012
7Selected Characteristics Source: U.S. Census Bureau, American Community Survey PUMS, 2009Prepared by the National Center for Veterans Analysis and Statistics
8VA Care vs. Community Care Veteran Affairs (VA)CommunityCultureQuasi- MilitaryNurse-led MovementRoleProvider and PayerProviderFundingFixed appropriation and budgetEntitlement-Medicare/Medicaid hospice benefit: 3rd party reimbursementAccountabilityCongressGoverning body, CMS, Fiscal Intermediaries, and StateLocationLarge Medical CentersCBOC’sPrivate Homes
10VA Palliative Care Holistic Interdisciplinary Model Nursing Spiritual PsychosocialSymptom ManagementMedical Management
11Palliative CareEven if a Veteran meets eligibility criteria for Hospice Care, he might not be mentally ready for Hospice care.Palliative care (skilled nursing care symptom management) is offered until the Veterans symptoms are managed to an acceptable level set by the veteran. Palliative Care continues until the skilled need or the goals of therapy are met or the veteran elects Hospice care.
12Palliative care cont’Palliative care falls under the homecare umbrella of insurance coverage and can be offered through a home health and hospice agency. Not all homecare/hospice agencies have palliative care teams available.The Veteran must have a skilled need and be homebound in order for insurance to pay for it.
13Veterans in Community Hospice / Palliative Care Home Hospice Care is provided wherever the Veteran calls HomeThe VA purchases Community Hospice Service as a Comprehensive Bundled per Diem Service for a Specific Period of Time.If a Veteran has Medicare or Other Private insurance, he may elect to have the VA pay or his other insurance pay.If a Veteran does not have insurance to pay for hospice care, the VA will pay through FEE basis, for the care the Veteran needs, through a community hospice agency.
14Veterans in Community Hospice The VA will pay for 3 levels of community hospice careRoutine home careContinuous careInpatient Care when indicatedFor inpatient care, the hospice agency is to contact the VA for authorization prior to admission to an contracted facility.
15Veterans in VA Health care A VA Facility should be considered before a community facilityReasons for Inpatient Admissions for Hospice and Palliative CareUncontrolled SymptomsInadequate Care or No CaregiverCaregiver Burden
16What Influences Veteran Needs ? Cultural ImpactsFearsDifferent War ErasWhere They Served, How They Served
17Cultural Impacts Military Service Combat influences Military Values StoicismCombat influencesHeroic MeasuresAdvance DirectivesPets
18Fears 65% Veterans : Have Poor Support Systems Have Psychological StressPrefer the “Strength of many and the power and wisdom of the group”Oppose Institutionalization at End-of LifeDesires Open Communication with Professionals
19Different War Eras WWII Cold Injuries Mustard Gas Effects PTSD vs. DeliriumRadiation ExposureKorean ConflictCold sensitivityPTSDMinimizing of Experiences
20War Eras Con’t Vietnam Alcohol/Substance abuse Agent Orange Exposure HomelessnessIncreased need for careGulf war/OEF/OIFExposure to ToxinsGulf war SyndromeTBIChronic Fatigue Syndrome
21PTSD- Post Traumatic Stress Disorder What is PTSD?3 Major SymptomsRe-experiencingAvoidanceIncreased ArousalManagementSpiritual and Emotional DistressInterdisciplinary Approach to Care
22How can We IMPROVE Care to Veterans? We Honor VeteransNo Veteran Dies Alone
23Designed to empower hospice professionals to meet the unique needs of dying Veterans : Military Check listHonoring Veteran Medical NeedsPTSD & Psychosocial NeedsVeteran Healthcare Benefits
24How to Become Involved… EnrollLearnComplete Activity ReportsNetwork
25VA Provides Tiered Recognition Level 1- Commit to ProgramLevel 2- Provide Education to StaffIdentify VeteransLevel 3- Strengthen Relationships with VALevel 4- Increase Access and Quality Care to Veterans
26No Veteran Dies Alone“No one should die alone…. Each human should die with the site of a loving face”-Mother Teresa of CalcuttaWhat is it?Who may help?How to help?Many years ago friends and family surrounded dying loved ones as they reached the final stage of their life. Today many people are living longer due to medical advances and frequently outlive their family and friends. Working in a health care setting, hospital staff observe many patients are dying alone. For this reason a program called ‘No One Dies Alone’ was originated. The ‘No One Dies Alone” program is a volunteer Companion Program for Dying Hospital Patients. The program is designed to train volunteers in assisting with the care of veterans at the end of life.
27No Veteran Dies Alone National initiative The Department of Veterans Affairs says its mission is "to fulfill President Lincoln's promise ... 'To care for him who shall have borne the battle.' “VA hospitals around the country, provide the special care that Veterans desire when their final battle is coming to an end.
28A Veteran’s Story Jim Cooper Navy Frogman Korean War Veteran Advanced COPD
29Home Care Agencies’ Best Friends Federal Guide to Veteran & Dependent Benefits (on line & in print)(VA benefits, especially healthcare)(general VA benefits)VHA Handbook (Community Hospice Referral & Purchase Procedures)Your local VA facility Hospice/ Palliative Care POC, Community Home Health Coordinator and Pre-registration staffCounty Veteran Representatives – located usually in county courthouses
30Summary Growing Numbers of Veterans Unique Needs How can WE honor Veterans?CollaborationUse of tools and ExpertisePartnerships