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Scars unseen The Unique Needs of VETERANS AT END OF LIFE.

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Presentation on theme: "Scars unseen The Unique Needs of VETERANS AT END OF LIFE."— Presentation transcript:

1 Scars unseen The Unique Needs of VETERANS AT END OF LIFE

2 Objectives Review Statistics of Veterans’ Illness and Death in PA Describe the Differences between VA Model of Care and Community care Develop an Understanding of the “WE Honor Veterans” Campaign Develop an Understanding of the “No Veteran Dies alone” Mission

3 Pennsylvania Statistics Rank 5 th in the nation for Percent of Veteran Population > 65 years

4 Pennsylvania Statistics Ranks 5 th in the nation for Veteran Deaths

5 Pennsylvania Statistics Veterans Enrolled in VA Total Veterans = 1,014,884 – War Time = 708,200 – Gulf War = 183,500 – Vietnam = 320,400 – Korean Conflict = 117,700 – WWII = 109,800 – Peacetime = 255, 900 – OIF/OEF/OND = 51, 784 National Center for Veterans Analysis and Statistics, 2010 VISN 4 OIFOEF Dashboard, 2012

6 Demographic Imperative Only 4% of Veterans die in VA (~21,000) ~642,370 Veterans will die in 2012 PTF file and VetPop for 2012 MANY with advanced serious illness

7 Selected Characteristics Source: U.S. Census Bureau, American Community Survey PUMS, 2009 Prepared by the National Center for Veterans Analysis and Statistics

8 VA Care vs. Community Care Veteran Affairs (VA) Community CultureQuasi- MilitaryNurse-led Movement RoleProvider and PayerProvider FundingFixed appropriation and budget Entitlement- Medicare/Medicaid hospice benefit: 3 rd party reimbursement AccountabilityCongressGoverning body, CMS, Fiscal Intermediaries, and State LocationLarge Medical Centers CBOC’s Private Homes

9 VA Hospice and Palliative Care Film clip

10 VA Palliative Care Holistic Interdisciplinary Model – Nursing – Spiritual – Psychosocial – Symptom Management – Medical Management

11 Palliative Care Even 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.

12 Palliative 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.

13 Veterans in Community Hospice / Palliative Care Home Hospice Care is provided wherever the Veteran calls Home The 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.

14 Veterans in Community Hospice The VA will pay for 3 levels of community hospice care Routine home care Continuous care Inpatient Care when indicated For inpatient care, the hospice agency is to contact the VA for authorization prior to admission to an contracted facility.

15 Veterans in VA Health care A VA Facility should be considered before a community facility Reasons for Inpatient Admissions for Hospice and Palliative Care Uncontrolled Symptoms Inadequate Care or No Caregiver Caregiver Burden

16 What Influences Veteran Needs ? Cultural Impacts Fears Different War Eras Where They Served, How They Served

17 Cultural Impacts Military Service – Military Values – Stoicism Combat influences – Heroic Measures – Advance Directives – Pets

18 Fears 65% Veterans : Have Poor Support Systems Have Psychological Stress Prefer the “Strength of many and the power and wisdom of the group” Oppose Institutionalization at End-of Life Desires Open Communication with Professionals

19 Different War Eras WWII – Cold Injuries – Mustard Gas Effects – PTSD vs. Delirium – Radiation Exposure Korean Conflict – Cold sensitivity – PTSD – Minimizing of Experiences

20 War Eras Con’t Vietnam – Alcohol/Substance abuse – Agent Orange Exposure – Homelessness – Increased need for care Gulf war/OEF/OIF – Exposure to Toxins – Gulf war Syndrome – TBI – Chronic Fatigue Syndrome

21 PTSD- Post Traumatic Stress Disorder What is PTSD? 3 Major Symptoms – Re-experiencing – Avoidance – Increased Arousal Management Spiritual and Emotional Distress Interdisciplinary Approach to Care

22 How can We IMPROVE Care to Veterans? We Honor Veterans No Veteran Dies Alone

23 Designed to empower hospice professionals to meet the unique needs of dying Veterans : Military Check list Honoring Veteran Medical Needs PTSD & Psychosocial Needs Veteran Healthcare Benefits

24 How to Become Involved… Enroll Learn Complete Activity Reports Network

25 VA Provides Tiered Recognition Level 1- Commit to Program Level 2- Provide Education to Staff Identify Veterans Level 3- Strengthen Relationships with VA Level 4- Increase Access and Quality Care to Veterans

26 No Veteran Dies Alone “No one should die alone…. Each human should die with the site of a loving face” -Mother Teresa of Calcutta What is it? Who may help? How to help?

27 No 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.

28 A Veteran’s Story Jim Cooper Navy Frogman Korean War Veteran Advanced COPD

29 Home 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 staff  County Veteran Representatives – located usually in county courthouses

30 Summary Growing Numbers of Veterans Unique Needs How can WE honor Veterans? – Collaboration – Use of tools and Expertise – Partnerships


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