Become Aware of Your Patient’s Background
In an article published by NPR in 2015, Robert Siegel stated that according to the Department of Veteran Affairs, half of men that die are military veterans (Lawrence, Q., 2015). The unfortunate reality that impacts this significant figure is that several healthcare providers that are caring for patients with severe, progressive, or terminal illness are not aware of their patients’ military background. Furthermore, providers do not always recognize that when symptoms progress, and treatments are no longer successful, the uncontrolled pain, anger, and/or nightmares, may be delayed symptoms of, or overall undiagnosed post-traumatic stress disorder (PTSD) which is so very common among veterans.
In a Health Affairs article published in 2017, researchers found that the strategic efforts of the Veterans Administration to improve the quality of end-of-life care, by increasing hospice use, have been effective (Miller, S. C., et al, 2017). Although these findings are significant, it is essential to understand the implications that are inevitable when caring for veterans, as “caring for vets isn’t always the same as caring for others: as veterans approach the end of life, old traumas can resurface or appear for the first time,” (Lawrence, Q., 2015).
The Unique Needs of Veterans are Treated in Hospice Care
Hospice care providers are trained to understand the unique end-of-life needs of veterans, and provide guidance to them with the emphasis on a more peaceful transition. As experiences from the past often resurface near the end of life, this becomes especially essential for veterans who have experienced combat service or other violent trauma.
Given the unique needs of veterans, the National Hospice and Palliative Care Organization (NHPCO) and the Department of Veterans Affairs (VA) have initiated a pioneer project entitled, “We Honor Veterans” which focuses on respectful inquiry, compassionate listening and thankful acknowledgement of veterans. Precious Hospice is a contributing partner in “We Honor Veterans,” and we are recognized for our dedication to those who have served our country.
The Physical, Psychological, and Emotional Impact of Military Service
Serving in a war takes a toll on military personnel both physically and emotionally. This impact includes but is not limited to diseases, disabilities and illnesses, which can create difficult challenges in providing end-of-life care. Depending on the war(s) in which veterans have served, they may have been exposed to ionizing radiation, Agent Orange, open-air burn pits, battlefield transfusions, below-freezing temperatures and infectious diseases. Furthermore, this intense exposure puts them at an increased risk for several types of cancer, type 2 diabetes, kidney disease, heart disease, hepatitis C, respiratory illnesses, malaria, TB and more. Additionally, veterans can also suffer from co-morbidities such as post traumatic stress disorder (PTSD), depression, anxiety, drug addiction, alcoholism, and mental illness.
Along with the physical and psychological conditions that veterans endure, emotional concerns may arise, like the feeling that they need to purge themselves of memories by speaking with their family members about their military experience, sometimes for the very first time. Veterans also commonly are worried about the well-being of their families, in terms of how they will manage after the veteran dies.
Essential Elements of Hospice Care for Veterans:
- Streamlined referral and admission processes
- Thorough understanding of the Veterans Administration (VA) system, and how to identify and access all benefit options available for veterans you are serving
- Coverage of hospice care for veterans via the VA, TRICARE, Medicare, Medicaid, private insurance and other forms of reimbursement
- Coordination of care with local VA medical staff, including combined visits when appropriate
- Staff is trained to function as direct contacts for communication, and primary educational sources to the VA and other local veteran organizations
- Referrals for additional community services when necessary
- Bereavement support, including grief and loss programs, support groups and memorial services, for the loved ones of veterans
- Recognition and celebration of important events such as Veteran’s Day and military anniversaries
If you have a seriously ill patient who is also a military veteran under your care, talk to the patient and their family about whether they are utilizing or have any questions or concerns regarding their VA benefits. Working with a hospice provider can help the family navigate the VA system, and help the patient feel both respected and listened to as they are nearing the end of life.
Lawrence, Q. (2015). End of life care can be different for veterans. National Public Radio (NPR). Retrieved from https://www.npr.org/2015/01/28/382218316/end-of-life-care-can-be-different-for-veterans
Miller, S. C., Intrator, O., Scott, W., Shreve, S. T., Phibbs, C. S., Kinosian, B., Allman, R. M., & Edes, T. E. (2017). Increasing veterans’ hospice use: The veterans health administration’s focus on improving end-of-life care. Health Affairs, 36(7), 1274-82. Retrieved from https://www.healthaffairs.org/doi/pdf/10.1377/hlthaff.2017.0173