A Fragmented SystemAnyone who has tried to navigate the health care system in America knows that often there is fragmented communication and coordination of services among health care providers, public and private insurance agencies, and patients and families. So how can we ensure veterans receive quality end-of-life care? It's an important question to answer-particularly when considering these facts:
These statistics highlight the importance of partnerships among VA and community health providers as well as organizations that serve veterans. There is a great need for education about hospice care and how it can be accessed. Hospice care is part of the basic eligibility package for veterans enrolled in the Veterans Health Administration (VHA). If hospice care is appropriate for enrolled veterans-and other funding is not available-VA medical centers will either provide hospice care directly in their facilities or purchase it from community hospice agencies. All Medicare-eligible veterans, whether or not they are enrolled in VHA, have access to hospice care through Medicare. Veterans not eligible for Medicare may have hospice benefits through Medicaid or other private insurance. However, like 90 percent of Americans, most veterans simply don't know that these options exist. The need for education extends beyond the public to community hospice and VA providers as well. Many community hospice agencies are unaware of the dedi- cated inpatient hospice units that exist in VA facilities. Likewise, VA facilities are often unfamiliar with the services community hospices can offer and how to work with them. There are also complex issues surrounding payment reimbursement and administration. |
Mr. C is an 86-year-old veteran with end-stage heart failure and moderate dementia. After surviving some of the toughest fighting in World War II, he went on to earn a law degree and establish a successful practice. Mr. C never talked about the war with his family. They never thought to mention it to his doctors or the nursing home staff. Now, as he lies in bed, Mr. C is haunted by memories from more than half a lifetime ago. Observing his frequent tears and periods of profound depression, his family and the nursing home staff realize something is wrong but they don't know how to comfort him. Mrs. J is a 67-year-old veteran who served as a nurse in Vietnam. She has been told by her doctor that she has less than six months to live. For the past two years, Mrs. J has been receiving treatment at a VA medical center an hour away. Although she still wants to maintain contact with VA staff, she is no longer able to make the trip to the VA Medical Center and has decided to spend her remaining time in the comfort of her home. Mr. L is a 56-year-old veteran with end-stage liver disease and a limited prognosis. He lost a leg in Vietnam and has struggled with alcohol abuse and depression since returning to the United States. Now homeless and with no income or family support, he is in a VA hospital after collapsing outside an office building. These stories represent just a few of the 674,000 veterans who are expected to die this year. Many of these veterans could benefit from hospice care, an end-of-life care option that provides dying patients and their loved ones with comfort, compassion, and dignity. Hospice care involves a team-oriented approach to expert medical care, pain management, and emotional and spiritual support. Care can be provided in a number of settings including patients' homes, inpatient hospice units, hospitals, nursing homes, and long-term care facilities. At the center of hospice care is the belief that everyone has the right to die pain-free and with dignity. The emotional and spiritual components of hospice care can be especially meaningful to veterans, who often face issues near the end of life relating to their military experiences. Support is even more crucial for veterans who do not have a strong network of family and friends. |
This toolkit is provided by the Department of Veterans Affairs National Hospice-Veteran Partnership (HVP) Program. Development of the toolkit was made possible through support by Rallying Points, the National Hospice and Palliative Care Organization, the Center for Advanced Illness Coordinated Care, and other end-of-life care advocates. Information about VAHPC initiatives is made available for use within the Inter-Institutional Collaborating Network on End-of-life Care (IICN) with the assistance of Growth House, Inc.