Hospice-Veteran Partnership Toolkit : 7. Exploring Veterans' Issues and the VA Health System : VA Palliative Care Initiatives

What is the History of Palliative Care in the VA?

The VA has a substantial history of embracing palliative care. In 1992 the VA implemented a new policy indicating that all veterans should be provided access to a hospice program, either within the VA system or through referral to a community hospice agency. Additional initiatives include the adoption in 1999 of pain as a 5th vital sign within all VA facilities; the VA Faculty Leaders Project for Improved Care at the End of Life (1998-2000), intended to educate faculty and expand palliative care information contained in the curriculum for general internal medicine residencies; and a one-year Training and Program Assessment for Palliative Care (TAPC) Project conducted in 2001 to identify and describe hospice and palliative care programs within the VA, create resources to facilitate the development of hospice and palliative care programs, and explore the viability of initiating palliative care fellowship programs.

The TAPC project revealed significant findings, including:

Results of TAPC lead to the development of the TAPC Toolkit (http://www.va.gov/oaa/flp) and the implementation of the VA Interprofessional Palliative Care Fellowship program at six VAMC sites. TAPC also launched the VA Hospice and Palliative Care Initiative (VAHPC) in November 2001. This two-year project was funded in part by generous grants from the National Hospice and Palliative Care Organization and the Center for Advanced Illness Coordinated Care. It has focused on improving veterans' access to hospice and palliative care services within the VA and in the community and included efforts to improve end-of-life care education and facilitate the development of local VA/hospice partnerships.

What are some Specific Initiatives Currently Underway?

The VA has mandated that all VA facilities are required to have a Palliative Care Consultative Team (PCCT) in place by May 2003. The directive makes recommendations for involvement of nursing, medicine, social work, and chaplain services and requires facilities to submit an annual report to VA Central Office regarding their activities.

An Accelerated Administrative and Clinical Training (AACT) Program was developed to assist every VISN in meeting the PCCT directive and enhancing palliative care activities at each VAMC. This program uses a train-the-trainer approach to create VISN Palliative Care teams to perform site visits and assist local facilities in expanding hospice and palliative care services and educational activities.

In local communities, partnerships are being developed between VA professionals and community hospices. A Hospice-Veteran Partnership (HVP) is a partnership of people and community organizations working together to ensure excellent care at the end of life that is available for our Nation's veterans and their families. The mission of HVPs is to establish enduring networks of hospice and VA professionals, veterans, volunteers, and other interested organizations working together to provide quality services through the end of life for all veterans. The National HVP Program is a program of the Department of Veterans Affairs (VA) Hospice and Palliative Care Initiative, and individual HVPs have been developed in numerous states and regions throughout the country.

What are Examples of Exemplary Initiatives within the VA Heath Care System?

A number of outstanding palliative care initiatives have been developed under the auspices of the Veterans Health Administration.

Information contained in this document was taken directly from the 2003 Department of Veterans Affairs Federal Benefits for Veterans and Dependents Booklet, the Hospice and Palliative Care Services in the Department of Veterans Affairs: A Report of the TAPC Project Survey, and information documents published on the Veterans Administration Web site (http://www.va.gov).

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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.