Hospice-Veteran Partnership

Hospice-Veteran Partnership
• Overview of the Hospice-Veteran
Partnership Program
• Making the case to form an HVP
• Strategies for HVP success
• Tips for Getting Started and
• Examples
• Resources
Message from Tom Edes
Department of Veterans Affairs
“We in the VA depend on you,
community hospice agencies to
deliver home care for our terminally
ill patients. The VA does not intend
to replicate the excellent system that
is already in place for home hospice
care and we in the VA must learn to
collaborate with and learn from you.”
National Collaboration
• VA Hospice and Palliative Care Program Office
– Dr. Scott Shreve, National Director
– HPC program office staff
– VISN Program Managers and Clinical Champions
• NHPCO We Honor Veterans campaign
– Emil Zuberbueler, Director, National Veterans Program
– WHV program staff
• Veterans Advisory Council
• Council of States
Hospice-Veteran Partnerships
• Home: State hospice organization,
coalition, VA VISN or facility
• Leadership: Co-chairs, generally
representatives from community
hospice and VA
• Structure: State-wide organization
and coordination with local or
regional HVPs around the catchment
areas of VA faciities
HVP Partners
State Hospice Organizations
End-of-Life Coalitions
Community hospice agencies
VISNs and VA facilities
– VA Medical Centers
– Community Based Outpatient Clinics
– Vet Centers
• State Veterans Homes
• Veterans Service Organizations (VSOs)
• Community Veteran Organizations
Veterans Health Administration
21 Veterans Integrated Service Networks
Why Are HVPs Important?
• More than 1,800 veterans are dying every day
– . . .but not much is known about end-of-life issues for
this special population
• The vast majority of veterans do not receive their
health care from VA
– . . .but community healthcare providers and
organizations often don’t know who they are or how to
reach out to them
• Significant barriers exist
– . . .but they can be overcome through communication
and collaboration
Volume of Veteran Deaths
• Number of veteran deaths reached an alltime high in 2006 (664,842 projected
Veterans deaths)
• At least 600,000 deaths a year through
• Less than 4% Veteran deaths (about
21,000/yr) will occur in VA facilities
• HVPs are solving care coordination
problems at the local, state and national
Projected Veteran Deaths (2011)
n = 648,354
20-24 25-29 30-34 35-39 40-44 45-49 50-54
55-59 60-64 65-69 70-74 75-79 80-84 85-89 90+
104,299 134,788 132,764 82,760
Total Projected Veteran Deaths by State
Top 10 States represent
50% of Veteran deaths
Highest #: 58,250 (CA)
Lowest #: 1,060 (DC)
Top 10 States with highest number of
Veteran Deaths
How Can HVPs Help VA?
• Honors veterans’ preferences
• Expands the interdisciplinary team
• Increases VA staff knowledge of the
Medicare Hospice Benefit
• Frees up inpatient beds for incoming
• Shares the job of caring for Veterans
with the community
How Can HVPs Help
Community Hospices?
• Clinical Care
– Honors veterans’ preferences
– Improves communication and continuity
– Expands understanding of veterans unique
end-of-life issues
• Administrative
– Increases referrals
– Improves payment for services
– Clarifies interface between VA and community
hospice policies and procedures
How Can HVPs Help
• Honors Veterans’ preferences
• Standardizes VA response to
community hospices
• Informs community response to
Veterans’ unique end-of-life issues
• Contributes to continuity and quality
of care
• Eliminates “charity care” for Veterans
Getting Started
with the HVP Toolkit
Begin with a Planning Committee
Identify potential partners
Form a Leadership Committee
Conduct Needs Assessment
Develop strategic objectives and measure
• Plan educational, program development
and outreach activities
• Work together to build solutions
Potential HVP Projects
Community Outreach
Legal and Regulatory Issues
Education and training for providers
Research and Evaluation
Member Recruitment
Strategies for Success
• Strong support from VA leaders
– Identify champion from each facility in
– Invite staff from CBOCs, State Veterans
Homes, and VetCenters to participate
– Secure support from VISN leadership
– Include HVP in strategic planning efforts
– Coordinate HVP activities within your
VISN and with adjacent VISNs
Strategies for Success
• Equally strong support from the state
hospice organization or coalition
– Identify Community hospice champion
– Invite all community hospices in state to
– Secure board of directors support and
appoint HVP community leader(s)
– Establish an HVP standing committee or
Strategies for Success
• Acknowledge and respect all interest
positions and cultural differences
– WIIFM factor
– Language of organization
– Rules, regulations and SOP
– Perceptions
Understanding Differences
Quasi-military Community healthcare
Provider and
and budget
Entitlement - Medicare/
Medicaid hospice benefit;
3rd party reimbursement
Accountability Congress
Governing Body, CMS,
Fiscal Intermediaries and
HVP Outcome Measures –
1st Tier
Are we improving veterans’ access to
hospice and palliative care?
– # veterans being served by community
– HVP has the name and contact
information of VA HPC liaison(s) at each
facility in the state and makes this
information available to all hospices in
the state
– # educational sessions among providers
of care for veterans in all settings
HVP Outcome Measures –
2nd Tier
• Are we meeting veterans needs?
– # education sessions/events for veterans and
their families
– Post death family satisfaction survey data
collected and shared among providers
– # referrals from community hospice to VA for
assistance with care, benefits or services
– # and % of community hospices that have
written agreements with VA facilities and State
Veterans Homes
HVP Outcome Measures –
3rd Tier
• Are HVPs paying attention to the
strength and sustainability of their
– Composition of HVP membership
– # HVP projects ongoing and completed
– # HVP meetings
HVP National Program - Local
• State lines and VISN boundaries are
• Solution: form regional HVPs around
each VA Medical Center in the state
– Region includes the VAMC’s service area
– Coordinate activities with your State
HVP to ensure that everyone has the
same information
– Many benefits!
Regional HVPs
• HVP survey can identify perceptions and
• Roundtable sessions drill down and
identify barriers and opportunities
• Solutions and best practices can be shared
and “hard wired” into performance
• Relationships strengthened through
routine meetings and collaboration on
specific tasks and objectives
How to Start a Regional
• Establish a Regional or Local HVP
• Hold regular meetings
• Report back to the State HVP and
VISN palliative care leaders
Regional HVP Start-up
• Schedule initial “Round Table or Open House”
– Invite local VA facilities, community hospices, State
Veteran Homes and others
– Develop agenda collaboratively
– Plan logistics carefully
• Pay attention to local issues that affect the
interface of VA with community providers in the
• Understand the different perspectives of
individual member groups
Regional HVP Agenda
• VA Continuum of Health Care Services
– Eligibility & Burial Benefits
– VA Palliative and End-of-Life Care:
Inpatient and Outpatient Services
– VA Bereavement Program
– Coordination of Care
– MD orders for start of care
– Medications and DME
– Home Hospice Agency follow up
– VA Purchased Home Hospice Care
• Agencies Description & Services
• Open Discussion
Next Steps for Regional
• Establish ongoing relationship
• Create an e-mail group and send
regular updates
• Partner for training and education
• Identify ways to increase hospice
• Improve coordination of clinical care
Resources for HVPs
We Honor Veterans website
Military History Check List
Military History Pocket Card
Peace at Last: Stories of Hope and
healing for Veterans and Their
Families (Deborah Grassman, 2009)
• State Hospice Organization websites
VA Pocket Card Homepage

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