Scars unseen - Pennsylvania Homecare Association

Report
Scars unseen
The Unique Needs
of VETERANS
AT
END OF LIFE
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
Pennsylvania Statistics
• Rank 5th in the nation for Percent of Veteran
Population > 65 years
Pennsylvania Statistics
• Ranks 5th in the nation for Veteran Deaths
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
Demographic Imperative
Only 4% of Veterans die in VA
(~21,000)
~642,370 Veterans
will die in 2012
MANY with advanced
serious illness
PTF file and VetPop for 2012
Selected Characteristics
30
25
20
15
Male
10
Female
5
0
Has a service Uses VA
Use VA only
connected Health care
disability
No Health
Coverage
Below
poverty
Source: U.S. Census Bureau, American Community Survey PUMS, 2009
Prepared by the National Center for Veterans Analysis and Statistics
VA Care vs. Community Care
Veteran Affairs (VA)
Community
Culture
Quasi- Military
Nurse-led Movement
Role
Provider and Payer
Provider
Funding
Fixed appropriation and
budget
EntitlementMedicare/Medicaid
hospice benefit: 3rd party
reimbursement
Accountability
Congress
Governing body, CMS,
Fiscal Intermediaries, and
State
Location
Large Medical Centers
CBOC’s
Private Homes
VA Hospice and Palliative Care
Film clip
VA Palliative Care
• Holistic
• Interdisciplinary Model
– Nursing
– Spiritual
– Psychosocial
– Symptom Management
– Medical Management
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.
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.
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.
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.
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
What Influences Veteran Needs ?
• Cultural Impacts
• Fears
• Different War Eras
• Where They Served, How They Served
Cultural Impacts
• Military Service
– Military Values
– Stoicism
• Combat influences
– Heroic Measures
– Advance Directives
– Pets
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
Different War Eras
• WWII
– Cold Injuries
– Mustard Gas Effects
– PTSD vs. Delirium
– Radiation Exposure
• Korean Conflict
– Cold sensitivity
– PTSD
– Minimizing of Experiences
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
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
How can We IMPROVE Care to
Veterans?
• We Honor Veterans
• No Veteran Dies Alone
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
How to Become Involved…
• Enroll
• Learn
• Complete Activity Reports
• Network
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
•
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?
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.
A Veteran’s Story
Jim Cooper
• Navy Frogman
• Korean War Veteran
• Advanced COPD
Home Care Agencies’ Best Friends
 Federal Guide to Veteran & Dependent Benefits (on line & in print)
 www.va.gov (VA benefits, especially healthcare)
 www.vba.va.gov (general VA benefits)
 VHA Handbook 1140.5 (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
Summary
• Growing Numbers of Veterans
• Unique Needs
• How can WE honor Veterans?
– Collaboration
– Use of tools and Expertise
– Partnerships

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