Hospice caregivers tune into special needs of veterans

September 1, 2011

Phyllis Hill, a hospice social worker, was visiting a 90-year-old patient for the first time. They made polite small talk in his living room. Hill asked if he'd been in the military.

He smiled broadly. Yes, he said, he was in the Navy in the Pacific Theater during World War II. Out came his old scrapbook — and the flood of memories from almost 70 years ago.

"He talked about the weapons he'd used and the lives he saved," said Hill, who works for the hospice program at St. Anthony's Medical Center in St. Louis. "He was proud and happy to talk about it."

Hill has a head start in engaging patients who are veterans. Before she joined St. Anthony's, she worked as a civilian

therapist at two major Army installations. But she also makes use of a new national program that can help hospice workers who may not know what questions to ask.

Called "We Honor Veterans," it was created by the nonprofit National Hospice and Palliative Care Organization in collaboration with the U.S. Department of Veterans Affairs. It offers ways for hospices to help veterans apply for benefits they are due, and for hospice staff members to better tailor the care they give to patients who are veterans.

The program began last fall. Already, almost 800 hospices nationwide are taking part, including well over a dozen CHA members.

Online tools
Emil Zuberbueler, a program director for the hospice membership organization, said participating hospices use information from the program website, and can train their own staffs without need of visiting specialists.

One of the tools is the "military history checklist," a one-page form on the website. It helps caregivers seek information on when a veteran served and in which military branch, whether the service was in wartime and if the patient endured "traumatic assignments." It also asks whether a veteran has received benefits through the VA.

The line of questioning is twofold, said Zuberbueler — to engage patients in conversations that affirm their life stories and to help arrange timely VA benefits. While some veterans proudly display their service, he said, others have buried unpleasant memories and avoided contact with the VA. Zuberbueler said many veterans don't know the government agency pays for hospice care, in-home visits and other benefits.

"And with end-of-life care, there is no time for delay," he said.

Tammy Hawkins directs St. Bernards Hospice in Jonesboro, Ark. She said that she noticed well before that hospice program joined We Honor Veterans that many patients who were veterans had special needs. Hawkins said many veterans avoid taking pain medication or seem never to want to go to sleep.

"They were taught to be stoic and never complain," said Hawkins, a hospice nurse. "Some wouldn't touch morphine. They'd remember back in the war when it was given to dying comrades. They'd associate it with death.

"Often, we wouldn't understand," Hawkins said. "We need to find ways to let them know we care and to help them."

Hawkins said St. Bernards Hospice recently began using We Honor Veterans to train its staff. She said she also is reaching out to local veterans' organizations to train volunteers who can help care for the patients.

Thank a veteran
Almost 25 percent of patients in hospice care are veterans, Zuberbueler said. Two million of the 16 million Americans who served in World War II are still living, although the youngest are in their mid-80s. Almost 800 die each day. The VA estimates that 2011 is the peak year for deaths among the 5.7 million who served during the Korean War. For Vietnam-era veterans, who generally are at least 60 years old, the daily toll is 360 and rising.

Zuberbueler said the hospice organization has been working with the VA since 2000. He said We Honor Veterans evolved from work the organization did through a VA contract for rural veterans.

He has been aware of veterans' special needs since 1983, when he first became a hospice volunteer.

"So much of what we do, really, is hearing their life stories," he said. "Sometimes, with veterans, they've held back some horrible experiences all their lives. At the end of life, they may want to share some of that, but don't know how. We want them to know their legacy has real value."

Ruth Southards, hospice patient care coordinator at St. Anthony's in St. Louis, said it joined the national program to help its staff of 75 better serve their patients who are veterans. "We want to respect and show them appreciation for what they've done," Southards said.

Hill, one of Southards' employees, suggests a simple opener whenever a hospice caregiver asks whether a patient is a veteran.

"If they say 'Yes,' I always pause a moment and then say, 'Thank you,'" Hill said. "Most often, their eyes well up with tears. If we don't ask the right questions, we can't uncover buried treasure."

And it works. Just ask the family of Kenneth McKalip, 79, who is in a nursing home in De Soto, a town just south of St. Louis, and suffers from late-stage chronic obstructive pulmonary disease. McKalip was a tank crewman who was captured in Korea and spent 33 months as a prisoner of war.

Candace Stokes, a St. Anthony's hospice nurse who visits McKalip, used the veterans program to ask him about his Army service. Debbie Harris, McKalip's daughter, said he was flattered and talked with her about it as best he could.

McKalip told Catholic Health World, "She treated me with respect."

Other CHA members participating in We Honor Veterans include:

  • Hospice of Siouxland, Sioux City, Iowa
  • St. Catherine Hospice of Garden City, Kan.
  • CHRISTUS Schumpert Community Hospice and Grace Home, Shreveport, La.
  • Mercy Memorial Hospice of Monroe, Mich.
  • St. Cloud Hospital Hospice/Homecare, St. Cloud, Minn.
  • St. Francis Riveredge Hospice, Breckenridge, Minn.
  • Alegent Health Hospice, Omaha, Neb.
  • Saint Mary's Hospice of Northern Nevada, Reno, Nev.
  • Mercy Hospice, Devils Lake, N.D.
  • Presentation Hospice of Carrington Health Center, Carrington, N.D.
  • Mercy Medical Center, Roseburg, Ore.
  • Mercy Medical Center Homecare, North Canton, Ohio
  • Mercy Residential Hospice, Knoxville, Tenn.
  • Franciscan Hospice and Palliative Care, University Place, Wash.
  • Providence Hospice and Home Care of Snohomish County, Everett, Wash.
  • Providence Hospice of Seattle
  • Providence SoundHomeCare and Hospice, Olympia, Wash.
  • St. Paul Manor and St. Paul Elder Services, Kaukauna, Wis.
  • Avera Sacred Heart Hospice in Yankton, S.D.

Each war carried distinct risks

In addition to the risks and trauma of combat, each major war carried particular health risks.

World War II
Dec. 7, 1941 — Dec. 31, 1946

Total who served in all Armed Forces: 16,112,566
Battle deaths: 291,557
Wounded: 671,846
Medals of Honor: 433
Health risks: Tuberculosis, rheumatic fever and tropical diseases cause long-term disability

Korean War
June 25, 1950 — July 27, 1953

Total who served in all Armed Forces: 5,720,000
Battle deaths: 33,741
Other deaths (in theatre): 2,833
Wounded: 103,284
Medals of Honor: 131
Health risks: Cold-related injuries including frostbite

Vietnam War
Aug. 4, 1964 — Jan. 27, 1973

Total who served in all Armed Forces: 8,744,000
Deployed to Southeast Asia: 3,403,000
Battle Deaths: 47,424
Other Deaths (in theatre): 10,785
Wounded: 153,303
Medals of Honor: 238
Health risks: exposure to herbicides, insecticides and tropical diseases

Source: We Honor Veterans

 

Copyright © 2011 by the Catholic Health Association of the United States
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