What Programs or Benefits Does Hospice Offer Veterans?

Hospices across the U.S. offer services to U.S. veterans and their families that strive to provide quality end-of-life care that recognizes the unique needs of this population. Services may be accessed through several channels, including:

• The Department of Veterans Affairs, which offers inpatient hospice services through a network of Community Living Centers or VA nursing homes. The VA also partners with community home hospice agencies that provide hospice care in the veterans home. These services are provided at no charge as long as the veteran meets established criteria, e.g. has a life-limiting illness and a projected life expectancy of fewer than six months. Patients seeking hospice services will need a referral from their VA primary care provider. If you wish to take advantage of this benefit, you will need to first sign up for VA health care. Learn more about how to do so and what information you will need on the Veterans Affairs VA Benefits and Healthcare web page.

• We Honor Veterans, a partnership between the National Hospice and Palliative Care Organization and the VA, which works with community organizations across the United States to provide compassionate end-of-life care to U.S. veterans and their families. The program works to educate hospice providers in the provision of care focused on “respectful inquiry, compassionate listening, and grateful acknowledgment” through a network of over 4,000 partners across the U.S. These partners include:
  • VA Hospice Partners – Hospice providers who have received education and training in providing veteran-centric care, including trauma-informed care for veterans suffering from PTSD, substance use disorder, military sexual trauma, and other psychological issues related to their military service and ensuing life experiences. 
  • VA Community Partners – These include hospitals, skilled nursing facilities, nursing homes, home health agencies and funeral homes that have shown a commitment to recognizing and serving the unique needs of U.S. veterans. 

Partners in the WHV program are ranked from Level One to Level Five based on their reaching certain benchmarks. For example, Level One partners must demonstrate that they ask appropriate questions about veterans’ military service and recognize what the answers may mean. These organizations use resources provided by WHV to educate staff on ways to honor veterans and help them tell their stories as they approach the end of their lives. 

Level Two partners actively work towards building capacity within their organizations, while Level Three through Five work with local and statewide organizations to build capacity within the surrounding community. 

Those seeking care through the WHV program can find a partner in their area by searching this interactive database provided on the WHV website. 

• Medicare – Veterans who are either disabled or over the age of 65 are eligible for Medicare and may access hospice care using the Medicare Hospice Benefit at any time. 

Unique Needs of Veterans at End of Life

Veterans are, first and foremost, individuals, each with their own values, goals and preferences around end-of-life care. Nevertheless, many veterans share similar experiences and, as a result, have similar, specialized needs. Some factors that may influence veterans receiving hospice care include:

Post Traumatic Stress Disorder

Between 7% and 13%  of combat veterans suffer from PTSD, the symptoms of which can become more prevalent and disturbing at the end of life. Pain, shortness of breath, fatigue,  frailty and an overall sense of loss of control can exacerbate existing symptoms of anxiety, self-loathing, hypervigilance and distrust. Flashbacks, intrusive memories, insomnia and panic attacks can occur or recur. Hospice staff trained in trauma-informed care can help alleviate these symptoms and allow the veteran to experience a calmer, more meaningful and less fearful end of life. 

Chronic Pain

About one-half of veterans who receive care at a VA facility experience chronic pain as a result of musculoskeletal injuries, traumatic brain injuries and/or PTSD. As these individuals approach the end of life, their pain often increases due to physical stressors, the effects of illnesses such as cancer, and psychological issues such as fear, anxiety and depression. Hospice providers who offer veteran-centric care are aware of these issues and work to ease the patient’s suffering using a comprehensive, multidisciplinary approach. 

Depression

According to Pathways, a community partner of We Honor Veterans, 11% of veterans over the age of 65 suffer from major depressive disorder, more than twice the number of non-veterans in the same age group. Untreated depression can lead to feelings of worthlessness, lack of motivation, loss of pleasurable feelings and thoughts of suicide. These feelings can be greatly increased by end-of-life symptoms such as pain, anxiety, fatigue and emotional distress. Hospice providers trained in veteran-centric care assess each patient who enters hospice for symptoms of major depression and work with an interdisciplinary team to provide appropriate psychological care. 

Substance Use Disorder

Substance misuse, including illicit drugs, prescription painkillers and alcohol, is prevalent among veterans in all age groups. Alcohol use disorder is particularly common in older veterans, many of whom have co-occurring mental health issues such as depression and PTSD. This population presents particular challenges to hospice providers as they may be less responsive to analgesic and anxiety-relieving medications due to chronic drug and/or alcohol use. Hospice providers must be sensitive to this reality and use all modalities available to help veterans with SUD achieve a meaningful end of life. 

Of course, these are just a sampling of the issues that may affect military veterans. Even those who do not have a chronic physical or mental illness may carry psychological burdens associated with combat, including feelings of guilt and shame, or fear of retribution in the afterlife for acts committed during war time. As caregivers strive to control physical symptoms related to end of life, another goal of hospice for veterans is to help them tell their stories through compassionate inquiry and honor their life journeys through non-judgmental emotional support.

Sources

“About VA health benefits”. U.S. Department of Veteran’s Affairs. https://www.va.gov/health-care/about-va-health-benefits/

“Mental Health”. U.S. Department of Veteran’s Affairs. https://www.mentalhealth.va.gov/msthome/index.asp 

“What is Trauma-Informed Care?” Trauma-Informed Care Implementation Resource Center. https://www.traumainformedcare.chcs.org/what-is-trauma-informed-care/ 

“Partner Directory.” We Honor Veterans. https://www.wehonorveterans.org/partner-directory/ 

“PTSD and Veterans.” Hill & Ponton. https://www.hillandponton.com/resources/veterans-statistics-ptsd/ 

“PTSD: National Center for PTSD”. U.S. Department of Veteran’s Affairs. https://www.ptsd.va.gov/professional/treat/care/index.asp 

Pathways Home Health and Hospice. https://www.pathwayshealth.org/