Bill, a 73-year-old former Navy SEAL and warrant officer first class, served two tours in Vietnam and endured some awful assignments. At a ceremony to honor him at our hospice in South Portland earlier this year, Bill, dying from chronic obstructive pulmonary disorder, hugged a veteran volunteer and wept in his arms. “No one has ever thanked me,” he said. “No one.” Bill passed peacefully in May.
The U.S. health care system is better than ever at delivering end-of-life care for Americans. But we still need to improve how we specifically take care of our dying veterans. Veterans often face distinctive issues approaching death.
One in every four dying Americans is a veteran. Approximately 680,000 veterans die each year, about 1,800 per day.
Of the approximately 114,000 veterans who live in Maine, about half are 65 or older. The percentages of veterans in Maine is higher than the national average, according to the U.S. Department of Veterans Affairs.
I work at Amedisys, the nation’s third largest hospice provider. I was a clinical social worker for five years at Beacon Hospice and have spent the last six overseeing our programs nationwide, including Maine centers in Auburn, Augusta, Bangor and South Portland, where we have admitted 230 veterans so far this year.
Our company cared for 5,540 dying veterans at 142 care centers in 32 states last year, 306 in Maine alone. We partner with the “We Honor Veterans” program, a collaboration established in 2010 between the VA and the National Hospice and Palliative Care Organization. “We Honor Veterans” provides resources that encourage hospices to commit to honoring veterans at the end of life, including ongoing staff education and support in offering veteran-centric care. Three of our Maine centers have achieved the Level 4 distinction (Level 5 is best).
Veterans diagnosed as terminal face unique issues and therefore require equally unique end-of-life care. Though all hospice care is holistic, involving attention given to psychosocial, emotional, moral, spiritual and physical issues, this approach is all the more important in end-of-life care for veterans.
When in the field, I witnessed what can happen to a veteran on his deathbed. He saw killing in the line of duty. He emerged traumatized, suffering from post-traumatic stress. He came home from war trying to forget, saying nothing about his service. He incurred what is called moral injury, an injury to the soul. He struggles to forgive himself, forgive his enemies and find peace.
This was true of the homeless Vietnam War veteran I cared for who did not share his stories until the end, far too late. He died in such a high state of anxiety, his trauma left unspoken, that he had to be physically restrained.
This story is all too common for Vietnam War veterans, who now vastly outnumber surviving veterans from World War II and the Korean War, in Maine and nationwide. Vietnam War veterans came home from war less recognized, less appreciated and certainly less honored.
Veterans who have lived through violence may only want now to die in peace. But to do that, they may need gentle and compassionate encouragement from an engaged and aware staff.
Nothing will make more of a difference on this front than proper clinical training. In my role at Amedisys, I have helped develop a program we use to train our nurses, social workers, chaplains, bereavement coordinators, hospice aids, volunteers and others to deliver veteran-centric care.
The course ultimately encourages staff to improve the quality of care for veterans at the end of life. Addressing the psychosocial, emotional and spiritual aspects of war are strongly emphasized.
One effective program in providing veteran-centric care here is to deploy volunteers who are veterans to support fellow veterans in hospice. Another is veteran-to-veteran cafes that bring veterans together to socialize and talk about shared experiences.
Hospices also stage pinning ceremonies like the one we held for Bill, where patients are presented with an American flag pin and certificate, thanked for their service and given a military salute, usually with family, friends and staff present.
Certainly we’re making progress on the educational front, but nowhere near enough. Nursing and medical schools should adopt special training to care for veterans at the end of life. All hospitals and hospice providers should do likewise.
On this Thanksgiving, as on every other, we hospice professionals are grateful for the privilege of caring for and honoring our veterans. In return for serving our country, our veterans deserve nothing less than our deepest gratitude and the best service we can give.
Kathy McDonough of Wells is the hospice director of psychosocial, spiritual and volunteer services at Amedisys.