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Erika L. Sayles, LMSWSocial Worker/Volunteer Coordinator

Hospice of Southwest Iowa

Joni Vallier, RN Operations Director

Hospice of Southwest Iowa

How We Got Connected

The Palliative Care Rural InitiativeThe National Hospice and Palliative Care Organization (NHPCO) awarded eighteen national grants in 2009 to community hospices

“Reaching Out: Quality Hospice and Palliative Care for Rural and Homeless Veterans” initiative accepted applications from community hospice agencies working collaboratively with their local VA

VISN 23 was asked to implement 5 of the successful models developed and measure the outcomes

VISN 23 awarded the contract for this project to the National Rural Health Resource Center

Who The Center Is…

The National Rural Health Resource Center is a nonprofit organization dedicated to sustaining and improving health care in rural communities. As the nation’s leading technical assistance and knowledge center in rural health, The Center focuses on five core areas:•Performance Improvement •Health Information Technology •Recruitment & Retention •Community Health Assessments •Networking

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•In January of 2012, Hospice of Southwest Iowa (HSI) was awarded a grant to develop a Veteran-to-Veteran Volunteer Program.

•Funding allowed HSI to improve the scope and quality of the existing program, including but not limited to:

•Development of Veteran to Veteran volunteer program•Quality of Care Measures

•Staff & Volunteer Training/Participation•Community Outreach

How We Got Connected Objectives

•Describe some services available to Veterans through the VA and hospice.

•Recognize the unique and special needs of Veterans, specifically those in rural areas.

•Identify ways to build service excellence for Veterans within a hospice program.

•Define ways to recognize and honor Veterans

• Outline possible goals of a Veteran-centric program.

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VA/Hospice Service

Who is a Veteran?

•Eligibility for most VA benefits is based upon discharge from active military service under other than dishonorable conditions.

• Active service means full-time service, other than active duty for training, as a member of the:

-- Army, Navy, Air Force, Marine Corps, Coast Guard

-- Or as a commissioned officer of the Public Health Service, Environmental Science Services Administration or National Oceanic and Atmospheric Administration, or its predecessor, the Coast and Geodetic Survey.

Veterans Health Administration21 Veterans Integrated Service Networks

United States Congress

Department of Veterans Affairs

Veterans Health Administration (VHA)

Mental Health and

Homelessness

Primary Care

Specialty Care

Geriatrics and

Extended Care

Surgical and Specialty Services

21 Veteran Integrated Service Networks (VISNs)

VISN 23

FargoBlack Hills

Central Iowa

Iowa City

Surgical and Specialty Services

Geriatrics and

Extended Care

Mental Health and

Homelessness

Primary Care

Specialty Care

NWISioux Falls

St. Cloud

Minneapolis

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Funding and Reimbursement

• There is no Medicare reimbursement in the VA

• The VA sets their own reimbursement rates for hospice care. All services must be pre-authorized through the VA

• The Veteran will not have a co-pay for hospice care

• Veterans have a choice to use their VA Benefit or Medicare Hospice Benefit. The VA Hospice Benefit can be used by ANY Veteran honorably discharged.

Veterans Health Benefits

• In order to access the VA Hospice Benefit, the Veteran must be enrolled in the VA Health System

To enroll the Veteran contact the County Veteran Service Office (VSO) to get the Veteran signed up for benefits

Then, contact the local Community Health Nurse Coordinator to start the benefit and get authorization

Medical Benefits Package(Standard Benefits)http://www.va.gov/healtheligibility/coveredservices/StandardBenefits.asp

• Preventative Care Services– Immunizations– Physical Examinations– Health Care Assessments– Screening Tests– Health Education

• Ambulatory (Outpatient) Diagnostic and Treatment Services

– Emergency outpatient care in VA facilities

– Medical– Surgical– Chiropractic Care– Mental Health – Bereavement Counseling for families

of veterans in hospice and select mental health programs

– Substance Abuse

• Inpatient Diagnostic and Treatment– Emergency Inpatient Care in VA

facilities– Medical– Surgical– Mental Health– Substance Abuse

• Medications and Supplies *– Prescriptions medications– Over the counter medications– Medical and Surgical supplies

*Generally medications must be prescribed by a VA provider and be available under the VA’s national formulary system

www.pbm.va.gov/default.aspx

Special and Limited Health Care Benefits http://www.va.gov/healtheligibility/coveredservices/SpecialBenefits.asp

• Agent Orange Exposure Treatment and Registry Examination

• Automobile Assistance• Beneficiary Travel (including Ambulance)• Bereavement Counseling• Blind Veterans Services• CHAMPVA• Combat Veteran Eligibility• Dental Care• Domiciliary Care• Emergency Care in Non-VA Facilities• Extended Care • Eyeglasses• Foreign Medical Program• Gulf War Illness• Hearing Aids

• Home Health Care• Home Improvement and Structural

Alterations• Homeless Programs• Hospice• Ionizing Radiation Exposure Treatment and

Registry Examination• Long Term Care• Maternity Care• Military Sexual Trauma Counseling• Non-VA Health Care Services• Nose and Throat Radium Treatment• Nursing Home Care• Project 112/SHAD Participants• Prosthetic (Medical Equipment and Sensory

Aids)• Readjustment Counseling• Women Veterans Services

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Unique Needs of Rural Veterans

Challenges in Rural Areas

• Lack of family caregivers

• Financial hardships

• Lack of qualified staff

• Increased travel expenses

• Reimbursement for rural hospices

• Lack of grief and bereavement resources

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Veteran-Specific Challenges• Accessing care at VA Medical Centers

• VAMC distance from family, friends

• Understanding VA benefits and enrollment and navigating the system

• Coordinating and transitioning between VA and community care

• Reimbursement

• Combat-related struggles

Themes and Challenges

• Communication and partnerships were not smooth, integrated, or well organized

• Community hospice agencies often found VA partners to be non-engaged and inconsistent

• Knowledge deficits were found in both the community hospice agencies and the VA

VA enrollment process Available VA and other community hospice and

palliative care resources Veteran specific issues at end-of-life

(National Hospice and Palliative Care Organization, 2010)

We Honor Vets Campaign

Developed in cooperation with the VA and NHPCO as a resource for community hospice programs

There are levels of designation based on hospice programs involvement and program development

All community hospice programs are encouraged to enroll

The Value of the Military History Checklist

Identify Veterans upon Admission

• Veterans often carry experiences from their military service that present unique challenges at the end of life

• It is impossible to treat Veterans’ unique needs if no one is aware that they served

• Because the unique needs of Veterans may require specific interventions, the first step to handling these issues is to identify them as Veterans.

The Value of the Military History Checklist

Ask about a Veteran’s Time in the Service

• You may be the first person the Veteran has ever shared his military history with.

• Because experiences can be so difficult to share, patients may wish to spare family members from hearing their deep emotions and the atrocities they experienced.

• As a healthcare professional you may be the “safe” person they can finally share with.

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Building Service Excellence for Veterans

Our Mission:

Cherishing life’s journey through an extraordinary

commitment to compassion, comfort, and holistic care.

History of Hospice of Southwest Iowa:

Hospice of Southwest Iowa (HSI) was developed in 2007, through a partnership between the VNA

Hospice of Pottawattamie County and Alegent Mercy

Hospital

Today

• HSI now serves 9 counties: Pottawattamie, Mills, Harrison, Fremont, Union, Taylor, Montgomery, Cass, and Adams counties.

• 2 locations: Council Bluffs and Corning

• Average Daily census of 25-35 patients.

• Plans to open a Hospice House

How to Build Service Excellence…

-Identify Leaders

-Establish Importance

-Collaboration…

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How to Build Service Excellence…

-Identify Leaders

-Establish Importance

-Collaboration

- Education

-Program Development

- Community Engagement

Community Outreach•More than twenty community presentations of the We Honor Vets program in our service area for American Legions and VFWs. (Included volunteer recruitment component.) These were regular monthly meetings.

•Presentation at 7th District Spring Conference with more than 75 posts represented.

•Eight Veteran recognition events to date in nursing homes/assisted living facilities.

• 20 individual pinning ceremonies for veterans on hospice service.

•Meeting with Omaha VA to discuss WHV program and procedures in place for serving veterans.

•Identified veteran “champion”.

•Website has calendar celebrating important military dates throughout the year.

How to Build Service Excellence…

-Identify Leaders

-Establish Importance

-Collaboration

- Education

-Program Development

- Community Engagement

- Advocacy

www.holybears.com

Honoring our VeteransPinning

Ceremonies

Honoring our VeteransMemorial Items

http://beyondthisday.com/

Honoring our Veterans…

Veteran-to-Veteran Volunteer Program

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Honoring our Veterans

Patriot Body Covers

Honoring our Veterans

• Mission Moments

• Daily Non-Pareil

• Calendar of Events/Community Events

•Webpage dedicated to Veterans

PLEASE SHARE YOUR

THOUGHTS/IDEAS

Erika L. Sayles, LMSW712-352-1389

erika.sayles@alegent.org

Joni K. Vallier, RN712-352-1389

joni.vallier@alegent.org