Nebraska Hospice-Veteran Partnership

2007 Annual MeetingFeb 23, 2007

Content

• Hospice-Veteran partnership Program– Status of HVP Program– National Collaboration– NHPCO’s Veterans Advisory Council (VAC)

Update

• State Veterans Home Project– State Veterans Homes Data and

Demographics– Survey, Focus Group and Interviews Findings– Next Steps

• Resources

• Established (green) HVPs (33 states) – Steering Committee, and– Regular meetings and– Activities initiated

• Emerging (orange) HVPs (8 states)– Leaders identified , or– Interest expressed, or– Planning initiated

• Pre-contemplative (pink) (9 states)– Little activity

The HVP Map

There is some HVPactivity in every VISN

Hawaii: GreenWashington, DC: GreenAlaska: Pink

Strategies for Success

• Acknowledge and respect all interest positions and cultural differences– WIIFM factor– Language of organization– Rules, regulations and SOP– Perceptions

Understanding DifferencesVA Hospice

Culture Quasi-military

Nurse-led grassroots movement

Role Provider andPayer

Provider

Funding Fixed appropriation and budget

Entitlement - Medicare/ Medicaid hospice benefit; 3rd party reimbursement

Accountability

Congress Governing Body, CMS, Fiscal Intermediaries and State

National Collaboration• VA Field Advisory Council

– Led by Dr. Scott Shreve– Family Satisfaction, Bereavement and State

Veterans Homes

• NHPCO National Veterans Advisory Council– Chaired by Kandyce Powell– Membership mirrors Hospice-Veteran

Partnerships

• Council of States– Led by Donna Bales– Promoting Hospice-Veteran Partnerships with

state hospice organizations

Veterans Advisory Council

• Policy and Advocacy Workgroup– VA Purchased Hospice Care– VA/Medicare Hospice Benefit Interface– VA Physician - Community Hospice Interface– Hospice - Nursing Home Interface

• Access and Outreach Workgroup– VA 101 Toolkit– Veteran Volunteer Training Manual– HVP Listserv (svickers@nhpco.org)

• Data and Outcomes Workgroup– Veteran/military status – Veteran-specific family satisfaction survey

VA Hospice and Palliative Care Veterans Home Workgroup

• National web-based survey (completed)– 58 of 119 State Home administrators and

managers responded (48%)

• Focus group (completed)– 19 State Home administrators and

managers attended

• Interviews (ongoing)– 15 administrators and their staff

participated

State Veterans Homes Data and

Demographics• Veteran deaths

– > 6,000 veteran deaths in State Veterans Homes each year

– 20% average mortality rate

• Length of stay variable– Demographics of patient population– Eligibility criteria– Size of facility and focus of services

SVH Web-based Survey

• Availability of HPC services– Few SVH have designated hospice

beds– Many SVH contract with community

hospices

• What works– Pain and symptom management– Bereavement support to families– Overall quality of hospice care

SVH Web-based Survey

• What could work better?– Support to SVH staff– Meeting unique needs of veterans– Communication between SVH and hospice

• What are some of the challenges?– SVH staff limited understanding of the

Medicare Hospice Benefit– Hospice prognosis requirements and

treatment limitations

Focus Group

• Availability of HPC services– Confirmed that more SVH contract with

community hospices than provide care directly

• What’s working– Expertise in pain and symptom management– Bereavement for families and SVH staff

• What could work better– Communication and coordination– Hospice understanding the unique needs of

veterans– Physician to physician communication

Focus Group

• What can hospices do to help SVHs?– Provide hospice and palliative care

education and training for SVH staff– Know about PTSD and other unique

care needs of veterans– Be able to navigate the systems of

care and services for veterans

• What can VA do to help SVHs?– Good question!

Interviews

• Availability of HPC services– Provided directly or contracts with

community hospices– Rate of hospice referrals variable– Triggers for hospice referrals

variable

Interviews

• What works with Hospices?– Pain and symptom management– Immediate access to hospice

services– Consistent staff and services– Patient, family and SVH staff benefit– Hospice staff visibility within SVH– Hospice is responsive to requests

for community resource information

Interviews

• What could work better?– Lack of knowledge about veterans’

issues– Medications (receiving, packaging)– Communication, interaction with

hospice staff– Patient and family education

Next Steps

• Encourage VA hospice and palliative care staff to interface with SVH staff– Hospice and palliative care education and

training– Resource for consultation, information and

collaboration• Encourage community hospices to

– Learn more about the systems of care and services for veterans

– Learn more about veterans’ and their unique end-of-life issues

– Communicate more effectively with SVH staff

Resources• Hospice-Veteran Partnership Toolkit (on

NHPCO’s Veterans’ Webpage)– www.nhpco.org/veterans

• Military History Card– www.va.gov/oaa

• Wounded Warriors: Their Last Battle– email djones@ethosconslut.com

• VA Hospice and Palliative Care – www.va.gov/GeriatricsSHG/page.cfm?pg=6

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• National Association of State Veterans Homes– www.nasvh.org

• List of SVH Websites– www.va.gov/statedva.htm