We Honor Veterans: Honoring and Caring for all Veterans End of Life Care for Veterans in their...
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We Honor Veterans:Honoring and Caring for all Veterans
End of Life Care for Veterans
in their Community
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How do you change a culture?
Jerry Sternin Story
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Coming Home: Era of Service
• World War II: Heroes
* country worked together
• Korea: Ignored
* forgotten war
• Vietnam: Shamed
* country torn apart
Courtesy of Margaret Walkosz, MS, GNP-BC
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Video clip
Hospice Foundation of America Living with Grief Series
Improving Care for Veterans Facing Illness and Death
https://youtu.be/77KuIEiL7VA
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Demographic Imperative
Only ~3% of Veterans die in VA facilities (~20,000)
~632,931 Veterans died in 2014
PTF file and VetPop for 2012
Many more with advanced serious illness and dementia
(510,314 expected to die in 2025)Source: VetPop 2007
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Collaborate (kuh-lab-uh-reyt)
1. To work, one with another; cooperate
2. To cooperate, usually willingly, with an enemy nation
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It all begins with…
“Are you a Veteran?”
Can we work together to;
- ensure reliable access,
- to quality hospice and palliative care,
- for all Veterans?
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www.WeHonorVeterans.org
• Hospice Veteran Partnerships
• Education• Partner Tools• Best Practices
(e.g., pinning ceremonies)
• Announcements• And more…
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Mar-11
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3000 Level Four
Level Three
Level Two
Level One
Recruit
We Honor Veterans Partners (www.WeHonorVeterans.org)
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Veteran-to-Veteran Volunteer Program
• Veterans often have a distinct culture• Common language and experience can
form strong bonds• Camaraderie among Veterans can provide
invaluable support• Identify Veterans in your Volunteer pool,
build on this resource and recruit others
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Vision for VA’s Community Engagement
• Empower field leadership to develop and strengthen partnerships
• Communicate VA’s willingness to effectively partner
• Leverage partnerships to expand capacity, resources and access to services
Hospice Veteran Partnerships/ Veteran Community Partnerships
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We Honor VeteransTop 10 Reasons to Participate
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% of Veterans with CAN > 95 with Pall Care
3.4% got Pall Care
However, avg CAN score for Veterans that got Pall Care Consults is 98
Veterans “at risk” for needing palliative care
CAN- Care Assessment Need score
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Goals of Care Conversations
Dr. Atul Gawande
How to have those end of life discussions?
https://www.youtube.com/watch?v=45b2QZxDd_o
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A big question…
How would you make culture change happen across VA?
What indicators/measures would convince you VHA is moving towards improved care for Veterans with advanced illness?
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% of Inpt Deaths in HospiceMore inpt deaths in hospice than in all of acute
and ICU combined
FY09 FY10 FY11 FY12 FY13 FY140
10
20
30
40
50
60
Funding support
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When hospice is available, many will use it(absolute % change in inpatient deaths by venue nationally)
ICU Acute Nursing Home Hospice
Change 8% 17% 14% 39%
FY14 20% 22% 6% 52%
FY04 28% 39% 20% 13%
Note, inpt deaths declined over this period, ~5060 veterans impacted
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Inpt Hospice Deaths by VISN(sorted)
20 7 17 19 2 5 9 22 8 3 18 11 1 15 16 12 21 6 4 10 23 Nat'l0%
10%
20%
30%
40%
50%
60%
70%
FY08 FY15 Q1
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# of Palliative Care ConsultsLevel 3+ consults considered “comprehensive”
FY 2014
FY 2013
FY 2012
FY 2011
- 5,000 10,000 15,000 20,000 25,000 30,000 35,000 40,000
31,266
30,511
26,773
19,092
5142
4584
4487
4232
8005
6768
6878
6287
3477
2498
2625
2456
Palliative Care Consult Workload: 2011 - 2014
Inpatient Consults Level 3-5
Inpatient Consults Levels 1-2
Outpatient Consults Level 3-5
Outpatient Consults Levels 1-2
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Days between Consult and Inpatient Death Trend
0-3 days 4-7 days 8-30 days > 30 days
FY 2015 Q1 20% 13% 25% 41%
FY 2014 21% 13% 26% 39%
FY 2013 23% 14% 26% 37%
FY 2012 25% 16% 29% 30%
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National Average % of Families Rating Last Month of Care as “Excellent”
FY08 FY09 FY10 FY11 FY12 FY13 FY14 FY15 goal
20%
25%
30%
35%
40%
45%
50%
55%
60%
65%
70%
52%
56% 57% 58% 59%
63% 62%65%
Families of VA inpatient decedents, response rate ~56%, sample sizes ~11,000/yr
I CARE Initiative
Access Scandal
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% of Families Rating End of Life Care as “Excellent” in Acute Units vs. Palliative care vs. Inpatient Hospice Unit Settings
P values< 0.001
N=4,222 N=3,494 N=4,072 FY2011 N=3,178 N=3,836 N=4,005 FY2012 N=2,122 N=3,523 N=3,090 FY20130%
10%
20%
30%
40%
50%
60%
70%
80%
48%50%
52%
61%59%
64%66% 67%
70%
Usual care Palliative Care Inpatient Hospice Unit
p<.001 p<.001
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Confronting our “foes”
http://www.nbcnews.com/video/nightly-news/43433937#43433937
Healing can come decades later