Katherine Kemp, NHPCO Access Specialist
- Welcome and introductions
- Welcome to the We Honor Veterans family our two new community partners:
- Washington Square Healthcare – Ohio
- Oasis Dementia Care – Indiana
Amanda Bow, NHPCO Director of Communications
- Veterans Day resources will be created for all of our partners to use for your Veterans Day outreach. These resources can be found on the We Honor Veterans website.
- Resources will include brand new social media graphics. Please remember to use #WeHonorVeterans so that we can follow all of the great postings that you are all sharing.
- A press release can also be found in these resources, which can be customized to your organization. Feel free to share your press releases with us at veterans@nhpco.org
- If you have anything special planned for Veterans Day, we want to hear about it! Please send them to Veterans@nhpco.org , through our website, or directly to Amanda at abow@nhpco.org
May Kumora – Bayada Hospice
Veteran-to-Veteran Letters of Thanks Initiative
- A few years ago Bayada Hospice had a World War II Veteran. The Veteran had spent time in Germany and was struggling with letting go, due to guilt from his time overseas. An active duty comrade, stationed in Germany at the time, wrote to this patient, letting him know the impact that had been left, how he is remembered, and that his service is not in vain. Although the letter did not make it in time for this patient to read it, the letter was given to another patient and it was very much appreciated.
- Currently May Kumora, of Bayada Hospice, has 10-12 letters from active duty military, who are all stationed around the world. These letters are available to be shared with any and all Veterans. The goal is to continue collecting letters, maybe even videos, from active duty military, to say thank you to the Veterans who have gone before them.
- These letters can be found on our website please feel free to email us your letters at veterans@nhpco.org so that we can help to carry out this initiative.
Kathy Van Pelt – Opus Peace Upcoming Events and Updates
- Opus Peace is a non-profit organization founded by Deborah Grassman, the author of Peace at Last, Stories of Hope and Healing for Veterans and their Families. Opus Peace was founded two years ago, after Deborah’s retirement, after 30 years as a nurse practitioner on the hospice unit at the VA caring for over 10,000 dying Veterans.
- The mission of Opus Peace is to provide educational programs to healthcare providers to help people recon with unassessed wounds of soul injuries, thereby liberating unmourned loss, unforgiven guilt and/or shame, which can sabotage lives.
- Many Veterans and the caregivers of these Veterans may be carrying soul injuries as a result of their military experience, which may not develop into PTSD. A soul injury can be a spectrum of wounds leading to the sense of being separated from ones’ own self. Soul injury in defined by Opus Peace as an aching wound perpetuated by unmourned loss or unforgiven guilt or shame that is often manifested as emptiness, loss of meaning or a sense that part of yourself is missing. The approach to addressing these soul injuries includes learning how to grieve our losses, grieve our failures, grieve our disappointments and releasing that loss, as well as how to forgive ourselves and forgive others, releasing that shame.
- Dying people know things that the rest of us don’t; we refer to this as warrior wisdom. This wisdom emerges in the last few weeks of life. With the opening of Opus Peace, Deborah feels very strongly about the mission to carry forward the wisdom that Veterans who have died have shared with her and all of the workers in community hospices.
- Opus Peace has developed educational programs and workshops based on time honored ceremonies that facilitate hope and healing, not only for Veterans at end of life but all Veterans, including active duty military as well as all traumatized populations, even the caregivers and healthcare professionals providing the care and services may also be in need of healing from their own soul injuries.
- The Hospice Foundation of America is partnered with Opus Peace and will be offering the first Soul Injury Webinar in January, 2017. This will be a similar format to that of the Living through Grief series that was offered in the spring, where they now offer the DVD that you can purchase and watch throughout the year and offer CEs if you hold a panel discussion afterwards at a host sight.
Scott Shreve – Department of Veterans Affairs Updates from VA
- Thank you to the National Hospice and Palliative Care Organization for all that they have done to make this program possible, to the many community partners on this call, Opus Peace, and Bayada Hospice, it is heartwarming to see the community energized in its efforts to recognize Veterans at the end of life.
- The Hospice CAHPS survey will be going national within the next 12 months. During the call Scott asked for feedback on this survey, as he will be meeting with representatives from the Center of Medicare and Medicaid soon, and would appreciate hearing our partners’ perspectives. The goal is to get to the point where we can compare end of life care as provided by the VA, with end of life care as provided by the community. The Department of Veterans Affairs is looking to create greater uniformity in our quality indicators both in and outside of the VA.
- The second topic was about concurrent care. There are no restrictions from the VA side for Veterans to continue to receive ongoing palliative treatments from their VA, even while the Veteran is receiving community hospice care under their Medicare Hospice Benefit. However, there are some challenging regulations and policy issues on the Medicare side of things, which can be difficult. What Scott and the VA have been pushing for is that Veterans retain full access to their VA benefit, as long as it doesn’t duplicate in anyway what is being provided by the community hospice. Scott asked to hear of any issues that partners have been having with concurrent care, so that he could further discuss the issue at his meeting with CMS.
Q &A
- Q: How can we help our Veterans get access to their benefits?
A: Veterans Benefits Administration is completely separate from the hospital system. A great source is a Veterans Benefits person at a VA facility. In the past 18 months I truly believe the VA has changed dramatically. If you call the VA looking for resources, they will bend over backwards to help you. If that contact isn’t working for you, we may be able to help you; please send an email to Veterans@nhpco.org and let us know what facility you are working at and where you are having trouble getting to the right person so that we may assist. - Q: We had a veteran patient receiving 3 showers a week from a home health aide through the VA. I contacted the home and health aide social worker at the nearest VA hospital and she said that would not be considered a conflict of interest. Further down the line, it was a conflict of interest. Can you speak to this?
A: My understanding of the Conditions of Participation is that the Hospices are to provide the care for the terminal illness. Often times this may include home maker and home health services. Often time duly eligible Veterans can receive support from their VA as well. This can be a bit of a balancing act. Hospices must provide what they are required to under the Conditions of Participation, however, Veterans enrolled in benefits can often time supplement that care and sometime additional care can be provided under comorbidities that are not necessarily terminal themselves. Where duplication occurs is often not a black and white issue.
Partner Networking/Success Stories
- As a billing specialist, leading the We Honor Veterans program at our hospice, the best advice I could give when it comes to duplication of services is the importance of thorough documentation of services, as well as who you spoke with and when.
- Do people have updates of success stories of what their local HVPs are doing?
- We have an excellent relationship with our local VA. We have begun performing pinning ceremonies. This has really strengthened our relationship with the VA. We love what we are doing!
- Our closest HVP is several hours away from us. We do phone in to the activities but we have never been able to go and participate. However, in our own community we have begun “Vet-net” the “net” symbolizing both a safety net and networking. Every month we host a luncheon open for all service providers working with Veterans in our community, to share announcements and happenings in their programs. It is very Veteran centric and the partnership has helped us all work together as a team to serve the Veterans in our community. Out of that we have formed a homeless Veteran coalition as well.
- We have a lot of younger people on our staff, and the difference between World War II Veterans and Korean War and Vietnam Veterans is that often now the World War II veterans aren’t really able to participate much as far as having a conversation. What we are finding is that the psyche of some Vietnam Veterans is much different from the World War II Veterans. We are looking for material to train our staff on what these differences are. What are some resources available to us?
- We are currently updating the ELNEC presentations which have military culture consideration but I don’t think it digs deeply into the issue as you would probably like it to. Scott and Katherine will further discuss this topic to come up with resources to help partners with this topic. The Living with Grief series, presented by the Hospice Foundation of America, Improving care for Veterans with Advanced Illnesses, covers the Vietnam era; we may be able to obtain this training material for you.
- A link to some of our Vietnam related material
- A partner suggested a few movies as resources: Born on The Fourth of July, The Deer Hunter, and Apocalypse Now. These three films provide such an emotional emergence that characterizes the traumatic experience during the Vietnam era.
- One thing that we benefit from is that we can go straight to the Veterans themselves. Not only with the patients but with the Veteran volunteers, we can address these topics with them and get their input on certain situations.
- We have an excellent relationship with our VA and VA facilities but they are several hours away. One barrier that we have run into is when our patients are nearing the end of life and need a routine level of care or respite care and have full VA benefits, they are required to receive those benefits at the VA facility. Will the choice program be working on an agreement to allow Veterans to access full benefits closer to home where their family can stay nearby?
- The VA is allowed to pay for the general inpatient care. What we are not allowed to pay for is anything such as assisted living or personal care. As far as nursing homes the VA can only contract with a certain number of facilities in an area, therefore limiting where Veterans can receive skilled nursing. The GIP VA can enroll Veterans.
Wrap Up and Next Meeting
- The next meeting will be in December, 2016.
