Nebraska Hospice-Veteran Partnership 2007 Annual Meeting Feb 23, 2007

1. Nebraska Hospice-Veteran Partnership2007 Annual MeetingFeb 23, 2007

2. 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

3. The HVP Map • 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 • Hawaii: Green • Washington, DC: Green • Alaska: Pink There is some HVPactivity in every VISN

4. Strategies for Success • Acknowledge and respect all interest positions and cultural differences • WIIFM factor • Language of organization • Rules, regulations and SOP • Perceptions

5. Understanding Differences

6. 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

7. 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

8. 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

9. 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

10. 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

11. 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

12. 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

13. 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!

14. Interviews • Availability of HPC services • Provided directly or contracts with community hospices • Rate of hospice referrals variable • Triggers for hospice referrals variable

15. 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

16. Interviews • What could work better? • Lack of knowledge about veterans’ issues • Medications (receiving, packaging) • Communication, interaction with hospice staff • Patient and family education

17. 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

18. 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=65 • National Association of State Veterans Homes • www.nasvh.org • List of SVH Websites • www.va.gov/statedva.htm