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VA 101 Hospice-Veteran Partnership Program

VA 101 Hospice-Veteran Partnership Program. Content. Overview of the Hospice-Veteran Partnership Program Making the case to form an HVP Strategies for HVP success Tips for Getting Started and Succeeding Examples Resources. Message from Tom Edes Department of Veterans Affairs.

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VA 101 Hospice-Veteran Partnership Program

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  1. VA 101Hospice-Veteran Partnership Program

  2. Content • Overview of the Hospice-Veteran Partnership Program • Making the case to form an HVP • Strategies for HVP success • Tips for Getting Started and Succeeding • Examples • Resources

  3. Message from Tom EdesDepartment of Veterans Affairs “We in the VA depend on you, community hospice agencies to deliver home care for our terminally ill patients. The VA does not intend to replicate the excellent system that is already in place for home hospice care and we in the VA must learn to collaborate with and learn from you.”

  4. VA Hospice and Palliative Care Initiative • AACT Program (Accelerated Administrative and Clinical Training) • VISN-wide interdisciplinary teams support the ongoing development of hospice and palliative care programs and clinical training in all VA facilities • HVP Program (Hospice-Veteran Partnership) • Stakeholder groups work together to help ensure quality hospice and palliative care is available for veterans across all settings and levels of care

  5. 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

  6. Hospice-Veteran Partnerships • Home: State hospice organization, coalition, VA VISN or facility • Leadership: Co-chairs, generally representatives from community hospice and VA • Structure: State-wide organization and coordination with local or regional HVPs around VA catchment areas

  7. HVP Partners • State Hospice Organizations • End-of-Life Coalitions • Community hospice agencies • VISNs and VA facilities • VA Medical Centers • Community Based Outpatient Clinics (CBOCs) • Vet Centers • State Veterans Homes • Veterans Service Organizations (VSOs) • Community Veteran Organizations

  8. 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

  9. Veterans Health Administration 21 Veterans Integrated Service Networks

  10. Why Are HVPs Important? • More than 1,800 veterans are dying every day . . .but not much is known about end-of-life issues for this special population • The vast majority of veterans do not receive their health care from VA . . .but community healthcare providers and organizations often don’t know who they are or how to reach out to them • Significant barriers exist . . .but they can be overcome through communication and collaboration

  11. Volume of Veteran Deaths • Number of veteran deaths reached an all-time high in 2006 - 687,500 • At least 600,000 deaths a year through 2016 • Only about 4% (approximately 23,000/yr) will occur in VA facilities • HVPs are solving care coordination problems at the local, state and national levels http://www.va.gov/vetdata

  12. Projected Veteran Deaths (2006) http://www.va.gov/vetdata

  13. Total Projected Veteran Deaths by StateRange = 66,000 (CA) to 1,000 (AK) Top 10 States 52%

  14. Top 10 StatesProjected Veteran Deaths (2006)

  15. How Can HVPs Help VA? • Honors veterans’ preferences • Expands the interdisciplinary team • Increases VA staff knowledge of the Medicare Hospice Benefit • Frees up inpatient beds for incoming veterans • Shares the job of caring for veterans with the community

  16. How Can HVPs Help Community Hospices? • Clinical Care • Honors veterans’ preferences • Improves communication and continuity • Expands understanding of veterans unique end-of-life issues • Administrative • Increases referrals • Improves payment for services • Clarifies interface between VA and community hospice policies and procedures

  17. How Can HVPs Help Veterans? • Honors veterans’ preferences • Standardizes VA response to community hospices • Informs community response to veterans’ unique end-of-life issues • Contributes to continuity and quality of care • Eliminates “charity care” for veterans

  18. Getting Startedwith the HVP Toolkit • Begin with a Planning Committee • Identify potential partners • Form a Leadership Committee • Conduct Needs Assessment • Develop strategic objectives and measure outcomes • Plan educational, program development and outreach activities • Work together to build solutions (www.nhpco.org/veterans)

  19. Potential HVP Projects • Community Outreach • Legal and Regulatory Issues • Education and training for providers • Research and Evaluation • Member Recruitment • Fundraising

  20. Strategies for Success • Strong support from VA leaders • Identify champion from each facility in state • Invite staff from CBOCs, State Veterans Homes, and VetCenters to participate • Secure support from VISN leadership • Include HVP in strategic planning efforts • Coordinate HVP activities within VISN and with adjacent VISNs

  21. Strategies for Success • Equally strong support from the state hospice organization or coalition • Identify Community hospice champion • Invite all community hospices in state to participate • Secure board of directors support and appoint HVP community leader(s) • Establish an HVP standing committee or workgroup

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

  23. Understanding Differences

  24. Success Stories • NY, NJ, MA: Holding regional roundtables • CO, NE, OH: Planning “Ask me” campaigns • NE: Developing Post Traumatic Stress Disorder educational materials for community hospices • VISN 5 and 6: AACT teams coordinating HVP activities across networks • IL, IN: Developed speakers bureaus

  25. HVP Outcome Measures – 1st Tier Are we improving veterans’ access to hospice and palliative care? • # veterans being served by community hospices • HVP has the name and contact information of VA HPC liaison(s) at each facility in the state and makes this information available to all hospices in the state • # educational sessions among providers of care for veterans in all settings

  26. HVP Outcome Measures – 2nd Tier Are we meeting veterans needs? • # education sessions/events for veterans and their families • Post death family satisfaction survey data collected and shared among providers • # referrals from community hospice to VA for assistance with care, benefits or services • # and % of community hospices that have written agreements with VA facilities and State Veterans Homes

  27. HVP Outcome Measures – 3rd Tier Are HVPs paying attention to the strength and sustainability of their infrastructure? • Composition of HVP membership • # HVP projects ongoing and completed • # HVP meetings

  28. Hospice-Veteran Partnerships - National Program - Local Solutions • State lines and VISN boundaries are complex • Solution: form regional HVPs around each VA Medical Center in the state • Region includes the VAMC’s service area • Coordinate activities with your State HVP to ensure that everyone has the same information • Many benefits!

  29. Regional HVPs in VISNs 2 and 3(New York and Northern New Jersey) • HVP survey highlighted perceptions and misunderstandings • Roundtable sessions drilled down and identified barriers and opportunities • Solutions and best practices shared and “hard wired” into performance • Relationships strengthened through routine meetings and collaboration on specific tasks and objectives

  30. How to Start a Regional HVP • Establish a Regional or Local HVP Steering Committee • Membership • Charter • Project Workgroups • Hold regular meetings • Report back to the State HVP

  31. Regional HVP Start-up Activities • Schedule initial “Round Table or Open House” • Identify local VA facilities, community hospices, State Veteran Homes and others • Send letter of invitation • Develop agenda collaboratively • Plan logistics carefully • Pay attention to local issues that affect the interface of VA with community providers in the region • Understand the different perspectives of individual member groups

  32. Regional HVP Agenda • VA Continuum of Health Care Services • Eligibility & Burial Benefits • VA Palliative and End-of-Life Care: Inpatient and Outpatient Services • VA Bereavement Program • Coordination of Care • MD orders for start of care • Medications and DME • Home Hospice Agency follow up • VA Purchased Home Hospice Care • Agencies Description & Services • Open Discussion

  33. Next Steps for Regional HVPs • Establish ongoing relationship • Create an e-mail group and send regular updates • Partner for training and education activities • Identify ways to increase hospice referrals • Improve coordination of clinical care

  34. Resources for HVPs • Military History Pocket Card • Wounded Warriors: Their Last Battle • HVP of Maine brochure • HVP of Florida lapel pin for veterans • Websites

  35. VA Pocket Card Homepagewww.va.gov/oaa/pocketcard/

  36. Wounded Warriors: Their Last Battle VA Mission: “To care for him who shall have borne the battle and for his widow and his orphan.” Abraham Lincoln

  37. HVP of Maine www.mainehospicecouncil.org/hvp/

  38. HVP of Florida Keep the focus on “Veteran” in yourHospice-Veteran Partnership

  39. Websites • Hospice-Veteran Partnership Toolkit (on NHPCO’s Veterans’ Webpage) www.nhpco.org/veterans • Military History Card www.va.gov/oaa • National Center for PTSD www.ncptsd.va.gov/ncmain/index.jsp • VA Hospice and Palliative Care • www.va.gov/GeriatricsSHG/page.cfm?pg=65 • HVP of Maine • www.mainehospicecouncil • HVP of Michigan • www.mihospice.org

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