Referring Veterans to Hospice and Other End of Life Services
The Massachusetts Hospice-Veteran Partnership
What is the Massachusetts Hospice-Veteran Partnership (MHVP)?
Established in January, 2004, MHVP is a coalition of VA facilities, community hospice programs, other veteran services and community organizations working together to ensure that excellent care at the end of life is available for U.S. veterans and their families.HVP is a national program of the Department of Veterans Affairs (VA) Hospice and Palliative Care Initiative.The purpose of MHVP is to provide leadership, technical assistance, educationand program development recommendations aimed at:
- Honoring veterans' preferences at the end of life
- Improving veterans' access to hospice and palliative care across all sites and levels of care
- Strengthening the relationship between community hospice agencies and VA facilities
- Providing information to veterans about hospice and other end-of-life options
Does the VA provide a hospice benefit?
Yes. Hospice and palliative care is a covered benefit for all enrolled veterans in all settings.
How can it be determined whether a veteran is eligible for the VA Hospice Benefit?
All veterans enrolled in the VA are eligible.If the individual is not currently enrolled under the VA benefit, evidence of an honorable discharge and income verification is necessary.If theveteran is determined to be in Enrollment Priority Level 8 (which makes him ineligible for VA care) than the veteran might be considered eligible under Priority 4 (catastrophically disabled).Eligibility can be checked through the VA's Medical Administrative Services.
What if the veteran is not eligible for VA benefits and wants to choose hospice care?
The veteran may be eligible for hospice care under Medicare, MassHealth (Medicaid) or other payers.
What are the VA's criteria for admission to hospice?
The VA criteria are the same as for Medicare, Medicaid and other payers.The veteran must:
- have treatment goals focused on comfort rather than cure and
- be diagnosed with a life-limiting illness and have a life expectancy or six months or less.
(The physician need not know that this specific individual will die but rather that individuals like this generally die within 6 months if the disease runs its normal course.)
Is hospice care only for cancer patients?
No.Hospice care can be provided to any patient with any terminal diagnosis -- heart disease, dementia, terminal decline, stroke and coma and many others -- as long as the patient meets the two basic hospice criteria.
Does the veteran have to have a DNR in place (do not resuscitate order) prior to being admitted to hospice?
Does the veteran have to have a primary caregiver in order to receive hospice care?
No.A hospice team with strong social work support will try to provide options using community resources to sustain the veteran at home as long as possible while determining a plan should the situation becomes unsafe.
What does the VA hospice benefit include?
The VA hospice benefits mirrors the Medicare hospice benefit.Hospice care is paid on a per diem basis and coverage includes: nursing care, social services, pastoral care, personal care, volunteer support, and all drugs and medical equipment that relate to the terminal illness.There are no additional costs to the patient or family.
Where is hospice care provided?
Hospice care can be provided at home, in a group home, shelter, assisted living facility or nursing home.
What about the veteran's family? Can hospice help?
One of the hallmarks of hospice care is that the needs of the family as well as the patient are considered by the interdisciplinary hospice team in the care planning process. After the patient dies, the family receives 13 months of bereavement services at no cost to them.Knowing that the family will be supported can be a great comfort to the veteran.
When is it time to refer a patient to hospice?
The veteran can choose admission to hospice once the two basic criteria are met. Most patients and families say that they wish they had known about hospice sooner. With an earlier admission, there are fewer crises requiring emergency or hospital care. Pain and symptoms are better managed and families and patients experience less emotional and spiritual stress.A longer stay in hospice can create an atmosphere of greater dignity, quality and comfort at the end of life.(See Q. 5).
What should a hospice team understand about a veteran admitted to hospice?
All human beings share some common experiences as death approaches.However, veterans may have even more complex needs, especially combat soldiers and Prisoners of War who have faced the grim realities of death in a very dramatic way.Veterans may also be coping with unresolved grief or survivor guilt having witnessed traumatic deaths and injuries that may color how they come to terms with their own death. The following questions may help understand a veteran's unique needs:
- Is there anything about your military service that still bothers you?
One of every four deaths in Massachusetts is that of a veteran.Many veterans are not covered by VA benefits but rather under Medicare, MassHealth or other health plans.If it is not known whether an individual is a veteran, ask "Are you a veteran” during the assessment visit.Then continue with the above two questions.
What resources are available should a hospice want to consult on unexpected PTSD symptoms?
What resources are available should a hospice want to consult on unexpected PTSD symptoms.
What will the VA expect from a hospice program providing care for one of its veterans?
The VA will expect ongoing coordination and communication to ensure services fit the patient's need such as treatment issues, changes in the patient's condition, and level of care.They will also expect to be notified when the veteran dies or is discharged.
Can a hospice team provide care to veterans inside a VA facility?
No, not at this time.
Are there are other end-of-life services for veterans in Massachusetts?
State-run Soldier's Homes in Chelsea and Holyoke provide dormitories and long term care services.Veteran's Homestead is a residence for homeless veterans in Fitchburg that contracts with local hospices for hospice care.In addition, the VA provides burial benefits and, depending on eligibility, may include a headstone, flag, certificate and plot.Each town in Massachusetts has a veteran service officer that can provide information about veteran benefits.
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National Hospice & Palliative Care for sample outreach materials including certificate templates for honoring veterans
National Post Traumatic Stress Disorder Center for information
Soldiers Homes for dormitories and end of life care
Boston VA, Fee Basis Supervisor 857-364-5890
VA Boston, Continuing Care Office 857-364-5700/5703 and 857-364-5697
Boston VA, Medical Administrative Services 857-364-4265 or 857-364-5269
Veterans' Homestead Hospice
Residence in Fitchburg 978-353-0234
Veteran Service Officers
Contact Town Hall