Palliative Care for our Veterans
Memorial Day is a time to honor those who have died in service of the United States. On this day, many Americans also take a moment to reflect on the sacrifices of the men and women who have served or are currently serving in our Armed Forces.
Over the next 25 years, the number of Veterans is projected to drop from 21 million[i] in 2015 to 15 million in 2040 with the passing of the “baby boomer”, post-WWII generation. It is a challenge to care for the large numbers of elderly from this wave. A major challenge in caring for aging populations is properly tempering the dominance of high-tech interventions that tend to be applied even in terminal patients and to those at the end of life. Communication is another major challenge:both communication barriers built into the health care system and a culture not wanting to or being unequipped to talk about death and end of life needs.
I recently had the opportunity to speak about these issues and more with Dr. Scott Shreve, Director for Hospice and Palliative Care for the National Department of Veterans Affairs (VA). Dr. Shreve works to ensure that Veterans have access to quality end of life care—to serve the Veterans as honorably in death as they have served us in life.
Under Dr. Shreve’s leadership, the VA’s Hospice and Palliative Care Program was awarded the American Hospital Association’s Citation of Honor award in 2013. The award honors innovative palliative and end of life care in hospices, hospitals, health care systems, long-term care facilities and other direct care providers.[ii]
Communication is Key
A recent study[iii] in the Annals of Internal Medicine showed that the American health system has lost ground in the battle against pain and depression at the end of life. Between 1998 and 2010, the study showed an increase in end of life pain of 12 percent and an increase in end of life depression by 26 percent. Care at the end of life seems to be getting worse.
Proper communication is an essential tool to help limit these symptoms. Discussions help to ensure that individuals can come to a place of peace and contentment even when finding a cure is impossible.
Dr. Shreve described the efforts of his program to develop this important skillset:
“…what we have done as a system is worked with some national experts on communication. Our goal is to train primary care physicians how to have these discussions.
And our belief is, first, they’ll elicit the goals of care of these patients, and help patients when it’s unwanted and unnecessary for them to go into, for example, the ICU [Intensive Care Unit] or ED [Emergency Department]. That, perhaps, we can cater the care to meeting their needs as opposed to…the default mode of ‘do everything humanly possible,’ whether it’s really going to change the outcome or not.”
Leading by Example
Dr. Shreve discussed some of the progress the Veterans Health Administration has made:
“We have a system now that 10 years ago wasn’t even making hospice referrals to the point where now more than half of our inpatient deaths are occurring in designated hospice beds with hospice teams. And it’s just become a part of our culture.”
I’m often impressed but no longer surprised at how often both the Department of Defense and the Veterans Health Administration are “first out” with many innovations in health care.
The nation should learn from the VHA system about end of life care. In the VHA, patients at the end of life are provided with the resources needed to aid them as they prepare for the end of life. The VHA leads by example. How do we get the rest of the country to follow suit?
Through collaborative efforts, such as Samueli Institute’s upcoming breakthrough collaborative, experts in the field of hospice and palliative care convene to discuss and act upon these issues. As Dr. Shreve pointed out, the effort is ongoing, the need is great, and only grows as the aging population increases.
So on this Memorial Day and every day, I am grateful to those who gave their lives in service of this great country. I think of the many Service Members and Veterans who continue to sacrifice and I am thankful for the committed families, caregivers and medical professionals who treat these men and women like the heroes they are through the end of their lives.
[iii] http://annals.org/article.aspx?articleid=2107746Ann Intern Med. 2015;162(3):175-183. doi:10.7326/M13-1609