Veterans Nearing the End of Life: Distinct Needs, Specialized Care

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Veterans Nearing the End of Life:
Distinct Needs, Specialized Care

CE Provider Information
VITAS Healthcare programs are provided CE credits for their Nurses/Social Workers and Nursing Home...

Goal
• This presentation equips the healthcare
professional with a multifaceted
understanding of the unique needs of the
v...

Objectives
• Discuss pertinent statistics regarding
ill and aging U.S. veterans.
• Highlight why it is important for
non-V...

U.S. Veteran Statistics
The National WWII Museum. “WWII Veteran Statistics.” The National WWII Museum,, https://www.nation...

Each Veteran Is Unique
• How they adjust to civilian life
• How they cope with life stressors
• Whether they enlist help
•...

Factors That Influence Veteran Experience
• Which war they served in
• Whether they had PTSD and
whether it was treated
• ...

Military Cultural Values
• “Big boys don’t cry”
• “No pain, no gain”
• “The more it hurts,
the better”
• Fear/pain is a si...

Military Cultural Values
• Being in control
• Deference to authority
• Death as the enemy
– “Fight to the bitter end.”
• S...

Military values essential for the battlefield might be
contraindicated when the veteran is nearing the end of life.
Stoici...

Combat vs. Non-Combat Veterans
Non-combat
• Fewer psychological and
social obstacles transitioning
to civilian life
Combat...

World War II 1941-1945
• Country united behind war effort
• Men lied about their ages to join the war effort
• Degree of s...

Korean War 1950-1953
• “Police action” - limited war
• No formal declaration of war from Congress
• Korean vets felt ignor...

Vietnam War 1964-1975
• Soldiers were young, many were drafted
• U.S. involvement was unclear
• War was unpopular; massive...

Gulf War 1990-Present
• Societal support was split
• Success and failure were/are
hard to measure
• Extensive, vivid media...

Combat: Physical Ailments and Injuries
Vietnam veterans
• Chemical warfare (Agent Orange)
• Presumptive conditions and dis...

The PACT Act
Grassman, D. (2007). Wounded warriors: Their last battle. Home Health Nurse, 25(5), 299-304.
• Expands and ex...

Integration of Trauma
Grassman, D. (2007). Wounded warriors: Their last battle. Home Health Nurse, 25(5), 299-304.
• Integ...

• Personality and resiliency
• Social, familial support
• Financial stability
• Physical health
• Faith support
• Ability ...

Ganzel, B. (2018). Trauma-Informed Hospice and Palliative Care. The Gerontologist, 58(3), 409-419.
Trauma-Informed Care
Tr...

Military history checklist:
Assess and plan for PTSD
Assess for pain – may underreport
Assess for moral Injury
Identify mi...

Veteran Suicide Rates in the U.S.
• 17.6 suicides per day in 2022
• Suicide rate is almost double than
non-veterans (1.5 t...

Veterans Crisis Line
*Please Note: this number will only work from a cell phone.
It will not work on a landline.
Dial 988 ...

Post-Traumatic Stress Disorder (PTSD)
Trauma- and Stressor-Related Disorders. (2013). DSM-5.
*One symptom from the list **...

Post-Traumatic Stress Disorder (PTSD) (cont.)
Trauma- and Stressor-Related Disorders. (2013). DSM-5.
D: Negative alteratio...

Most Prevalent Mental Disorders in Veterans: PTSD
Kessler, R., et al. (2005) Lifetime prevalence and age-of-onset distribu...

Military Sexual Trauma
“Military Sexual Trauma,” retrieved from US Department of Veteran Affairs https://www.mentalhealth....

Guilt
Williamson, V., et al. (2019). Moral injury in UK armed forces veterans: a qualitative study.
European Journal of Ps...

Guilt (cont.)
Miller M., et al. (2012). The prevalence and latent structure of proposed DSM-5 posttraumatic stress
disorde...

What Is Moral Injury?
Litz B., et al. (2009). Moral injury and moral repair in war veterans: A preliminary model and
inter...

Moral Injury
Drescher, K. D., et al. (2011). An exploration of the viability and usefulness of the construct
of moral inju...

What Is “Soul” Injury?
Grassman, D. Retrieved from Opus Peace www.opuspeace.org
• Disruption of fundamental identity
• Sen...

Military Cultural Competency
Community Hospices: Suicide Prevention for Vietnam Veterans. Sponsored by the Empowering Comm...

Treatment for PTSD
Diefenbach, T.M. (2018). Improving the integration of psychoeducation, prolonged exposure, and
psychoph...

Treatment for Moral Injury
Litz, B., et al. (2015). Adaptive disclosure: A new treatment for military trauma, loss, and mo...

Treatment for Soul Injury
Grassman, D. Retrieved from Opus Peace www.opuspeace.org
• “Re-own and re-home” part of the self...

The Veteran Nearing the End of Life
• Advanced illness can be traumatic
• For the veteran, both can rekindle wartime
memor...

Care for Veterans Nearing the End of Life
• Trauma treatment options determined by:
– Nature and intensity of symptoms
– L...

Veterans With Advanced Illness
• Establish rapport in a helpful,
respectful manner
• Manage symptoms pharmacologically
• R...

Trauma-Informed Physical Care
Grassman, D. (2007). Wounded warriors: Their last battle. Home Health Nurse, 25(5), 299-304....

Trauma-Informed Physical Care (cont.)
Grassman, D. (2007). Wounded warriors: Their last battle. Home Health Nurse, 25(5), ...

Enhancing Coping Skills
• Offer permission to accept declining
health, allow support from others
• Suggest that emotional ...

Supporting Spiritual Growth
• Help construct a “trauma narrative” with room
for personal strengths, positive relationships...

Forgiveness: Cornerstone of Healing
• Forgiveness of the enemy, for killing
or not killing, the U.S. government and
God or...

• Memories remain vivid for the veteran
• Externalizing stories is cathartic
• Both provide self-acknowledgement,
self-for...

“Listen with all your might and do not judge.” —Deborah Grassman
Do
• Take your lead from veteran
• Validate their experie...

Recognition
Engenders psychological and spiritual
congruence between personal values and
motivation for enlisting, vis-a-v...

United States of America Vietnam War Commemoration
• Commemorative partner
• Welcome home ceremonies
• Commemorative pin a...

Minorities & Women Veterans
• Minority veterans fought on “two fronts” – at
the home front and with the enemy on the
front...

Gratitude
• Thank them for:
– Serving our country
– Giving us our freedom
– Putting their life on hold
• Celebrate accompl...

Appreciation
“
“You are the peacemakers
of today.”
“It’s because of your service
that we are free today.”
“We’ll always re...

Treating the Veteran Family
• Acknowledge their sacrifices
• Assess for secondary trauma
• Facilitate an understanding of ...

VA Caregiver Support Programs
• Every VA hospital has a Caregiver Support Team
• Two programs:
– Program of General Caregi...

Life Review Questions
Open-ended Life Review Questions
Some open-ended questions that elicit storytelling might include:
•...

Life Review Questions (cont.)
Advanced questions might include:
• What surprised you most about being overseas or deployed...

In closing…
Let’s not allow the soldier dying in our midst be
unknown any longer… Let us BEHOLD and
FEEL BEHOLDEN!
—Debora...

Hospice Care
• Interdisciplinary team-oriented approach to EOL care
– Patient- and family-centered care
– Goals of care/sh...

Medicare Hospice Benefit
These services are mandated by the Medicare Hospice Benefit.
Interdisciplinary
Team of Hospice
Pr...

Continuous Care
Higher level of care
• Acute symptom management
• Patient’s bedside/preferred care setting
• VITAS RN/LPN/...

Patient and
Family
Volunteers
Physicians
Spiritual
Counselors
Social
Workers
Bereavement
Counselors
Hospice
Aides
Therapis...

How VITAS Can Help
Services VITAS Home Health
Nurse 24-Hours a Day ✓ Variable
Nurse Frequency of Visits Unlimited Diagnosi...

VA Resources
www.vetcenter.va.gov Veteran Centers provide counseling free of charge
www.va.gov US Department of Veteran Af...

Questions

References
American Psychiatric Association. (2013) Diagnostic and statistical manual of mental disorders, (5th ed.). Wash...

References
Hoge, C., et al. (2004) Combat Duty in Iraq and Afghanistan, Mental Health Problems, and Barriers to Care. New ...

References
“Military Sexual Trauma,” retrieved from US Department of Veteran Affairs https://www.mentalhealth.va.gov/menta...

References
Steenkamp, M., et al. (2011). A brief exposure-based intervention for service members with PTSD. Cognitive and
...

Additional Hospice Resources
The VITAS mobile app includes helpful
tools and information:
• Interactive Palliative Perform...

Veterans Nearing the End of Life:
Distinct Needs, Specialized Care

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