published Thursday, June 18th, 2009

Veterans and end-of-life care

The Veterans Administration is charged with providing life-long health care services to eligible veterans. Doing so honors a promise the nation makes to those who serve in the military. Fulfilling that pledge is sometimes difficult, but on the whole the VA works diligently to meet its mandate. A new grant initiative on hospice and palliative care demonstrates that commitment.

The useful goal of the program is to learn how to best meet end-of-life needs of veterans in VA care. Hospice of Chattanooga is the recipient of one of 18 recent grants to palliative care organizations across the country. The match between VA and hospice organizations to pursue such information is a near-perfecto one.

Hospices and palliative care providers have considerable experience in managing and dealing with end-of-life issues. The Veterans Administration has an increasing population of men and women who are growing older and increasingly in need of such assistance. Clearly, the former should be able to help the latter in developing supportive services for veterans who desire that sort of help at the end of their lives.

The need is great. A spokesman for the National Hospice and Palliative Care Organization says that about 28 percent of all deaths in the United States each year -- or about 50,000 a month -- involves a veteran. Many of the veterans do not know about palliative care -- which focuses on quality of life and alleviating pain and discomfort rather than a "cure" at the end of life -- or that VA provides a benefit for it. Participants in the grant program hope to broaden knowledge about both.

The effort to do so is especially important in rural areas, where about 40 percent of veterans who receive health benefits live, and among the nation's homeless population. The latter, officials report, now includes innumerable veterans, many with mental illnesses or in increasingly frail health, who have no health insurance, though many are eligible for VA care. Reaching them has been a persistent problem.

The hospice groups receiving grants will develop templates for outreach programs about both general VA benefits as well as end-of-life care that can be replicated across the nation. The agency also hopes grantees can help streamline the VA's first-time enrollment process. Currently, the process can take many weeks. That's not an attractive option for a veteran in need of urgent medical care, but it can be particularly unacceptable for a man or woman with a terminal illness.

The VA properly wants to "honor a veteran's preferences for care at the end of life" and to do so by providing supportive services in the home and elsewhere for those with terminal illness. The agency recognizes it will be hard-pressed to provide the services to an expanding population without outside assistance. The decision to turn to hospice and palliative care groups with proven expertise in the field for help is a wise one. Veterans and their families confronting difficult end-of-life decisions will benefit from the decision.

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