Honoring and Caring for Veterans at the End of Life

1. Honoring and Caring for Veterans at the End of Life

2. Minnesota Hospice Provider Guideto Veteran Hospice and Palliative Care Services Hospice Provider Tool Kit

3. Minnesota Hospice Provider Guide to Veteran Hospice and Palliative Care Services End of Life Statistics Pertaining to Veterans • More than 1800 veterans die each day; this represents a quarter of all deaths in America • Approximately 85% of them do not receive care through the VA Health Care System • Most veterans who are enrolled in the VA health care system still die in the community • Only four percent of veterans die in VA facilities.

4. Minnesota Hospice Provider Guide to Veteran Hospice and Palliative Care Services Issues Related to Veterans 28,000 veterans/yr die as VA inpatients • 24% not Medicare eligible • 65% not married • Median income less than $10,000/year 76,000 enrolled veterans/year die outside VA facilities • 20% are not Medicare eligible Emotional and Spiritual components • Can be especially meaningful to veterans, who often face issues near the end of life relating to their military/combat experiences. • Support is even more crucial for veterans who do not have a strong network of family and friends.

5. Mission of the Minnesota Hospice-Veteran Partnership (MnHVP) • To establish a network of VA and Hospice Providers that work together to assure end-of life services for veterans in Minnesota and surrounding communities

6. Vision of the Minnesota Hospice-Veteran Partnership(MnHVP) • All Minnesota Veterans will have access to quality end-of-life hospice and palliative care as part of their continuum of care. • To provide a seamless transition between VA and community hospice agencies to ensure that veterans’ end of life care needs are met.

7. Objectives of the Minnesota Hospice-Veteran Partnership(MnHVP) • Increase Veteran referrals to Community Hospice Programs • Improve collaboration between the Veteran’s Organizations, State Veteran’s Homes, Community Hospice and other agencies to improve end of life care • Assess Hospice needs for veterans • Provide education for VA facilities and Hospice agencies regarding end of life benefits • Present outreach programs for CVSOs

8. Minnesota Hospice Provider Guide to Veteran Hospice and Palliative Care Services VA Home Hospice Benefit Services include: • Routine Home Care • General Inpatient Care • Respite Care • Continuous Care • Per Diem Payment • VA Provider may continue as the primary care physician: Medications must be prescribed by a VA provider

9. What services are provided? • Services of the Hospice Team consist of your physician, nurses, home health aides, social workers, chaplains, and trained volunteers • Respite Services • Medication and equipment related to the terminal illness • 24 hour on-call help • Patient/Family centered care • Control of pain and symptoms • Support of the physical, emotional and spiritual needs of patients and family • Grief support and education for families and significant others for one year following the death of a loved one

10. Minnesota Hospice Provider Guideto Veteran Hospice and Palliative Care Services Veteran Eligibility: Check with the Veterans service officer for your county at: http://www.mdva.state.mn.us/macvso/ The Veteran’s eligibility is determined by the Veteran’s Administration through an enrollment process. To receive benefits, all veterans must be enrolled. • Eligibility for most Veteran’s health care benefits is based solely on active duty military service in the Army, Navy, Air Force, Marines, or Coast Guard (or Merchant Marines during WW II), and discharged under other than dishonorable conditions.

11. Minnesota Hospice Provider Guideto Veteran Hospice and Palliative Care Services Veteran Eligibility Continued • Health Care eligibility is not just for those who served in combat. • Veteran’s health care is not just for service-connected injuries or medical conditions. • Veteran’s health care facilities are not just for men only. VA offers full-service health care to women veterans.

12. Minnesota Hospice Provider Guideto Veteran Hospice and Palliative Care Services Veteran General Information: www.va.gov/health Veteran Must enroll for benefits: Veteran’s Benefits Phone (National) Phone: 1-800-827-1000 State VA website: http://www.mdva.state.mn.us/

13. Minnesota Hospice Provider Guideto Veteran Hospice and Palliative Care Services Benefits for Reservists and National Guard: Reservists and National Guard members who were called to active duty by a Federal Executive Order may qualify for VA health care benefits. Returning service members, including Reservists and National Guard members who served on active duty in a theater of combat operations have special eligibility for hospital care, medical services, and nursing home care for two years following discharge from active duty.

14. Veterans Health Administration 21 Veterans Integrated Service Networks

15. Minnesota Hospice Provider Guide to Veteran Hospice and Palliative Care Services

16. Eligibility: Veterans who are eligible for VA healthcare may qualify for Hospice Care Who may qualify for Hospice? • Veterans who have a terminal illness with limited life expectancy • Veterans who choose comfort care • Veterans who apply and qualify for VA healthcare

17. Minnesota Hospice Provider Guide to Veteran Hospice and Palliative Care Services VA Benefit for Hospice Inpatient Services (Inpatient Options that require pre-approval) • Inpatient care at VA facility • VA purchases inpatient hospice services in nursing homes that the VA has a contract with as well as pays the full room and board at these facilities. • VA purchases inpatient hospice services from community provider at locally negotiated rates. • Each VA facility has a Palliative Care Consult Team.

18. Minnesota Hospice Provider Guide to Veteran Hospice and Palliative Care Services Many VA facilities have special beds/suites dedicated for provision of hospice and palliative care.

19. What is the Cost? • Costs are covered by private insurance, Medicare, Medicaid, or by the Veteran’s Administration. • Veterans who choose Medicare Hospice retain eligibility for VA Care and benefits

20. Minnesota Hospice Provider Guide to Veteran Hospice and Palliative Care Services How Does the Veteran Obtain Hospice and Palliative Care? Providers would refer the patient/caregiver to local VA enrollment service. Referral Process for Hospice and Palliative Care • For home care the primary care provider, service officer, or Home Health or Hospice Agency, consultant identifies the veteran in need of this care and makes a referral • Once the need for referral has been established, the VA Community Health Nurse Coordinator must be contacted. The coordinator sets up all outside services.

21. Minnesota Hospice Provider Guide to Veteran Hospice and Palliative Care Services Hospice Agencies should contact ChampVA or Tricare to determine coverage for individual veteran. ChampVA • Civilian Health and Medical Program of the Department of Veterans Affairs is a federal health benefits program administered by the Department of Veterans Affairs • VA shares the cost of covered health care services and supplies with eligible beneficiaries • Contacting CHAMPVA: Phone: 1-800-733-8387; http://www.va.gov/hac/forbeneficiaries/champva/champva.asp

22. Minnesota Hospice Provider Guide to Veteran Hospice and Palliative Care Services TRICARE • Program of the Department of Defense • Regionally managed • Active duty and retired members of the uniformed services • Contacting Tricare: Phone: 1-888-874-9378 or website: http://www.tricare.mil/mybenefit/home/overview/Eligibility • www.cem.va.gov

23. Minnesota Hospice Provider Guide to Veteran Hospice and Palliative Care Services Veteran Burial Benefits: Mission: To honor veterans with final resting places in national shrines and with lasting tributes that commemorate their service to our nation Purpose • Provide burial space for veterans and their eligible family members • Maintain national cemeteries as national shrines, sacred to the honor and memory of those interred or memorialized there • Mark veterans’ graves with a Government-furnished headstone or marker and to provide Presidential Memorial Certificates in recognition of their service to a grateful nation • Administer grants for establishing or expanding state veterans cemeteries.

24. Minnesota Hospice Provider Guide to Veteran Hospice and Palliative Care Services Burial Benefits Continued For questions about burial details for, • VA cemetery • Private cemetery • Burial benefits for families of veterans, contact the office of Veteran’s Benefits at: Phone: 1-800-827-1000 or www.cem.va.gov. Who can be buried in a VA cemetery? • Veterans • Any members of the Armed Forces of the USA who die on active duty

25. Minnesota Hospice Provider Guide to Veteran Hospice and Palliative Care Services Veteran Eligibility Criteria For Death Benefits • Before 1980 Honorably discharged 24 months of active duty • After 1980 Honorably discharged 24 months of active duty Not guilty of capital offense

26. Minnesota Hospice Provider Guide to Veteran Hospice and Palliative Care Services Burial Benefits in a private cemetery: Contact Veterans Benefits • Government headstone or marker • Burial flag • Presidential Memorial Certificate • Some veterans may also be eligible for Burial Allowances • No benefits available to spouses and dependents

27. Minnesota Hospice Provider Guide to Veteran Hospice and Palliative Care Services Veteran Burial Benefits in a National Cemetery • Gravesite in any of the 124 national cemeteries with available space • Opening and closing of the grave • Perpetual Care • Government headstone or marker • Burial flag • Presidential Memorial Certificate • http://www.va.gov/vaforms/va/pdf/VA40-0247.pdf. • Some veterans may also be eligible for Burial Allowances • Burial benefits available for spouses and dependents. Refer to Decedent Affairs

28. Minnesota Hospice Provider Guide to Veteran Hospice and Palliative Care Services Burial Allowances: Contact Veteran’s Benefits • Partial reimbursements of an eligible veteran’s burial and funeral costs • Burial Allowances based on eligibility • 1. Up to $300 toward burial and funeral expenses • 2. Up to $300 plot-internment allowance • 3. If the veteran died because of a service-related disability, the burial allowance increases to up to $2,000 • Eligibility criteria can be found http://www.cem.va.gov

29. Resources

30. Minnesota Hospice Provider Guide to Veteran Hospice and Palliative Care Services Additional Hyperlink/Resource Page http://www.tricare.mil/mybenefit/home/overview/Eligibility http://www.va.gov/healtheligibility/coveredservices/StandarBenefits.asp Contacting CHAMPVA: Phone: 1-800-733-8387; http://www.va.gov/hac/forbeneficiaries/champva/champva.asp Contacting Tricare: Phone: 1-888-874-9378 or website: http://www.tricare.mil/mybenefit/home/overview/Eligibility www.cem.va.gov http://www.mvh.state.mn.us/board.html Contacting NHPCO: Phone: 1-800-658-8898; http://www.nhpco.org Contacting Hospice MN: Phone: (651) 659-0423 or toll free: (800) 214-9597; http://www.hospicemn.org

31. Contacts • Minneapolis VA Medical Center: 612-467-2043 • Saint Cloud VA Medical Center: 320-255-6414 • Fargo VA Medical Center: • State Veteran’s Homes: • Department of Veterans Affairs: (800) 827-1000 www.va.gov • Hospice Minnesota: (800) 214-9597 or 651-659-0423 www.hospicemn.org • National Hospice and Palliative Care Organization(800) 646-6460; www.nhpco.org