Meeting Veterans Special Needs at the End of Life

U.S. Armed Forces are trained to be mission-focused, stoic and brave. Military personnel—whether deployed at home or abroad—also have extraordinary stresses, including being in combat theater and away from family, as well as physical demands and isolation. Once a servicemember transitions to civilian life, triggers may manifest in unexpected ways. These experiences can become even more acute when a veteran is diagnosed with a terminal illness.

Veterans deserve end-of-life support from a care team that knows how to support, uplift and address the unique and unspoken needs of veterans and their families. Unfortunately, the strength that served them so well when on active duty, often prevents a veteran from asking for help. That’s why hospitals, as well as private practice doctors, often refer terminally ill patients with military service to experienced hospice programs.

Hospice Explained

Hospice is a type of care, not a place. No matter where a patient lives, the focus of the team is on providing quality of life instead of continuing often painful treatment that will not extend life expectancy. Hospice care may begin once a physician determines that medical interventions will no longer change the outcome and their patient has a prognosis of six months or less. The interdisciplinary care team (IDT) usually includes a patient’s personal physician, hospice physician or medical director, nurses, hospice aides, social workers, bereavement counselors, clergy or other spiritual counselors, trained volunteers as well as other supportive and clinical care specialists, as needed. Learn more about hospice care.

Trauma Informed Care

Most military veterans, especially those who’ve served in a hot zone, have post-traumatic stress disorder (PTSD). Some have also been exposed to chemical warfare, suffered a traumatic brain injury, or are more susceptible to substance abuse. Sudden movements, loud noises, physical restraints, challenges to authority, perceived disrespect, or even certain medications can bring back nightmares, emotional wounds, acute anxiety or panic, destructive behaviors—even physical pain. Diagnosis of a terminal illness can also trigger trauma experienced by the family.

Across the U.S., there are 4,120 hospice partners in the We Honor Veterans initiative. Developed jointly between the U.S. Department of Veterans Affairs and the National Hospice and Palliative Care Organization, their mission is to better address veterans’ needs at this important time of life. It includes compassionate listening and grateful acknowledgment of military service.

New York-based MJHS is one of only 11 hospices nationally to have earned the highest We Honor Veterans partner level status, which includes serving as a regional mentor to other hospice programs.

All military veterans under the care of Level 5 We Honor Veterans programs are assessed for trauma. Those who are already receiving or could benefit from counseling, but who are too frail and medically-vulnerable to travel to the VA, are referred to PTSD-specialist counselors who are able to support their needs at home.

Other elements of the We Honor Veterans program include, but are not limited to:

• Accessing resources based on available military benefits
• Adjusting medication management to ensure those with a history of drug dependency don’t relapse or live in pain
• Incorporating nonpharmacologic and alternative therapies—including music and art therapy
• Fostering reconciliations and feelings of control
• Veteran to veteran volunteer visits
• Assistance with military burials
• Emotional and spiritual support services for families, including younger children who may still be in the home

Family Unit

When members of the military serve our country, their families serve right along with them. Years after active service, military families often continue to play an active role as advocates and caregivers. While an act of love, this can be very stressful, especially if past traumas trigger agitation and outbursts from their loved one at end-of life. In these situations, members of the hospice team help the primary caregiver – and the whole family – come to peace with important decisions and provide emotional support.

In some cases, the hospice team also helps families celebrate the service of their loved one through a recognition, flag pinning and certificate of appreciation presentation ceremony. Support continues up to 13 months after the death of a loved one.

Always in Service

Just like when veterans were once in uniform, the hospice team is on-call 24 hours a day, seven days a week. And the goal is to never leave anyone behind or completely alone.

Each hospice patient is regularly visited, and the plan of care is adjusted as needed. The team:

• Provides basic medical care with a focus on pain and symptom control
• Supports the patient and their families with the emotional, psychosocial, and spiritual aspects of dying
• Provides medications and medical equipment
• Teaches families how to help care for their loved one and themselves
• Offers music and art therapies for families to help address or shift focus from emotional or physical pain
• Makes short-term inpatient care available when pain or symptoms become too difficult to manage at home, or the caregiver needs respite time
• Provides grief support and counseling to surviving family and friends

There are many ways to thank the military for their service to this country. Providing compassionate, respectful, mindful care to veterans at the end-of-life is a duty and one of the highest honors that any hospice program can have. Find more information on the We Honor Veterans program at MJHS here.

MJHS Hospice relies on generous donors to supplement veteran-specific programs and services. Lend your support at mjhsfoundation.org/supporthospicecare.

At MJHS, we value both personal and professional caregivers and recognize the critical work you do. That is why we have created these online caregiving resources to help you through this crucial time in your life.

If you need additional help and support caring for your loved one, please feel free to contact MJHS. We can recommend other care options available to you through one of our programs.