I get this call on a regular basis: a new patient just entered hospice care with VITAS Healthcare. Vietnam veteran, non-communicative, and he or she seems depressed. Can I come and talk to him or her?
The end-of-life care team calls me because I have an insider’s advantage. While I’m currently a hospice chaplain and veteran liaison with VITAS Healthcare in San Francisco, I’m also a Gulf War veteran with a 21-year service record.
As most know, the Vietnam War was unlike any other. Contrasting from the veterans of World War II and the Korean War, Vietnam veterans came home to a divided country with a large segment of the U.S. population in opposition of the war. As a result, many of these veterans did not receive a warm welcome upon return or the support needed to adapt to civilian life, leading to high numbers of Vietnam vets dealing with untreated PTSD. And now, as some of these heroes near end-of-life, they require unique medical and care services.
At VITAS, we’ve learned that veterans typically respond better to support and care from other veterans, especially Vietnam Veterans who have unique needs. Once I tell new veteran patients that I am a retired combat veteran myself, they start opening up and talking to me like a lifetime friend versus a caregiver.
However, you don’t have to be a veteran to provide great care for veterans who are nearing the end of life. By identifying the unique needs of veterans coping with life-limiting illness, caregivers and administrators can guide these men and women toward a more peaceful ending.
Recognizing the needs of veterans
According to the U.S. Census Bureau, there are an estimated 19 million veterans living in the United States. Veterans make up one-fourth of all deaths today; that’s 617,000 per year.
The harsh toll of war includes diseases, disabilities and illnesses that can complicate end-of-life care. Depending on the war, veterans may have been exposed to ionizing radiation, Agent Orange, open-air burn pits, battlefield transfusions, below freezing temperatures and infectious diseases. These exposures put them at a higher risk for a variety of cancers, type 2 diabetes, kidney disease, heart disease, hepatitis C, respiratory illnesses, malaria, TB and more.
Veterans can also suffer from what medical professionals refer to as “co-morbidities” or the simultaneous presence of two or more chronic conditions. PTSD, depression, alcoholism, drug addiction and mental illness are common conditions that can accompany the terminal disease of the veteran.
In addition to physical and psychological conditions, emotional concerns may arise, such as feeling the need to purge themselves of memories by discussing their military experience with family members, sometimes for the first time. Veterans also have concerns about their families and how they will manage after the veteran dies.
At VITAS, each veteran patient has an interdisciplinary care team that includes a physician, nurse, hospice aide, social worker, chaplain, volunteer and a veteran liaison, all of whom listen to the veteran to determine how we can best meet his or her needs. Every day, I see how veterans require special care and I work to educate my interdisciplinary teams on how to best care communicate with them, based on my personal experience. I often tell them do’s and don’ts, such as don’t make loud, starling sounds as they can still put vets on edge decades after the end of their service.
Many veterans also don’t understand the Veteran Affairs benefits they are entitled to because of frequent changes within the government, and the fact that the benefits change for each war. Providing a patient with information on their benefits is another way to connect with veterans and show them you care.
It is also important to remind veterans they have a support system and they are valued. For example, at VITAS we offer each veteran a recognition ceremony honoring his or her military service. Sometimes it happens quietly right at the bedside. Other times it’s held in a facility with other residents and family in attendance.
Giving veterans the recognition they deserve can mean a world of difference to them. And it’s never more important than at the end of life to show veterans unwavering honor and respect.
Franklin Yapp, M. Div, is a Veteran Chaplain for VITAS Healthcare in the San Francisco Bay area.
