Literature Review

Medicare to Veterans Affairs cost shifting—A challenging conundrumJAMA Health Forum; Kenneth W. Kizer, MD, MPH, DCM; Said Ibrahim, MD, MPH, MBA; 12/24In this issue, Burke et al highlight how costs previously paid by Medicare for VA-Medicare dual eligible enrollees are now being paid by the VA under the VCCP [Veterans Community Care Program]. Today, there is reason to be concerned whether VA health care will be adequately funded because of the rapidly rising VCCP expenditures (driven in part by Medicare to VA cost shifting) and the impact of caring for an additional 740,000 enrollees who have entered the system in the past 2 years. This has created a $12 billion medical care budget shortfall for FY 2024. The substantial budgetary tumult that has resulted from these dynamics is adversely impacting the front lines of care delivery at individual VA facilities, leading to delays in hiring caregivers and impeding access to VA care and timely care delivery, as well as greatly straining the traditional roles of VA staff and clinicians trying to manage the challenging cross-system referral processes. The intertwined issues of Medicare to VA cost shifting and the rising costs of the VCCP present a challenging policy and programmatic conundrum.

The Alliance celebrates the Dole Act becoming law, protecting burial benefits for veteransNational Alliance for Care at Home, Alexandria, VA and Washington, DC; Press Release; 1/7/25 The National Alliance for Care at Home (the Alliance) issued the following statement in response to President Biden signing S. 141, the Senator Elizabeth Dole 21st Century Veterans Healthcare and Benefits Improvement Act, into law on Thursday, January 2. This landmark legislation includes Section 301, Gerald’s Law, which addresses a critical gap in benefits for Veterans. Gerald’s Law ensures that families of terminally-ill Veterans receiving Veterans Affairs (VA)-furnished hospice care—whether at home, in a nursing home, or in another non-VA setting—retain access to their full VA burial allowance. “We are deeply grateful for the bipartisan support of Gerald’s Law and its inclusion in the Dole Act,” said Dr. Steve Landers, CEO for the Alliance. “This legislation ensures that Veterans and their families can choose hospice care in the setting that best meets their needs without risking the loss of crucial burial benefits. We thank Senators Moran, Tester, and Hassan, Representatives Ciscomani, Bost, Brownley, and Takano, and many others for their leadership, as well as President Biden for signing this important bill into law.”

Bridgeport WWII vet who fought at Iwo Jima begins home hospice with 'no regrets' News 12 Connecticut; by Frank Recchia; 12/10/24 Stew Lahey, 98, of Bridgeport, says he's not a hero -- but his life experiences tell a different story. "I'm one of the last surviving veterans who fought at Iwo Jima during the Second World War," the proud great grandfather told News 12 Monday. "I joined the Marine Corps when I was 17. I didn't wait to enlist because it was 1943 and they needed me," Lahey said. The longtime Bridgeport resident began home hospice this week, surrounded by his family. "We love him so much and we are so proud of what he did for our country," said granddaughter Mikela Lahey. "When he began home hospice, ... we all started to cry -- but he didn't want that. He wants us to smile and be happy with him at the end," she said. "He keeps saying he has 'no regrets' -- and we are so grateful to have the chance to be here with him at the end," she said.

VFW makes another large donation to Hospice [of the Panhandle] The Morgan Messenger; by TMM Editor; 11/26/24 The VFW Post 4019 hosted a chili cookoff in November with $17,000 of proceeds going to Hospice of the Panhandle. “We greatly appreciate what you do for veterans,” said Commander Arthur Schur. 

Dole Act could give veterans greater access to hospice, palliative care Hospice News; by Jim Parker; 11/26/24 The Senator Elizabeth Dole 21st Century Veterans Healthcare and Benefits Improvement Act, currently winding its way through Congress, would likely increase access to hospice and palliative care for veterans, if enacted. The omnibus veterans’ benefits reform bill contains two provisions in particular that could influence hospice and palliative care utilization. First, it contains language from Gerald’s Law, as well as clauses that would allow veterans to use their benefits to enter PACE programs. The bill recently passed the U.S. House of Representatives and now will go to the Senate. A reasonable chance exists that the bill will be approved by both chambers this year, according to Madison Summers, manager of public affairs for the National Alliance for Care at Home. 

The Alliance applauds Gerald’s Law passing through Congress National Alliance for Care at Home (the Alliance; formerly NAHC and NHPCO); Press Release; 11/19/24 The National Alliance for Care at Home (the Alliance) celebrates the historic passage of H.R. 8371, the Senator Elizabeth Dole 21st Century Veterans Healthcare and Benefits Improvement Act in the U.S. House of Representatives last night with a bipartisan vote of 389-9. This landmark legislation includes Section 301, Gerald’s Law, which addresses a critical gap in benefits impacting seriously-ill veterans and their families receiving hospice care. The story of Gerald “Jerry” Elliott, a U.S. Army veteran, underscores the importance of this legislative achievement. Diagnosed with cancer, Jerry was admitted to his local Veterans Affairs (VA) hospital in 2019 before transitioning to VA hospice care at home to be surrounded by his family. After his passing, his family discovered they were ineligible for full burial and funeral financial support because Jerry died outside of a VA facility.

Hospice of the Panhandle veteran volunteers reflect on their service to veteran patients The Journal, journal-news.net, Martinsburg, WV; by Hospice of the Panhandle; 11/17/24 In recognition of Veterans Day, we asked our veteran volunteers at Hospice of the Panhandle to talk about why they perform this service for their fellow veterans. Hospice performs Veteran Recognition ceremonies to all veteran patients and families who wish to take part.  ... Leroy James — Being a Veteran who served during the Vietnam era, I can appreciate the importance of the work that Hospice does when recognizing a veteran’s service to our country. Several of the veterans who I have had the honor of recognizing served during the Vietnam War years. They were grateful that we took the time to show our appreciation when the country did not do so upon their return from serving overseas. [Click on the title's link to continue reading volunteers' stories.]

99-year-old World War II veteran in Sioux City attends Hospice of Siouxland Veterans Luncheon KTIV 4, Sioux City, IA; by Taylor Deckert; 11/12/24 Siouxland veterans were busy on Nov. 11 as many businesses and organizations celebrated their service to our country. Hospice of Siouxland hosted their luncheon the following day on Tuesday, Nov. 12. Each year, they host it around Veterans Day so these veterans can enjoy all the other events in the area. Veterans and their families were celebrated with a pinning ceremony by Veteran Volunteers with Hospice of Siouxland. “I enjoy them. I’ve been going to these for many years. ...” said WWII Veteran, Robert Irwin of Sioux City who got pinned on Tuesday. He continued, “There are only one or two of us left. I got drafted in 1943, sent me to Europe as a machine gunner. We got shot down, but, were able to make it back to England. We made the rest of our tour. From that, I came back and helped start the Air National Guard,” said Irwin. “I had my windshield shot out.” He also served in Korea as a pilot. “I spent 24 years in,” said Irwin.

Veterans guest house to open a hospice home: Serving veterans through their final journey ABC 8 KOLO, Reno, Nevada; by Rebecca Kitchen; 11/11/24 For the last 30 years, the Veterans Guest House has made a commitment to serve veterans and their families as they seek medical care in our area. And over those 30 years, the need has grown tremendously. In fact, the Guest House has regularly been at capacity this year. To accommodate the increased need, the Veterans Guest House has also expanded on the services it offers. ... Every day, veterans and their families are confronted with end-of-life decisions. Some, have the resources to live out those days in comfort. But others face those last moments with uncertainty. “So, our solution is providing a home so they can get the hospice care and the 24-hour care that they need when they can’t get that where they live,” said Froslie. The current home and mission remain the same. This is a second home that will offer a cost-free, private residence for veterans in their final days. It is not a medical facility. Veterans will enroll with a hospice provider of their choice, who will oversee their medical needs. 

After Hurricane Helene, the VA in Western NC is making sure that no veteran is left behind  Southern Living; by Abigail Wilt; 11/11/24The agency has contacted 100% of the high-risk veterans they identified before the storm—some visits requiring mile-long hikes up unstable mountainous terrain. As Western North Carolina continues to pick up the pieces on a long road to recovery following the devastation of Hurricane Helene, teams from the local VA are going above and beyond to care for veterans. ... That service extended deep into the mountains. Prior to the storm, the VA identified over 2,600 vulnerable veterans at highest risk, including patients going through chemo treatments and those with spinal cord injuries, mobility issues, and home oxygen needs. When the floodwaters hit, the Emergency Department never closed. Immediately following Helene, the VA began addressing the oxygen needs of 1200 vulnerable veterans, Young shared, and a task force was mobilized to perform wellness checks. But as many roads were washed out and phone and internet service inconsistent, these wellness checks often took the form of compassion on foot. “We contacted 100% of the high-risk veterans, either by phone or in person at their homes,” Young said. “Some visits required mile-long hikes up unstable mountainous terrain to reach veterans, including those determined to stay in their homes."

To calm and to commend: Veterans’ musical preferences anticipating end of lifeMilitary Medicine; by Beatrice J Krauss; 11/24Listening to music was the most prevalent of the 20 coping mechanisms for stress in this sample of 30 veterans. Musical preferences were stable across age groups. For calming, music at resting heartbeat rhythms was chosen. Music from early adulthood or from the timelessness of the classics was selected most often. Modern music with lyrics has themes of duty, affirmation, gratitude, and relief. The nearly universal soothing effects of lullabies were recognized. For music for honor ceremonies, desires were often independent of the military branch. Patriotic songs, or songs recognizing multiple service branches, or with themes of peace and affirmation were more often chosen than music from a particular service branch.Publisher's note: Anticipating Veteran's Day on Monday.

Specialized hospice care program honors and supports veterans facing terminal illness NBC 10 News - WSLS, Southwest and Centeral Virginia; by Kelly Marsh; updated 11/7/24 In Southwest Virginia, a quarter of people with a terminal illness is a veteran, a statistic that highlights the unique challenges many former service members face in their final days. In response to this, several specialized hospice programs in the region have been developed to offer care that specifically addresses the needs of veterans as they navigate the end-of-life journey. For many veterans, the experience of facing terminal illness is compounded by the physical and emotional toll of their military service, particularly conditions like Post-Traumatic Stress Disorder (PTSD), depression, and anxiety. ... The We Honor Veterans program, created through a partnership between the National Hospice and Palliative Care Organization and the U.S. Department of Veterans Affairs, encourages hospice centers to offer a heightened level of care for veterans. Across Southwest Virginia, multiple hospice programs have achieved the highest level of recognition—Level 5—demonstrating their commitment to providing veterans with the best possible care. One such program is based in Franklin County. Despite its size, Carilion Hospice in Franklin County has earned a five-star status for its exceptional veteran services ...Editor's note: We thank and recognize all hospice organizations that find meaningful ways to support and honor your veterans. Click here for more information about NHPCO/The Alliance for Care at Home's We Honor Veterans program.

How to celebrate veterans in hospice on Veterans Day 3HC, Goldsboro, NC; by 3HC; retrieved from the internet 10/31/24 Some served our country in foreign lands while others dutifully protected us on our home shores. All of them demonstrate commitment and courage, helping secure the rights and freedoms we so often take for granted. These brave men and women should be celebrated every day—not just on Veterans Day. ... Do you have a relative or loved one in hospice care who is a veteran? Read more to discover great ways to celebrate veterans in hospice on Veterans Day. ...