Dying with dignity

As a social worker for Enloe Hospice, Tami Brown meets a lot of people who’ve led amazing lives. Among them are military veterans, a group that comprises around half of the hospice service’s patients.

Brown remembers one man in particular. He served in combat during the Korean War. Like many veterans, he did not brag about all he’d accomplished, but over the course of conversation, he shared many details. After a while he remarked: “Guess I really went through a lot, huh?”

Servicemen and -women do go through a lot. Not all their experiences and issues get resolved before they reach the end of their lives. They enter hospice with special needs.

That’s why Enloe has teamed with the National Hospice and Palliative Care Organization (NHPCO) and the U.S. Department of Veterans Affairs (VA) to become part of a program called We Honor Veterans. The program serves to educate hospice workers about specific circumstances surrounding veterans in order to improve the quality of care.

Enloe, in fact, has the only Butte County hospice service enrolled in We Honor Veterans.

Brown previously worked at the VA Clinic in Chico. Anna Marinelli, charge nurse for Enloe Hospice, said it was “very serendipitous” that Brown came to work for Enloe last spring just as the medical center ramped up its We Honor Veterans participation. Brown, meanwhile, didn’t realize how much of her previous experience would come into play until she began meeting patients.

“I knew that the VA utilized community hospices for veterans, but I didn’t know the extent I’d be involved,” Brown said. “Of course I love working with veterans, so I was very pleased, but it was pretty astonishing….

“I’m happy we’re able to serve so many. It’s really a privilege.”

Hospice care is designed to help people with terminal illnesses in the final months of their lives. Nurses and social workers help the patients find physical and emotional comfort, easing the transition for family members as well.

What the We Are Veterans program recognizes is a set of factors common to those who have served in the military.

“Specific to each war era or conflict, there are certain diseases that may be more common,” Marinelli said. “For example, at a time when they used the poison nitrogen mustard, there were certain side effects you might expect from a person [who served then] as he ages. That will make our staff more aware of things to look out for.

“And then there are psychosocial issues. It’s stressful enough to prepare to die without having a past history of being involved with wartime active duty and having gone through what they did. Bringing those issues into that process can be even more difficult.”

A major tool for We Honor Veterans hospice services is the Military History Checklist. This checklist helps hospice workers learn about a patient’s service in a sensitive way.

“A lot of times we find most veterans are so humble,” Brown said, “and unless you ask them specifically about their military service, it’s not brought up so often. The fact that we’re open about it and talking about it really opens a lot of doors, a lot of conversations and a great opportunity for healing.”

That’s particularly true for veterans who didn’t receive a heroic welcome home.

“I know a lot of Vietnam War veterans who came back and it was really difficult,” said Brown. “Some of them never heard a ‘thank you’ until the end of their life”—perhaps only from a hospice nurse.

As a result, much of Marinelli’s and Brown’s work with veterans includes connecting them with the VA. Veterans may learn they qualify for in-home help, pensions and a burial with honors. Additionally, they can get partnered with a veteran’s service officer.

“We have so many rural veterans up here, and helping them access benefits is a big piece,” Brown explained. “Many of the veterans aren’t really familiar with these resources. There also are veterans who really don’t want to have anything to do with the government until hospice comes around and they need a lot of help.

“In general, social services are not something that’s painted on a billboard. Unless you know who to talk to, someone who really knows all the resources, it’s really difficult to find all those pieces.”

Training through We Honor Veterans helps the entire Enloe Hospice staff learn about available resources. Since Enloe Hospice is affiliated with Enloe HomeCare Services, other in-home health-care providers will benefit, too.

Enloe joined the ranks of We Honor Veterans recruits in the fall of 2011. Last July, Enloe Hospice began using the Military History Checklist. Only then did Enloe realize around half of its hospice patients were veterans and others were the spouses or relatives of veterans.

“It’s been an eye-opener,” Marinelli said. “Before we did the military checklist, we really didn’t know how many veterans we were serving. After we starting looking at it and found that percentage of 50 percent, that really was an impetus to continue the process and go up through the different steps that are involved. …

“It’s a matter of commitment and making the time. It’s one more thing to do. We feel very strongly it is not only a service but a knowledge deficit on our part.”