Monday, November 29, 2010

Care only a veteran can give

When volunteer Gene Brayley recently visited Ralph Bishop in Niagara Hospice House, their nostalgic banter took them back 60 years to their military days in Washington, D.C.

They recalled everything from the slow, somber processions at Arlington National Cemetery to the auspicious inauguration of President Dwight D. Eisenhower.

"The Army led the parade because Eisenhower was in the Army," recalled Brayley, who played the saxophone in the Navy Band during the ceremony that day.

"That's right, we were in front with Eisenhower," boasted Bishop, an Army honor guard member who also marched.

They reminisced about the new president riding in a convertible on that cold, rainy day, and about a variety of other shared military experiences.

But there was one thing they didn't talk about: Bishop's stroke four years ago and its debilitating effects that brought him to the facility last year.

And that's the goal of their meetings. Reveling in highlights from his Army career keeps Bishop from thinking about his condition, as the two vets share "a different kind of camaraderie," said Brayley, 81, who served from 1947 to 1968.

Their weekly chats are part of a new initiative launched in September to ensure quality end-of-life services for veterans by revamping the hospice model of compassionate, pain-free care and death with dignity. The facility wants to infuse the care with methods specifically geared to veterans.

"We Honor Veterans," a nationwide project of the National Hospice and Palliative Care Organization and Department of Veterans Affairs, matches hospice facilities with local VAs, which train hospice employees to detect and tend to the unique conditions faced by veterans with advanced illnesses.

With the majority of veterans failing to utilize their VA health care benefits, the campaign also aims to bolster awareness of those benefits, especially the underutilized hospice care, which entitles veterans to free hospice care in various settings, including their homes.

The veteran-to-veteran visitations, in which hospice volunteers who are veterans visit patients who also are veterans, is a key component of the project. The pairings boost spirits and get veterans, characteristically mute about their service, to open up. That makes it easier to properly treat their anxiety and, in some cases, the guilt associated with taking a life and other combat-related demons that often surface around the time of death.

"I don't talk about my service; most servicemen don't," said Bishop, who served from 1951 to 1953 and worked in security for presidents Eisenhower and Truman. "But talking to [Brayley] about it is different because he understands."

Howard Bruning, Bishop's son-in-law, said Brayley's visits, which began last month, have had a dramatic effect on Bishop.

"The stroke left him withdrawn, but now I see him bouncing, happier and encouraged," Bruning said. "We're very thankful; it's been really good for him."

The Lockport hospice and other area hospices have teamed up with the VA Western New York Healthcare System to implement the project, which includes an aggressive effort to recruit new veterans to volunteer. They're also doing outreach to educate veterans and their families about the free hospice care and other benefits.

At Niagara Hospice, employees have been disbursed throughout the county, spreading the word through presentations at meetings of veterans' organizations.

Also, local hospice staff members -- from nurses to social workers -- have been traveling to the Bailey Avenue VA facility for workshops on pain and medication management, as well as training to recognize and treat common conditions faced by veterans, such as post-traumatic stress disorder.

"There are a lot of variables with vets that don't exist with the general hospice patient, and they weren't considered before but will be integrated into our services with this project," said Stacey Falkowski, Niagara Hospice's director of intake and provider relations.

Niagara Hospice kicked off its Niagara County program on Veterans Day with a special ceremony and informational session.

"We wouldn't be here enjoying the freedoms we have if it weren't for veterans," said John L. Lomeo, president and CEO of Niagara Hospice. "We've relied on the VA to do too much; and now they've reached out to us to help them reach vets. We're just in the infancy stages of giving vets the dignity and service they need and deserve."

Deborah Medakovich, the WNY VA's palliative care coordinator, is at the helm of the area's implementation efforts. She said the region's hospices are "committed to speaking to the uniqueness of the veteran population," and are at different stages of "assessing their current ability to serve veterans, accessing resources from the project to improve service and using best practices for continued improvements."

Area facilities are also revising their intake and medical forms, adding questions about military service to identify veterans upon admission, and organizing ongoing tributes, involving their families, to honor them.

Niagara Hospice plans to present its patients with handmade quilts, depicting their military careers, and has been surprising them with plaques from their military branches.

Hospice Buffalo has 115 patients who are veterans and for years has offered specific services for veterans, but will further enhance its program with the new initiative. For example, its VA nurse liaison will become more vigilant, and instead of only recognizing veterans' on Veterans Day with a pinning ceremony, special events will be held year-round, said Rose Collins, director of public relations for Hospice Buffalo.

"This new program will make anyone who provides care for veterans more sensitive to their needs, and know how best to care for them because they are different," she said.

With 680,000 veterans dying each year, the population is sizable and worthy of customized end-of-life services, said Jon Radulovic, vice president of communications for the national hospice organization.

"That's a quarter of all dying Americans, enough people who share that common trait for us to look more closely at their needs and find ways to address them," he said. Additionally, about 85 percent of veterans don't go to VA hospitals and only 4 percent of them die in those facilities.

"I run into vets every day who don't have a clue about the benefits they have earned, and that's why outreach is so critical," said Patrick Welch, a Vietnam veteran and director of Daemen College's Center for Veterans and Veterans Family Services. "Of the 24 million veterans, only 28 percent are taking advantage of VA health care. This collaboration with the community is something long overdue and will enable us to get the word out to vets and their families."

At Niagara Hospice, 39 veterans have so far been identified among its patients. Terminally ill Niagara County veterans who are patients at the VA in Buffalo also are being transfered to the Lockport facility, which aims to become the area's primary provider of hospice care for its veterans.

At their recent visit, Brayley presented a grateful Bishop with an Army plaque before igniting the long-standing, Army-Navy rivalry with the swapping of humorous barbs.

"Since you were in the so-called Army, you're gonna let a Navy man sit next to you?" Brayley asked, drawing his chair closer to Bishop's.

"Well yeah, you are bigger than I am," Bishop responded with a chuckle.

"As they say, the Army never got anywhere without the Navy," Brayley said, continuing with the teasing.

But after he left the room, Bishop said: "It's nice when he comes by; I look forward to it. You know, we were only joking with all that Army and Navy talk."