America’s veterans are rightly honored for their sacrificial military service, and in turn they deserve utmost respect as they face unique end-of-life challenges. But trauma, guilt, and other service-related factors may negatively impact veterans and their families when dealing with a life-limiting illness. 

Hospice staff and family caregivers can learn how to help their veteran loved ones cope. This Veterans Day, Heart to Heart Hospice highlights how the We Honor Veterans (WHV) program compassionately assists veteran hospice patients with terminal diagnoses.

Qualifying for Hospice Care

In the U.S., 25% of all deaths are veterans with more than 1,800 veterans dying each day. Only a minority is cared for by Veterans Affairs (VA) facilities at the end of life, with a majority (96%) dying in the community. Heart to Heart Hospice provides care for patients wherever they call home, including a private residence or care facility.

Many Heart to Heart Hospice locations are We Honor Veterans partners, trained and equipped to treat veterans with “respectful inquiry, compassionate listening, and grateful acknowledgment … and learn how to accompany and guide them through their life stories toward a more peaceful ending.” 

Veterans can qualify for VA- or Medicare-covered hospice when their doctors determine a life expectancy of six months or less and curative treatments are no longer working or desired. Comfort care, also called palliative care, continues in the home or a residential facility (such as a VA or private nursing home).


Trauma-Informed Hospice Care for Veterans

Heart to Heart Hospice uses a patient-centered, individualized approach to address the whole body, mind, and spirit. Beyond pain and symptom management, hospice utilizes nursing care, caregiver education and training, and support from spiritual care coordinators, social workers, aides, and volunteers. Bereavement care and end-of-life planning for funerals are also available to families.

Veterans require a unique intake and admission process, such as recording military history and learning of unique challenges related to deployments and conflict. Heart to Heart Hospice helps patients and families identify end-of-life goals. Assessments for veterans are tailored to 1) start conversations with sensitivity and 2) identify traumatic stress, depression, potential triggers, helplessness, or guilt from combat experiences. 

Often, emotional responses to trauma include anger, numbness, detachment/isolation, sadness, denial, helplessness, anxiety, and guilt (including survivors’ guilt). Delayed responses show up as irritability, hostility, mood swings, fear, shame, grief, and feelings of fragility. Trauma can manifest in numerous physical reactions like nausea, sweating or shivering, muscle tremors, elevated heartbeat or blood pressure, sleep disturbances/nightmares, appetite changes, alcohol/drug abuse, and more. Finally, trauma can result in extreme cognitive, behavioral, and existential reactions.

In response, WHV hospice staff is trained to properly respond to trauma disclosures and/or help patients seek additional resources if needed. Listening without judgment and guiding patients to properly work through trauma is vital in veteran care. Patient goals for addressing trauma include reducing potential triggers and shortening the length of traumatic response episodes by teaching stabilizing techniques. When treating physical symptoms like pain, the hospice team identifies how medications may cause emotional side effects and makes proper adjustments. 

A three-step approach is used to help veterans who experience PTSD (post-traumatic stress disorder): 

Stage I: Palliate immediate discomfort and provide social supports

Stage II: Enhance coping skills

Stage III: Treat specific trauma issues

Finally, military rituals are honored based on the patient’s requests and desires. This includes addressing the patient by their rank (sir, captain, etc.), pinning ceremonies, a military funeral and flag draping. Conversely, some veterans may prefer to avoid recognizing military service due to moral injury. 

About We Honor Veterans Partners

“We feel it’s an important part of our mission to learn how to serve veterans in challenges they may be facing from illness, isolation, or traumatic life experience,” said Robert Watson, Executive Director of HtoHH North Texas, which has one of the country’s largest veteran populations. 

“We invested in becoming a We Honor Veterans program to help us serve these men and women with the dignity, comfort, respect, and quality of life they deserve,” Watson added. “As part of the program, we provide flag presentations, pinning ceremonies, support of community events for Veterans including Memorial Day and Veterans Day, and a Vet-to-Vet volunteer program.” They also seek additional support from the Heart to Heart Hospice Foundation.

WHV offers five levels of partnerships, with certification building upon each previous level:

  • Level 1: Provide Veteran-centric education for staff and volunteers, and identify patients with military experience 
  • Level 2: Build organizational capacity to provide quality care for Veterans 
  • Level 3: Develop and strengthen relationships with VA medical centers and other Veteran organizations
  • Level 4: Increase access and improve quality of care for Veterans in the community
  • Level 5: Expand partnerships with other organizations in your community and other hospice providers to share knowledge and serve as a mentor

Heart to Heart Hospice Foundation and Veterans

The Heart to Heart Hospice Foundation provides additional levels of care and support, offering unique hospice and bereavement services to those who have served in the military, regardless of whether they’re a Heart to Heart Hospice patient. The foundation’s Veterans Care Program, along with the generous donors who fund it, provides for veterans with life-limiting conditions and nearing the end of life. This program includes, but is not limited to:

  • Emergency financial support
  • Critical unmet needs
  • Transportation
  • Wounded veteran support
  • Legal services
  • Counseling and other therapies
  • Legacy and honoring programs

Heart to Heart Hospice is committed to providing quality end-of-life care for hospice patients who are veterans, with dedicated training and experienced veteran-specific support. WHV is sponsored by the National Hospice and Palliative Care Organization (NHPCO) in collaboration with the Department of Veterans Affairs (VA).