Finding the Middle Ground: Bringing Palliative Care to Veterans


Giving Veterans with Serious Illness New Options for Staying Well and Independent

The Veterans Home of California-Yountville, the largest veterans’ home in the United States, has more than 1,000 aged or disabled veterans calling it home. One of its goals is to provide veterans with a living environment that protects their dignity and contributes to their feelings of self-reliance and self-worth.

One challenge has been helping those with advanced, chronic illnesses maintain that dignity and independence.

“We had been trying for years to be more forward-thinking about quality of life for vets coping with advanced chronic illnesses,” says Julie Fields, MD, MPH, Chief of the Ambulatory Care Clinic. “So when Collabria Care approached us to offer, free of charge, its Transitions palliative care program to our vets, we jumped at the opportunity.”

“The Veterans Home was once a hospital, complete with an ICU, so for many years, there has been what I call a more aggressive approach to treatment of serious, long-term chronic illness.  Our veterans are warriors—they have been trained to not back down quickly and of course, they want to remain independent at any cost—but what we are finding is that more aggressive treatment does not always equate to independence.  In the past, there hasn’t been a middle ground to meet them between aggressive work-ups/treatment and ‘giving-in’ and moving into skilled nursing care.”

“But adding palliative care allowed us to create that middle ground. It has reduced participating vets’ health complications, increased their comfort and given them more of a voice in the kind of care they want. It allows them to stay independent for as long as possible.”

 “While our initial goal was for Transitions to allow those with serious, advanced illness who wanted to continue to live independently to do so, we’ve found that palliative care also gives vets the opportunity to determine what ‘quality of life’ means to them in the face of illness. They now know what the options are and it allows them to face these possibilities and to make informed decisions for the future. They’re more comfortable with planning to ensure their needs and wishes are honored.”

“One of the operational benefits for the Veterans Home of bringing in “Transitions” was that we didn’t need to modify the existing care plan here to incorporate palliative care. Transitions Nurse Navigator Angela Kaufman worked with our doctors, nurses, social workers and section leaders to develop processes, creating more resources for staff and patients alike without adding another level of bureaucracy.”

“It’s allowed both our staff and our residents to think beyond treating illness to how to create the best quality of life possible.”

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