Understanding veterans’ challenges at the end of life

A quarter of Americans facing the end of life today are veterans, and they often experience specific challenges related to their military service. Delaware Hospice is emerging as a national leader in helping vets and their families with this difficult transition.

Military service, especially during wars, changes people; it often has lifelong effects. “Veterans have often gone through a traumatic experience when they were very young,” said Dr. Andrew Himelstein, medical director of Delaware Hospice. “It’s a sentinel experience at a very formative time in their growth.”

The effects of this life-changing experience often become more pronounced toward the end of life, said Himelstein.

“Veterans can sometimes be very stoic, and not communicate how much pain and discomfort they are having,” he said. A lifelong respect for authority may make them unwilling to complain about things, and they may not always communicate their needs.

Cindi Ann Smith of Seaford, Del., said that certainly holds true for her father, James Russo. The World War II veteran, who has lung cancer, is receiving hospice care.

“He never complains about pain, and definitely feels that any aspect of medication, or even glasses, are crutches,” said Smith. “He does everything in his power to not have a crutch,” said Smith.

‘Military checklist’ expands understanding

Knowing what questions to ask, and when to follow up even if a patient claims to be “fine,” is crucial. To care more effectively for veterans, who make up about 25 percent of the patients at Delaware Hospice, staff now ask patients to fill out a “military checklist” when entering into hospice care:

The checklist covers the basics, where patients served, when, and in which branch of the military, explained Susan Lloyd, president of Delaware Hospice. She said making staff more mindful of a patient’s military background can provide important clues.

“One of our nurses talked about the experience of watching a patient who she believed had physical pain,” recalled Lloyd. “As the nurse intervened with this gentleman, she started to understand that some of his body movements in the bed and what he was experiencing at night time really were related to how he reacted from a military experience.

“So no amount of medical intervention was going to help him until we identified the emotional pain he was in, and got the ability to talk that through,” she continued.

The hospice has received federal grants to educate its staff on veterans’ issues and to implement new strategies. It’s also the site for a pilot study on veterans and storytelling. The study explores whether telling and recording their stories can be helpful to veterans at the end of life.

Telling stories of service helps outlook

Smith said it has made a great difference in her father’s life. As he talked about his military service during World War II, she said, he re-evaluated his role.

“Dad had always said that he didn’t feel like he had given much to the war effort because he never saw combat, he didn’t carry a gun, that he was doing ‘just research’ and working in the aeronautical division,” Smith said. “But now, the more we talk to him and through this interview process, we realize his contribution was huge.”

Himelstein said veterans who participated in the story-telling project reported that it improved their quality of life as well as their general outlook.

“For some, it was a sense of making peace with the traumatic events that they had experienced, maybe some of the pain and suffering that is inflicted during the course of war,” Himelstein said. “I think that is a very important sense of closure they got.”

The Delaware Hospice staff members say what they are learning about issues affecting veterans at the end of life is important to their field. They say it will inform their work with younger generations of vets as they age.