[Congressional Record Volume 147, Number 53 (Wednesday, April 25, 2001)]
[Senate]
[Pages S3914-S3915]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]
VA CONTINUES TO LEAD THE NATION IN END-OF-LIFE CARE
Mr. ROCKEFELLER. Mr. President, I am committed to focusing a
spotlight on the good work of the Department of Veterans Affairs, VA,
in the area of long-term care. VA has hidden its light under a barrel
for too long.
The federally funded VA health care system, out of necessity, has
developed some of the most innovative ways to care for older people.
The necessity arises because approximately 34 percent of the total
veteran population is 65 years or older, compared with approximately 13
percent of the general population. And by the year 2010, 42 percent of
the veteran population will be 65 years or older.
As a result of this demand, VA has led the nation in developing adult
day health care programs, standardized clinical treatment protocols and
specialized units for Alzheimer's patients, home-based services, and
respite care. Our older veterans are leading richer lives because of
these innovations.
Today, I wish to highlight the Alzheimer's unit at the Salem VA
hospital, which has received extraordinary praise from the son of a
veteran who was treated there for Alzheimer's.
I know firsthand how difficult it is to care for a loved one
afflicted by Alzheimer's. The special needs of Alzheimer's patients are
all too frequently misunderstood and therefore go unmet. It seems,
however, that the VA is up to the challenge. The family members of this
particular veteran found the care at the VA hospital to be first-rate,
humane and loving. By all accounts, the veteran suffering from
Alzheimer's was well cared for up until the very end.
To quote from the article, ``His daily needs were met by the staff
less from obligation or duty than from true, honest caring. His aimless
wandering was confined behind secured doors, without restraints, thank
goodness. Dad's sleepless nights and constant babbling were `normal'
there. The staff was unshaken by any of his peculiar behavior.''
The Salem VA Alzheimer's unit is not one of a kind, thankfully.
Approximately 56 VA hospitals have specialized programs for the care of
veterans with dementia. These programs include inpatient and outpatient
dementia diagnostic programs, behavior management programs, adapted
work therapy programs for patients with early to mid-stage dementia,
Alzheimer's special care units within VA nursing homes (like Salem's)
and transitional care units, and model inpatient palliative care
programs for patients with late stage dementia. There are also various
programs for family caregivers.
While VA has developed significant expertise in long-term care over
the past 20-plus years, it has not done so with any mandate to share
its learning with others, nor has it pushed its program development
beyond that which met the current needs at the time. For VA's expertise
to be of greatest use to others, it needs both to better capture what
it has done and to develop new learning that would be most applicable
to other health care entities.
Those who would benefit by capitalizing on VA's long-term care
expertise are the health organizations, including academic medicine and
research entities, with which VA is now connected, and the rest of the
U.S. health care system. Ultimately, this expertise can benefit all
Americans who will need some form of long-term care services.
As Ranking Member of the Committee on Veterans' Affairs, I am
enormously proud of VA's efforts in end-of-life care. However, I have
always been dismayed that my colleagues here in the Senate remain for
the most part unaware of VA's good work in this area. Those of us in
the health policy arena should sit up and take notice. We simply must
stay ahead of the curve and explore the various ways to provide such
care, so all Americans will have the best choices available to them at
the time they need them.
I ask consent that a Roanoke Times article on VA Alzheimer's care by
Wayne Slusher, son of a veteran cared for at the Salem VA hospital, be
printed in the Record along with a press release on VA's newest end-of-
life care program, a fellowship in palliative care.
The material follows:
[From the Roanoke (VA) Times, Apr. 1, 2001]
Succumbing to Alzheimer's--In the Hands of the VA, a Declining Father
Got Genuine Care
(By Wayne Slusher)
It started out seemingly innocent enough. Wrong turns on
familiar roads, daily tasks forgotten and numerous other
little things not so significant as to send up red flags, but
still enough that it registered in the back of the mind that
something was not quite right.
In the years following, it got worse. Faucets left on,
asking for dinner an hour after leaving the table, inability
to use the phone, failing to recognize home, and on and on.
It had happened,
``If anything ever happens to me,'' my father would say
time and time again, ``you take me to the VA.'' It was a
frequent topic, since Dad was a deacon in his church and
spent a great deal of time visiting with the sick and the
elderly members in the community.
You spend your whole life hearing it, but reject the idea
that you'll actually have to act on it, much less take him to
the Veterans Affairs Medical Center so far from his home.
Even well-intentioned friends asked, ``Why the VA?''
But then, it had happened, and we decided that going to the
VA for help was what he had always wanted. There was
something so intrinsically important about honoring his wish,
especially when he was at a point of mental incapacity such
that he could no longer contribute to decision-making even
about himself.
So, in the middle of the night, we took him to the
emergency room. As we sat in the waiting room, Dad thought he
was in a train station on his way to visit old Army buddies,
and he was deliriously happy. Instead, the visit was with a
doctor who quickly determined that admission to the hospital
was warranted.
We doubt Dad ever fully understood what transpired that
evening. Leaving him there was one of the most difficult
tasks any of us had ever had to do.
That would be the beginning of our relationship with the VA
and, in particular, the staff providing services for those
with various levels of dementia.
Right away, we learned that the building to which he was
assigned was filled not only with people just like himself,
but also employed a staff of extremely skilled health-care
professionals who began the difficult job of taking care of
my father.
His daily needs were not met by the staff less from
obligation or duty than from true, honest caring. His aimless
wandering was confined behind secured doors--without
restraints, thank goodness. Dad's sleepless nights and
constant babbling were ``normal'' there. The staff was
unshaken by any of his peculiar behaviors. The specially
designed area provided as much of a homelike atmosphere as
possible, with bright colors, hanging plants and murals on
walls. The unit was always clean, always tidy.
The initial few weeks were full of all sorts of cognitive
tests, blood tests and scans. As the results of each test
came in, they ruled out, one by one, any chemical imbalances
or other underlying culprit that might bring on his state of
confusion. If there was a remote
[[Page S3915]]
possibility, it was tested for. Indeed, the unthinkable had
happened. Only now it had an official name: Alzheimer's.
In the months that followed, we watched the VA staff do
everything it could for Dad: bathing, dressing, feeding,
changing and hundreds of other daily tasks. Different
medications were tried, and in different combinations and at
different dosages, but his dementia had a mind of its own,
for lack of a better term. What had worked yesterday didn't
work today.
Each visit, Dad would be brought out to the visitation
area--a bright, sunny room with lots of plants, park benches
and a garden scene painted on the walls by the gifted wife of
another patient. The staff was always as glad to see us as we
were to see them, and it was during those months that we
began to realize that Dad, for all those years, had been
absolutely right about where he needed to be if it ever
happened.
The doctors, physician assistants, nurses, social workers,
occupational therapists, dieticians and others associated
with dementia services became more like family. It was
medicine administered in equal portions from the head and
from the heart. As Dad's mental state skidded deeper into a
quagmire, not one member of the staff ever complained. They
looked out for us just as much as they looked after my
father. When it appeared at one point that he might be stable
enough to consider releasing him to a long-term-care
facility, we were dismayed to think he might not receive the
same level of care he'd been getting at the VA. These folks
had come to know my father's needs, and we trusted them fully
with his care.
But the stability was short-lived and all too soon
interrupted by more difficulties. In particular, he's lost
his ability to swallow. In those last days and hours, he was
made as comfortable as possible. Even into the wee hours of
that final morning, the staff kept almost as constant a vigil
by his side as did the family.
The VA, we found, is full of immensely compassionate,
caring professionals who could not have done more for my
father. We think, too, perhaps they do not get recognition
and praise from the community as often as they should.
With my father's personal nightmare over, the staff at the
VA continues to care for others just as they cared for him.
They deal daily with patients who have long forgotten how to
say thank you. The staff never really knew my ``real''
father, a man who would have been so humbled and grateful for
their help. We hope we said thank you enough on his behalf.
We will never forget their kindness.
____
Department of Veterans Affairs,
Office of Public Affairs Media Relations,
News Release, April 20, 2001.
VA Sponsors New Program for End-of-Life Care
Washington.--Dying is never easy--not for an individual,
not for a family, not for the medical staff who administer
the care. But the Department of Veterans Affairs (VA) is
taking new steps to ease the process for everyone.
An initiative, called ``VA Interprofessional Fellowship
Program in Palliative Care,'' will develop health-care
professionals with vision, knowledge and compassion to lead
end-of-life care into the 21st century. Although aimed at
improving care for veterans, the program will affect how this
care--known as ``palliative care'' in medical circles--is
provided throughout the country.
``As VA serves an increasingly higher percentage of older
and chronically ill veterans, the need for end-of-life care
similarly increases,'' said Dr. Stephanie H. Pincus, VA chief
officer for Academic Affiliations, a program that educates
more than 90,000 physicians, medical students, and associated
health professionals each year. ``This interdisciplinary
fellowship will jump-start palliative care as an important
field in health care. It will change the way physicians,
social workers, nurses and other caregivers approach patients
at an extremely difficult time in their lives.''
Historically, VA has taken a leadership role in the
promotion and development of hospice care and, more recently,
in a national pain management initiative. In 1998, VA's
Office of Academic Affiliations addressed the need for
clinicians trained in end-of-life care and was awarded a
$985,000 grant by the Robert Wood Johnson Foundation to
support further education. On March 1, 2001, the palliative
care fellowship program was announced and will involve up to
six sites, with four one-year fellowships provided at each
site.
``The training changes the focus of health-care providers
who are treating the terminally ill,'' said Pincus. ``In the
past, doctors saw death as a failure, so they consequently
focused on medical cures and preventing death at any cost. We
are training medical care staff now to concentrate on symptom
management rather than disease management.''
Pincus further explained that the new fellowship program
has a large educational component. Trained clinicians are
expected to serve as leaders promoting development and
research. Selected training sites will be required to develop
and implement an ``Education Dissemination Project'' to
spread information beyond the training site through
conferences, curricula for training programs, patient
education materials and clinical demonstration projects.
And, of course, as resident doctors go out into the
community, they take their training with them. More than 130
VA facilities have affiliations with 107 medical schools and
1,200 other schools across the country. More than half the
physicians practicing in the United States have received part
of their professional education in the VA health care system.
``This is an important step for health-care providers. But
what does this mean to the chronically ill veteran?'' said
Pincus. ``It means that he will be more comfortable. It means
he might not have to die in ICU but instead be able to remain
in the secure surroundings of his home. It means he will be
treated by a caring, trained partnership of doctors, nurses,
chaplains and social workers. It means his family will be
included in decision-making and care giving.
``There comes a time when all the modern medicine in the
world can't cure the illness. That's when treating the pain,
communicating with compassion and providing support and
counseling become paramount. And that's what these
fellowships are all about,'' said Pincus.
____________________