[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.

                          ____________________