My first job out of nursing school in 1982 was at the Seattle VA Hospital. A neighbor reminded me of how the VA can be ahead of the curve. In the late 80’s they led the country in moving toward electronic medical records for example. But I digress as usual.
My neighbor’s elderly father is getting what is called “concurrent care” which allows him to use regular Medicare/Medicaid and VA Health Care simultaneously. This allows him to receive comfort focused hospice care in a Skilled Nursing Facility, without having to give up disease-focused treatment. His care is covered 100% between the two. She was shocked (and greatly relieved) to find out he had that coverage under his VA benefits.
I immediately thought about my father and my husband—both veterans. How is it I did not know about that? Well it only came about after the VA launched its “End-of-Life Care Initiative” in 2009. Read more about this here. This project led to expanded access to palliative and hospice care for those with late stage disease that chose continued disease-directed therapy as well.
I immediately thought about all the late stage cancer patients I used to see who were on the newer targeted therapies with a stage 4 diagnosis. These new drugs can “control” advanced disease for months or years. But by definition patients are not eligible for regular hospice while on active treatment. I was a palliative care nurse in the clinic where we did our best to keep on top of pain and symptoms, while offering social work and chaplaincy services in the clinic.
But it was not the same as hospice services in the home which are led by hospice physicians, pharmacists, bath aids, as well as social workers, chaplains and of course nurses who provide case management and navigation throughout the experience. Having hospice and providing active anti-tumor therapy was not a thing.
The other area where traditional hospice and disease-directed therapy have co-existed for awhile is pediatric patients with serious illnesses. Private insurance case managers have been innovators in this area for a long time.
An article in the Journal of the American Medical Association discussed the history of hospice billing and the increasing interest in finding a solution that encompasses 21st century medicine here .
If your loved one is a veteran, they could have benefits that may include concurrent care. Find the official VA fact sheet here.
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