Good afternoon, everyone. I’m delighted to be here to honor a few outstanding individuals and to thank you all for the work you do everyday, caring for Veterans in their last days.
It’s been a great honor for me to be part of the President’s team at VA. When Secretary Shinseki asked me to help him transform the Department, I saw a real opportunity to make a difference, and to support his tremendous drive for change and progress on behalf of our Nation’s Veterans.
Many of you know I am a Veteran of 26 years in the Navy, active and reserve. But you may not know that one of my principle reasons for leaving active duty was a call I got from my father when I was 28 …
People like you set the standard of care that helped my Dad through the end of his life and our family through that long good-bye. When I come to work each morning, I remind myself that today someone else is going through that experience. I’d like VA to be there for them.
So this is my reason for serving here. I know that many of your have stories about your choice to be here—to provide this “Indivisible Care” for Veterans.
Challenges and Uncertainties
I would share with you that our ability to render care is being challenged from many quarters. We are working in an unstable, even turbulent environment:
VA is facing some important challenges:
In order to meet these overarching challenges and make a difference in the lives of Veterans, we not only have to:
President Obama’s management agenda is clear—build a “high-performing government.” At VA, that means transforming our agency into a 21st century organization, and ensuring that we provide high-quality care and timely delivery of benefits to Veterans over their lifetime, from the day they take the oath of allegiance until the day they are laid to rest.
VA’s transformation can be defined in three sentences:
The President has demonstrated his commitment to VA transformation with strong budgets for 2010 and 2011 that boost VA’s discretionary funding almost 20 percent. These budgets provide us the resources required to increase Veteran access to benefits and services, reduce the backlog, and end Veteran homelessness within five years.
We Are Making Progress
These are just a few examples of the ways we are working to make VA more Veteran-centric, results-oriented, forward-looking, and advocacy-minded. Still a lot to do, but we’re picking up steam and gathering the momentum for a transformation push to last through 2012 and beyond.
Hospice and Palliative Care
Now to the transformation you and I are both personally invested in—
For some time now, the health-care community has been evolving its thinking about end-of-life care—moving away from a sharp division of labor between fighting the disease on one hand and comforting the dying on the other, toward a more integrated approach, combining curative or restorative care with palliative support from the early stages of illness.
As a major provider and purchaser of end-of-life care, VA has been evolving its thinking, too. Along with the change in thinking toward an integrated approach, we’re also seeing a generational shift in the Veterans needing care—from World War II and Korea Veterans, to Vietnam Veterans, who sometimes have different medical, emotional, and spiritual needs as well as different expectations of end-of-life care. As frontline care-givers, you adjust as needed at the bedside, but the change also requires an organizational response.
So we’ve partnered with community leaders in end-of-life care, including —
And we’ve planned and begun a three-year Comprehensive End-of-Life Care Initiative, or CELC, aimed at integrating palliative care across and beyond the VA health-care system. We’re about half-way through the initiative’s three years now, but we’re well on our way to achieving the goals set out for it.
We are more than half-way through the Five Phases of Organizational Change described by Quint Studer in his 2003 book Hardwiring Excellence:
So, where are we now with the CELC? Somewhere between the third and the fourth phases, between the Uncomfortable Gap and Consistency—still a few isolated points of resistance, but by and large the VISN’s are on board, and we’re making great progress.
For reasons beyond anyone’s control, it’s been held up for several months, but I am pleased to announce that the core of this new curriculum—minus the ethics module—has just been approved for use inside and outside VA. We will hold the first “train-the-trainer” sessions this September for some 250 VA staff members. By the end of next year, we expect to have every VA palliative care team—over 400 personnel—trained according to the new curriculum.
We have also just approved the Community Provider Awareness Campaign, which will use the new curriculum to train non-VA caregivers. Two out of three Veterans die at non-VA facilities. This campaign will help ensure that they receive better care at the end of life, tailored to their special needs as Veterans.
Of course, all this effort is only meaningful if it improves care for Veterans and their families. So as part of the initiative, we’ve begun surveying bereaved families on their perceptions of the care received. Thankfully, those surveys show the worth of what you’re doing:
We have also reviewed over 5,000 cases and found that Veterans who received palliative care consultations were —
The trend toward increased use of hospice care at the time of death continues, with most VISN’s reporting increases in the percentage of in-patient Veterans dying in hospice beds in the first quarter of FY 2010, compared to FY 2009. The overall total of in-patient Veterans ending their days in hospice beds was nearly 35% in the first quarter of 2010, compared with 28% in FY 2008 and 12% in FY 2004.
The results are clear: Veterans and their families often prefer hospice care at the end of life, and our Comprehensive End-of-Life Care Initiative is increasing VA’s success in honoring that preference.
We’re not exactly where we want to be yet. There are still some gaps in care that need to be closed, and some facilities that still need to be fully brought on board. We’ve got designated teams at every VAMC, but not all teams are at full strength. There’s also the need to make sure all teams are fully trained. Some training is already available to team members, free of charge, and, as I mentioned earlier, about 150 teams have already been trained. But the new Veteran-specific training curriculum will add substantially to the training efforts, filling in whatever gaps there are in existing training.
In sum, there’s still some work to be done, but we’re making great progress, and Veterans and their families appreciate it.
For all your work in bringing us this far, you have my sincere thanks and firm support. You are an example to the rest of VA of the transformation that’s needed. Let’s keep up the good work—caring for those who have “borne the battle” in the last battle of their lives.
Thank you for having me here today. I wish you all the best.