People who have been in the armed forces can face extra challenges around accessing palliative and end of life care. They might experience mental health problems such as post-traumatic stress disorder (PTSD), financial hardship and isolation. A diagnosis of a life-limiting illness might trigger memories of previous trauma.
These factors can all affect the quality of life before death for veterans who have a palliative diagnosis.
Saint Catherine’s Hospice has been working with Veteran Aware to become significantly more aware of how to support patients with a military background.
The hospice was the first in the UK to sign the Armed Forces Covenant and achieve Bronze accreditation with Veteran Aware. A year later, they became the first hospice to gain Silver accreditation.
Outcomes
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Supporting patients and carers
Saint Catherine’s carried out a survey of staff and volunteers to identify who was a veteran, a reservist or related to a veteran/reservist. There were significantly more people with a military connection than the hospice expected.
From this survey they identified two Champions, who were trained by Veteran Aware to support patients
As part of the assessment process for new patients, everyone is now asked if they have a military connection. If they do, this is automatically flagged to the Champions, who can get in touch. The Champions are able to ‘speak the same language’, build relationships and signpost people to relevant support.
Supporting staff and volunteers
Saint Catherine’s recognises that veterans can have a range of transferrable skills that could be useful to a hospice. This might include management and leadership skills or practical skills such as maintenance, catering, or driving. Some might have trauma medicine experience (although not professionally registered for clinical practice).
However, it can be challenging for ex-services personnel and their family members to find work. Employers aren’t always understanding and supportive of mental health issues such as PTSD, for example, and veterans might need training so they can apply their skills in a new environment.
People who have been in a military family often have to move around a lot, which means partners/spouses of veterans might have gaps in their employment history. This also disadvantages them when applying for jobs.
To become more inclusive to people with military connections, the hospice:
created a staff web page with links to resources for veterans – such as support services and funding
advertises jobs on two military websites and includes a sentence to explain that they welcome applications from veterans
allocates an extra 10 days annual leave to anyone who is a reservist, enabling them to carry out their duties without losing pay
guarantees an interview for applicants who fulfil the requirements of a person specification for a role.
The hospice was the first to be accredited by Step into Health, which provides training opportunities in the NHS for people who are about to leave the armed forces. The hospice can provide volunteering opportunities, work placements or bank contracts for individuals who want to gain experience in the sector.
Facilitators, challenges and advice
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Key facilitators
The armed forces has a strong community that will rally support for veterans.
Saint Catherine’s was approached by the Royal Navy Benevolent Fund, who found out about their work via a magazine article. The fund now donates £500 to the hospice for every patient they care for with a Royal Navy or Royal Marine background. This then goes towards the care delivered to that patient and family, providing financial hardship support for veterans as needed.
Challenges
Saint Catherine’s covers a huge geographical footprint so it has been challenging to map all the veterans work and organisations in the area. It also takes time to reach out to them all to share what the hospice is doing, learn from each other and identify areas of potential partnership working.
Tips and advice
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Find out about your patients’ past. It might sometimes be the source of distress, and unresolved trauma could affect their current care needs.
Veterans who have dementia might still think they are in the military or have clear memories of their time in the military. They might find it helpful or comforting to talk to someone who understands their background. This can also be explored in reminiscence work.
It might be really important to veterans to have a military funeral, even if they have lost touch with their regiment. If you record someone’s service number, you will be able to contact their regiment, who will can help with this.
People with military backgrounds can use black humour as a way of talking about death, dying and traumatic experiences. This might seem shocking to some people. It can be really helpful for veterans to talk to someone who ‘speaks the same language.'
Future development
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Saint Catherine’s has continued to work with the national team at Veteran Aware and supports other hospices who are working towards accreditation.
The hospice plans to widen the scope of the project to include people who have worked in emergency/Blue Light services, many of whom will have experienced similar trauma to veterans.
