I had the honor and pleasure to provide case management services to veterans in both the Department of Defense and Department of Veterans Affairs (VA) health care systems for more than 25 years. I also had the distinct pleasure of being raised by a Coast Guard veteran that you may have met if you have attended National CMSA conferences over the past 10 years. I truly learned about patriotism and respect for our nation's finest citizens. I am quite fortunate to continue to spend time serving veterans in the community for the private care management company that I work for as well as an American Legion Auxiliary member and volunteer. When I was asked to write a column regarding the rewards and challenges of working with veterans, it was easy to say I would.

At the time that I retired from Federal Service in January 2019, I was the Geriatric Nurse Navigator in Geriatrics and Extended Care at the Richmond VA Medical Center (RICVAMC), which is part of the VA Mid-Atlantic Health Care Network. One of the biggest challenges for veterans and their caregivers is to navigate through a large and complex government-run health care system. As I was the first nurse navigator at my facility, I received many requests for assistance, not only from veterans and caregivers for our geriatric population but also from others needing help to navigate the system. I designed an intake form to help me assess what services were needed. Once I collected this information, I pointed the veteran or their family in the right direction. They were mostly very grateful for my assistance. I did have one caregiver who told me I offered too little too late as her veteran husband had died. I have learned to ask all my current clients if they are veterans or were married to a veteran so that I can educate them on all the services that are available to them. I also encourage veterans and their family members to apply for their benefits sooner than later.

Like the community at large, access to specific services can be challenging, especially in specialty care areas such as dermatology, gastroenterology, and psychological testing, specifically cognitive testing for our geriatric patients. I was fortunate that Geriatrics and Extended Care created a Geriatrics Evaluation and Management Clinic that allowed us to offer appointments to veterans who were experiencing cognitive, physical, social, and/or emotional decline. I was part of an interdisciplinary team that provided a complete assessment of all these areas. My role was to make sure that veterans and their caregivers received the services that they needed for the veterans to function at their highest level. To be successful in my role, I needed to not only learn the available services but also develop relationships with my colleagues throughout the VA. When a service was needed, I could easily reach out to someone by name and assist the veteran in getting what they needed whether it was an appointment, medication, or piece of equipment. I quickly learned that if veterans have other health insurance (OHI) or Medicare and need a hospital bed that while the VA could provide one, if needed immediately, going with their OHI would get the bed delivered quicker.

I love working with veterans, but they can be challenging as they have been trained to take care of themselves ... very independent and not ask for help even when it is needed ... they can be stubborn as mules! I tell them they remind me of my mother who was an engineer in the 1950s and then a high school math teacher. It was her way or the highway! I had one Korean War era veteran whom I was assigned to when I was working as a transitional care nurse. He lived alone and had multiple hospital admissions for congested heart failure (CHF). I went to see him as an inpatient to introduce myself and set up a home visit. He was grumpy and did not want to have anything to do with me. After several contacts with him, he finally agreed to a home visit. One important service that we provided to our transitional care patients was to review their medications and pill box. As I was comparing his medication list with what was in his pill box, I was alarmed to discover that he had both his old dose and current dose of digoxin in his pill box. He looked at me and said, "I could have died." I told him that maybe not die but it could have caused a rehospitalization and that is what we are trying to prevent. He was quite glad that he agreed to that initial visit. We developed a close relationship such that I continued to keep up with him when I moved to my new position. Even after I retired, I would visit him for his birthday (which was easy for me to remember as it was the same day as my grandmother's) and at Christmas. I was getting ready to call his daughter to arrange my Christmas visit in 2021 when she informed me that he had died. I was able to attend his funeral where he received full military honors.

One of the first clients that I followed in the community after I retired was a veteran who was diagnosed with Alzheimer's disease. He was very proud of his service. When he retired from the banking industry, he served for many years as a VA volunteer and member of his American Legion Post in Northern Virginia. After his cognitive health declined, he went to live in a memory care community where I began to visit him monthly to provide updates to his trustee. When I first met him, I was with his cousin, so he considered me family. When I would leave him from my early visits, he would ask that I give anyone at home his regards. Unfortunately, during the COVID-19 pandemic, he not only declined cognitively but also suffered a stroke. He eventually transitioned to a nursing home and hospice care. I attended his funeral when he died and was quite surprised to see he did not have a flag on his casket. When I mentioned this to his sister, she said that she had asked for one, but the funeral home required a copy of his discharge paperwork, which she did not have. I went home and called my dad who is active with the America Legion. He provided the phone number for my client's former American Legion Post. I called and spoke with the post Commander who said he would mail me a flag. I personally delivered the flag and letter from the Commander to his sister. Even though it was after his funeral, she was very grateful. I would not have known to do this if I had not worked at the VA. These veterans are just a couple of the many wonderful veterans I have served.

Although I did have to work within the VA parameters for a nurse, I found that in the VA setting, I was allowed to practice to the full extent of my RN license as a case manager. The VA also recognized not only my experience but also my education, certification, and professional membership/involvement by hiring and paying me at Nurse III salary. I was honored in 2018 to receive the RICVAMC's Department on Veteran's Affairs Secretary's Award for Excellence in Nursing in an Expanded Role. The professional benefits and recognition I received while working at the VA were awesome and I have continued to be blessed as I work in the community with veterans. Working with veterans has its challenges, but I believe the rewards far outweigh the challenges. I have not only met some incredible heroes but also built some long-lasting relationships.