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Memorial Day is a day for remembering and honoring military personnel who died in the service of their country, particularly those who died in battle or as a result of wounds sustained in battle. Although those who died are also remembered on Veterans Day, this particular day was set aside to thank and honor all those who served honorably in the military, both in wartime and in peacetime. This issue of Home Healthcare Nurse focuses on thanking and honoring not only our veterans, but also the dedicated staff from the Department of Veterans Affairs' (VA) medical centers who provide and coordinate care given to veterans in the home setting.


The VA provides, either directly or through contract, intermittent primary care, telemonitoring services, and spinal cord injury care for veterans with chronic medical conditions who would otherwise require frequent home visits. Some home care services are not provided directly by the VA but are coordinated through community agencies. These coordinated services may include in-home hospice care, home infusion therapy and nursing, or aide and rehabilitation services from a traditional home health agency.


The VA has demonstrated success in maintaining the veteran's independence and quality of life, as well as exceptional management of chronic disease and prevention through its services provided to veterans in the home setting. The VA's Home-Based Primary Care program is unique as a model for meeting the needs of the veteran population. In contrast to other traditional home care programs that target patients with short-term needs and provide episodic, time-limited, and focused skilled services, the VA's Home-Based Primary Care program targets patients with complex chronic diseases and provides comprehensive longitudinal home care. Dayna Cooper and her colleagues discuss the uniqueness of the VA home care program model of care in the article "Home-Based Primary Care: The Care of the Veteran at Home." They also review the similarities and differences in relation to a typical home health agency.


Of the 25 million veterans currently alive, more than 600,000 die each year. In 2001, 25% of Americans who died were veterans. Hospice care is coordinated by the VA through community hospice providers or provided in a VA inpatient hospice unit. In the article "Wounded Warriors: Their Last Battle," Deborah Grassman discusses the importance of recognizing the significance of military history and its impact on end-of-life care. She also provides guidance for questioning veterans about their military history as a means for opening discussion and identifying its impact on end-of-life care. In the article "Post-traumatic Stress Disorder at the End of Life," Joy A. Laramie discusses how awareness of the types of veteran experience, including post-traumatic stress disorder (PTSD), helps hospice providers understand and effectively treat veterans' physical, emotional, and spiritual health at the end of life. Actually, PTSD issues may become more pronounced in the face of terminal illness and at the end of life, which is already a difficult period for patients and their families.


In 2006, the VA received the prestigious Innovations in American Government Award from Harvard's University's Kennedy School of Government for its advanced electronic health record and performance measurement system (United States Department of Veterans Affairs, 2006). Electronic medical records now store the documentation for the VA's 7.6 million enrolled patients, and the use of this record is discussed by Denise Shea in the article "Use of the Electronic Record in the Home-Based Primary Care Programs of the Department of Veterans Affairs Health Care System."


In a comprehensive study conducted by Harvard Medical School and published in the December 11, 2006 issue of the Archives of Internal Medicine, researchers assessed the quality of care for heart failure, acute myocardial infarction, and pneumonia in more than 4,000 U.S. hospitals. The study concludes that federal hospitals, including those run by the VA, provide the best care available anywhere for some of the most common life-threatening illnesses found, and that patients in federal facilities are more likely to receive high-quality care than those in for-profit hospitals (Landon et al., 2006). In addition, for the 7th straight year, the VA has received significantly higher marks than the private healthcare industry in a leading independent survey of customer satisfaction.The annual results from the American Customer Satisfaction Index (ACSI) showed that the overall satisfaction of patients for both in- and outpatient services increased last year at VA medical facilities. The VA significantly outscored the private sector in both categories: by 10 points for inpatient care and by 8 points for outpatient care (United States Department of Veterans Affairs, 2007).


These reports support my personal opinion concerning the high quality of care provided to the veteran from the VA staff in the home setting. I have personally made home visits and observed the wonderful care provided by many of the VA Home-Based Primary Care and Spinal Cord Injury Home Care program staff. They are truly a dedicated, highly professional, and competent group of physicians, nurse practitioners, nurses, rehabilitation staff, social workers, pharmacists, and dietitians whose mission it is to serve veterans and provide them the high quality of care they deserve.


Memorial Day is a good time to reflect on the sacrifices and services of the American soldiers and veterans and to honor our U.S. military men and women. It also is an opportunity to express the special place that veterans have in the hearts of American citizens and also to honor the people who work in the various branches of the military. We can never repay our debt to our veterans, nor shall we ever forget all that they have done!! It is with great honor that I say to them, "Thank you for serving our country."




Landon, B., Normand, S., Lessler, A., O'Malley, J., Schmaltz, S, Loeb, J., et al. (2006). Quality of care for the treatment of acute medical conditions in U.S. hospitals. Archives of Internal Medicine, 166, 2511-2517. [Context Link]


United States Department of Veterans Affairs (January, 2007). VA health care system outscores private sector again. Secretary Nicholson cites 7 years of success. Retrieved February 5, 2007 from [Context Link]


United States Department of Veterans Affairs (July, 2006). VA wins Harvard's prestigious innovations award. Retrieved February 5, 2007 from [Context Link]