At VA, They’re Making Sure No Veteran Dies Alone
Patti Crimmin-Greenan, left, and Priscilla West have started a hospice volunteer program for veterans at the VA. (Valley News - Jennifer Hauck)
Hartford — Given a choice, Patti Crimmin-Greenan would prefer to stay behind the scenes. The 56-year-old resident of White River Junction who enrolled in nursing school when she was 29 is not entirely comfortable being interviewed by reporters or posing for photographers. But as the palliative care coordinator at the Veterans Affairs hospital in White River Junction, Crimmin-Greenan is at the center of a new hospice volunteer program that aims to provide an around-the-clock human presence for any veteran who comes to the VA at the end of his life to use one of two hospice suites at the hospital. And for that, Crimmin-Greenan said, she is willing to “come outside the box.”
Standing alongside Crimmin-Greenan in her efforts to provide human companionship to dying veterans is Patricia West, of New London. At 53, West is the executive director of the Veterans Research and Education Association of New England, a nonprofit organization that administers non-VA funding to support research and education in veterans hospitals. Ninety-five percent of the time, West said, she oversees grants that fund research for clinical trials in areas such as oncology or cardiology or testing new drugs.
“But the fun part, the 5 percent, is education,” West said. “That’s one of the things I’ve really wanted to try to build up.”
The result of this partnership is a volunteer program called No Veteran Dies Alone. A first group of 10 hospice volunteers will begin training for the job on Feb. 21, under the guidance of Crimmin-Greenan and Kristin Barnum, of Bayada Home Health Care in Norwich.
Crimmin-Greenan and West recently spoke with the Valley News about No Veteran Dies Alone. An edited transcript of that conversation follows.
Valley News: How did the two of you find one another to collaborate on this program?
Patti Crimmin-Greenan: A member of the palliative care team, the chaplain, I think, linked us up. I had received a check from a family that had used the hospice suite and it was to the palliative care team. Normally, monies that we get go into a general post fund and they are distributed widely for different things. I wanted this to be specific for palliative care. So I held on to it for a little bit until I heard about her group.
I opened an account there and that’s how I was able to get it started.
Priscilla West: Then we started talking. When she brought the check over we talked about the palliative care program and this grew out of those initial discussions.
Patti wanted for years to make this happen.
PC: I’ve been here 24 years and I’ve pretty much been in a circle all the way around the VA. I started as an associate degree nurse, then I received my bachelor’s degree in 1998 and then my master’s in 2007.
Each time I went to school, I ended up with a different type job when I came out. I was on the wards as a ward nurse for eight or 10 years, and after I got my bachelor’s degree I went into the ICU to work and I worked there for three to six years. I say three to six years because I took a break and went up to the OR.
I had worked the surgical floor, taking care of people post-operatively, but I had never been in the OR, so I wanted that experience as well. I did a period up in the OR for about three years and then I came back down to the ICU.
When you’re on the floor, you’re taking care of patients. They’re getting better. They’re going home. But occasionally they have problems, they have complications, and then end up getting whisked to the ICU. I had never been a part of that ICU experience until I went in there and it was really kind of disheartening.
The first week I was there, a lot of people were dying. They would go to the ICU but a lot of them didn’t come out of the ICU. I don’t want to make it sound like everybody died, but it was a lot more than I saw on the floor.
I started noticing the way people died, how some were alone or some were getting a lot of futile treatments.
This would have been 2004, 2005. All along, I’ve kind of been in the palliative care mode.
There was a palliative care committee here that used to meet once in a while to talk about patients that had end-of-life needs.
But that’s all we were, a committee. I used to receive eight hours a week to designate to seeing patients for end-of-life care and helping them transition. It wasn’t enough, but it’s what they gave me while I worked my other job in the ICU at the time.
Eventually, it became a transformational measure throughout the whole nation and every VA had to have a palliative care coordinator and a palliative care team. So eventually we got that here. I applied for the job and, obviously, I got in. I’m on my third year.
When I got into nursing, I always had a holistic view of treating the whole person. It’s not just about their disease. It’s about all of them and their families. I’ve always been that way and I think that’s where I was looking for my niche, finding a way that would best fulfill that. I think I rounded myself out pretty well to come to this point.
But I noticed that people don’t die well on the whole and that was one thing I wanted to make a difference in.
VN: How many patients on average will come through the hospice suite?
PC: I get an average of 150 palliative care consults a year. Not all of them end up dying here. Hopefully, a lot of them choose home if they can do that.
But occasionally they can’t. I have about four years of records and (each year) there have been about a dozen patients who do actually die alone. But just in the past six weeks, we’ve have had four patients who would have been eligible for this program.
It doesn’t mean they’re totally alone. Some have family, or caregivers, but there’s only one and that person gets burned out. So they need a break and this allows them to come and have the veteran stay here.
But one of our criteria for the hospice suite is that family have to be with them 24/7. So that’s the need. Someone has to be there 24/7 or a good chunk of that time because the nursing staff can’t always be in that room.
VN: So this is the need that the volunteers will fill?
PW: Exactly. This has been Patti’s dream. We build up this group of trained volunteers and they are able to fill in those holes where the family is not able to fill in.
PC: I don’t want people to think that we would turn any veteran away. They would just go into the general hospital population, which isn’t always good for other patients in the room to be with someone who’s dying.
So they would put the patient in a private room or a semi-private room if they can’t use the hospice suite.
VN: But then they’re even more alone.
VN: So what part has the Veterans Research and Education Association played in developing this program?
PW: Patti came to me about a year ago and we put in a grant to the Vermont Veterans Foundation. This is actually the foundation that is funded by (Vermont taxpayers). You know, if you’re a Vermont resident and on your Vermont state income taxes there’s a little check-off box to contribute a dollar to veterans activities? That’s the fund we’re using (to promote) this program. It doesn’t take a lot of money to get these things going. It was $4,000. But it has enabled us to advertise, to get some training materials together, to get the momentum going and get the project off the ground.
VN: How many volunteers do you hope to get?
PC: I would say as many as we can get. (Laughs.) It depends on the shift, but I was thinking initially of two- to four-hours shifts. But I’ll leave it up to (the volunteers) as to what they’re able to do. There may be some who want to do more. There may be some who want to do less.
But I think two to four hours is a good starting part. So that would be 12 people in a 24 hour period to cover 24/7. And people can’t volunteer every day, so we need a big pool to draw from.
VN: What will the training involve?
PC: The National Hospice Palliative Care Organization usually requires a 20-hour orientation.
Here, we’re doing a 10-hour class of about four weeks of classes on Thursday evenings and the rest will be self study. The class will involve some role playing, communication skills, what to expect when somebody is dying, reviewing physical signs, reviewing different stages of grief.
We’ll look at PTSD, because veterans are unique in this situation. Sometimes they haven’t dealt with it their whole lives, and at end of life some of this stuff might come out in forms of restlessness or agitation. Kristin Barnum of Bayada is co-facilitating the classes with me.
VN: How much time does a patient tend to stay in the hospice suite?
PC: The criteria for being in the hospice suite is that death is imminent within two weeks. Most stay 24 to 72 hours. We don’t have many that stay the whole two weeks.
VN: What will the volunteers actually be doing with the patient?
PC: Hand holding, listening if there are stories the veteran wants to reminisce about. Reading to them, play music. Just being a reassuring presence.
VN: The first volunteer training session begins on Feb. 21. When do you hope to have volunteers active in the hospice suite?
PC: March 15. The 14th is the end of that first class of volunteers.
PW: And there will be more training sessions offered after that as well. If somebody doesn’t make it for the first class, they can still call and sign up for the program.
VN: Why is this so important to you, Patti?
PC: It’s just not fair to the veteran. Nobody should die alone. I really believe that. We have the hospice suite and I feel it should be used by everybody.
Editor’s note: Those interested in volunteering for the No Veteran Dies Alone program should contact Patti Crimmin-Greenan at 802-295-9363, ext 5226. Diane Taylor can be reached at 603-727-3221 or firstname.lastname@example.org.