A Veteran is someone who is currently serving, ex-serving or deceased, or reserve personnel both with and without operational experience in the Australian Defence Force (ADF). Veterans are diverse, with different roles and experiences. The veteran community includes partners and children of veterans, war widows and widowers, and carers of veterans. Transitioning from military to civilian life is an important and sensitive stage for veterans and can negatively impact a veterans’ sense of identity and belonging, and may lead to psychological distress. Veterans often have a different experience of ageing and unique health-related needs compared to the broader community, due to their service experience. Older adults who have served in the ADF report similar rates of chronic disease to the non-serving population, but have higher rates of mental and behavioural problems and arthritis. Many veterans find ageing challenging due to pain, injuries, chronic health issues, or psychological concerns. Veterans are more likely than the general population to experience homelessness. There are often specific considerations when providing aged care and palliative care to veterans. Click for more information about the health services available to the veteran community.
The Australian Department of Defence is responsible for the health care (including primary, dental, mental health, rehabilitation, hospital, specialist services and suicide prevention) of currently serving ADF members until their transition to civilian life. As civilians, veterans can access health care services under Medicare, state and territory government health arrangements, the private sector, or those administered by the Department of Veterans Affairs (DVA) if eligible. DVA funds a range of payments and services including pensions, compensations and income support, as well as many health services. According to the AIHW, at June 2017, more than 201,000 Australians aged 65 and over were receiving a DVA pension (including service, disability and war widow pensions). Older Australians made up almost 70% of all DVA pension recipients, with 19% of all clients aged 90 and over.
Aged care considerations for veterans
Due to wartime experiences and often complex medical issues, veterans may have special needs and often require high levels of support in old age. The Department of Health and Aged Care, and the DVA both offer aged care services to older Australians. There are differences between the services provided by each. The Department of Health and Aged Care's aged and community care services are available to all Australians and represent the full range of aged and community care services, from entry level assistance or low care, such as the Commonwealth Home Support Program (CHSP), to more comprehensive packaged home care, including Home Care Packages. CHSP is one of the main community-based programs providing support for older people to continue living independently in their homes. At 30 June 2017, the CHSP supported just under 24,000 DVA clients.
DVA provides information for veterans navigating aged care. Veterans can receive both DVA services and mainstream services at the same time, as long as services are not duplicated. An information sheet for aged care services for the senior veteran community is available. For people who cannot remain living independently at home, permanent or respite based residential aged care provides a higher level of support. At 30 June 2017, just over 26,000 DVA clients were in residential aged care, representing around 15% of all residential aged care clients. The majority of DVA’s aged care clients are WWII veterans and their partners, aged into their 80s and 90s, and requiring increasing and more intense aged care services. Since 2008, there has been a slow decline in the number of DVA clients in government funded residential aged care. It is expected that veteran numbers will decrease, but their levels of dependency in terms of high and complex care needs will continue to increase.
Both DVA and Department of Human Services (DHS) conduct aged care income and assets assessments to determine the subsidy the Commonwealth Government pays to aged care providers on veterans’ behalf (if they are eligible for government assistance) and whether a contribution towards aged care costs is required. All residents, including veterans and war widows and widowers, are required to contribute towards residential aged care costs based on their income and assets. Click here for more information on residential aged care eligibility and assessments, and financial supplements, or use the Residential Aged Care Fee Estimator. Residential aged care payments are set out in a Resident Agreement with aged care providers. There are special financial arrangements for former Prisoners of War (POW) and Victoria Cross (VC) recipients. Veterans are eligible for a DVA Health Card, similar to a Medicare card. Cards are assigned according to situation, and may be for all conditions, for specific conditions, or for pharmaceuticals only.
Residential facilities can also arrange for volunteers to visit residents who may not have regular contact with family or friends through the Community Visitor Scheme (CVS). Contact the CVS Network Member in your state or territory, or visit Social Support and Activities for more information. Representatives from ex-service organisations (ESOs) may be able to visit residents in residential aged care facilities if desired.
My Aged Care has further information on their website, and can be reached on 1800 200 422 to discuss assessments by an Aged Care Assessment Team (ACAT). ACAT can also assess eligibility for planned or emergency residential respite care, or Home Care Packages.
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Veterans living in government funded residential aged care facilities, who have service-related mental health conditions accepted by the DVA (including post-traumatic stress disorder, depression, anxiety or substance misuse disorders) may be eligible for the Veterans’ Supplement. The supplement is extra funding paid directly to residential aged care facilities to provide care appropriate to veterans’ circumstances. The DVA has an online self assessment tool to give veterans an idea of what benefits they may be eligible for. Click to learn more about the Veterans’ Supplement, Veterans’ Supplement in Home Care, and to view current rates of Veterans’ Supplement. For more information about veteran specific services, contact the DVA on 13 32 54 or 1800 555 254 from non-metropolitan areas, or email DVAagedcare@DVA.gov.au. For enquiries about the Veterans' Supplement in residential aged care, email firstname.lastname@example.org.
Veterans Home Care (VHC) can help eligible veterans and war widows and widowers to remain living in their homes and communities via home care options. Eligible veterans and war widows and widowers can receive a free VHC assessment to determine if they are eligible for a small amount of practical help, to maintain health, well-being, and independence. To receive an assessment for VHC services and learn more about associated costs, call the Veterans' Home Care Assessment Agency (1300 550 450). Home care can include domestic assistance, personal care, safety-related home and garden maintenance, and respite care. VHC also offes in-home respite care and carer support, residential respite, and emergency Short-Term Home Relief (ESTHR). Click to view the website on the Coordinated Veterans' Care (CVC) Program.
In 2016–2017, the VHC supported just under 50,000 veterans. Most common services provided included domestic assistance (89%) and home and garden services (34%). This video highlights one veteran’s experience with home-based aged care. Programs may also assist DVA carers in recognition of the role they play in the veteran community.
DVA Community Nursing can assist those with high level needs, or specific medical or medication management requirements. These services can include clinical nursing care, personal care and palliative care services to eligible veterans and war widows and widowers. Services can help with medication, wound care, hygiene, showering or dressing, to restore or maintain health and independence at home, and avoid early admittance to hospital or residential aged care. In 2016–2017, around 19,000 people received community nursing services, with almost all clients receiving clinical care. Health professionals and VHC assessment agencies can make referrals for assessments to receive such services. Only calls from landlines can be connected to assessment agencies.
Convalescent and Short-term Restorative Care
Convalescent care (for short periods of non-acute care) may also help eligible veterans and war widows and widowers recover from illnesses or operations immediately following acute hospital admissions. Care can be provided in public or private hospitals, residential aged care facilities, or other suitable facilities, but cannot be provided in the home.
Short-term Restorative Care (STRC) provides a range of care and services for up to eight weeks, to improve veterans’ well-being and independence, and delay or avoid entering long-term care.
Rehabilitation Appliances Program and CVC Social Assistance
Gold or White Card holders can access rehabilitation aids through the Rehabilitation Appliances Program (RAP) to help minimise the impact of disabilities, maximise independence, and enhance quality of life when undertaking daily activities at home. General Practitioners (GPs) can provide necessary referrals to allied health professionals, who can determine veterans’ clinical need for aids and appliances.
Eligible veterans can receive a one-off short-term (generally up to 12 weeks) intensive Social Assistance service to support them to participate in community activities (including groups, local clubs and associations) and benefit from social inclusion. GPs can refer eligible veterans to a VHC Assessment Agency for an assessment. Click to find out more about eligibility for CVC Social Assistance.
Further information, resources, and support
Open Arms - Veterans and Families Counselling (previously the Veterans and Veterans Families Counselling Service (VVCS)) is a free, professional and confidential nationwide 24/7 counselling and crisis support service for current and ex-serving ADF members and their families. Local calls to 1800 011 046 are free, while calls from mobiles or pay phones may incur charges. AT-Ease is the Australian Government’s health and well-being portal providing mental health resources for veterans and their families. Veterans 360 (V360) Australia is a charity conducting outreach, raising awareness and providing ongoing support specifically for homeless veterans throughout Australia. The Partners of Veterans Association of Australia Inc. (PVA Australia Inc.) is a voluntary organisation supporting veterans and their families with a 24/7 National Helpline (1300 553 835). Calls from landlines attract local call costs, and may be helpful for those living in rural and remote areas. Phoenix Australia has training programs for practitioners to help people who have experienced trauma by providing practical, effective support and treatment strategies to aid recovery. PTSD Coach Australia is a free smart phone app for those with PTSD or post-traumatic stress symptoms. The International Society for Traumatic Stress Studies (ISTSS) website hosts various trauma assessment tools. Veteran-centred care models are useful for health professionals to understand the complex factors that influence veterans’ health and welfare. RACGP’s gplearning system provides a 1-hour eLearning program to help GPs better understand common veteran mental health conditions due to prior military service. The program is free to RACGP members with a current login and provides information about referral pathways. Transition tips for medical practitioners can assist health providers when working with veterans’ medical records, health cards, and DVA health benefits. Veterans are encouraged to check if selected GPs and specialists accept DVA Health Card arrangements prior to consultations. The Veterans' Medicines Advice and Therapeutics Education Services (Veterans' MATES) has developed a project to improve the use of medicines and health services among veterans. healthdirect, the Australian Government’s online health service finder, is a useful tool to help find different service providers in your area. The DVA website has detailed instructions on how to use this search engine.
Palliative care and advance care planning considerations for veterans
Impact of prior experiences
Aspects of care are different for veterans compared to non-veteran populations. The Department of Health and Aged Care has released an exploratory analysis of barriers to palliative care and advance care planning report on veterans, which contains approaches for improving access and quality of care for this group. Veterans’ earlier life experiences of service and associated trauma or health concerns can present unique needs at the end of life, and add different dimensions to the support they need. Each veteran will have different end-of-life needs, based on factors like age during service, service branch and rank, experiences with PTSD, experiences as a prisoner of war, and involvement in combat or noncombat situations and the particular conflict they were involved in.
Many have not told their stories, as the defence force values strength, perseverance, and courage in the face of difficulty or pain. Veterans may associate admitting or sharing weakness with stigma and many find accepting treatment or help at the end of life especially difficult. Earlier physical or psychological trauma, illnesses, pain, and other challenges may reappear towards the end of life. Veterans may require increased support at this time. They may have experienced traumatic or survivor grief due to the loss of friends and colleagues. Veterans with experience of substance abuse may have unique concerns about using medications (e.g. prescription opiates) due to their similarities to drugs which may have been abused.
There are differences between military experiences and structures, and end of life care, with the military defined by hierarchical organisation, stoicism, downplaying suffering, and following orders. In contrast, end of life care encourages self-determination and choice, connection with others, life review and reminiscing, and openly grieving. Towards the end of life, veterans who have endured PTSD may feel the need to be in control or avoid reminiscing due to possible triggers, may prefer predictability and privacy, may be isolated and keep trauma from family, and may have difficulties with authority figures. Communication must be calming and reassuring so as not to retraumatise veterans.
Importance of person centred relationships and reflection
Conversations must be open to understand and document veterans’ needs and preferences. Palliative care must be high quality and tailored to the unique needs of each veteran and their family. End-of-life goals should include addressing PTSD symptoms if applicable. Many veterans lack close relationships with family and friends and may feel socially isolated or unsupported at the end of life. Encourage people to reconnect with loved ones and friends if they desire to, as this may be a source of support and comfort.
Towards the end of life, reflection is natural. Veterans with experiences of active combat or violence may experience anger, frustration, fear, anxiety, and question the purpose of life. Veterans from religious backgrounds may have specific concerns around death, and may be concerned with an afterlife, acceptance and forgiveness. Many veterans experience mixed emotions, including sacrifice, pride, pain, suffering, grief and loss.
Alternatively, some veterans may feel comfortable with notions of death and dying, due to their prior experiences. This may make them more likely to be open to discussions around planning for the end of life.
Considerations when working with veterans
There are unique considerations for health professionals and care workers who support veterans towards the end of life. Some general suggestions include:
- recognise and acknowledge veterans’ prior service when you speak with them
- extend appreciation to their families and carers in your workplace interactions
- take time to create trusting relationships and safe environments for veterans in your care
- respectfully inquire about their time in service and encourage the sharing of experiences and emotions, which may include guilt and anger
- listen to veterans’ stories in an empathetic, supportive, and non-judgemental way
- validate veteran’s feelings and concerns when they share them with you
- consider the impact of PTSD and other psychological issues on veterans in older age and towards the end of life. Recognise that PTSD is commonly stigmatised, which may lead to veterans feeling reluctant to disclose this information.
- arrange counselling for physical or psychological trauma where possible
- understand veteran benefits and funding schemes, so you can best support veterans in your care
- support families and carers with professional support, education and guidance
- encourage connection with veteran volunteers, to help veterans feel more connected and less alone
- appreciate that many veterans may question their faith or spirituality, and may have particular concerns around forgiveness and acceptance towards the end of life. Encourage spiritual exploration and counselling with appropriate individuals, journaling as a reflection practice, and link veterans to spiritual support if desired.
- encourage relaxation through music, art, meditation and other strategies
- train staff about veterans’ special needs, so they can respond appropriately
The palliAGED website provides information to plan for and provide appropriate palliative care to veterans in the community. Grieflink provides information about the grief associated with military service.