Fox Valley Veterans Council
2015 Veterans Honor Home Task Force
A Vision for Our Veterans
Findings and Recommendations for
Veterans Care Including End-Of-Life
James Strong (MAJ, USA, Retired)
Fox Valley Veterans Council President and
Task Force Co-Chair
Dr. Tom Wiltzius, PhD
Task Force Co-Chair
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Preface
War is nothing new to our country. Veterans of America’s wars have existed from
the times of our Declaration of Independence, through today.
The wounds of war take some veterans during battle as they wear the uniform of
soldiers, sailors, marines and airmen. Yet other veterans pass away many years
after their uniform has long been retired.
We bury our war dead with dignity and flag-draped caskets as they return from
the battlefields. But, for those who linger with wounds, we do not pay the same
homage. Their caskets are still flag-draped, but their dignity has often been
eroded at life end.
The care these veterans are provided often diminishes their honor, not through
malevolence, but by failure to understand and address the unique character of
their service, their sacrifice, and the wounds they have born.
Do not cast me away when I am old; do not forsake me when my strength is
gone.
Psalm 71:9
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Background
After experiencing the demands of supporting WWII veteran, Lillian Wiltzius, over
the last several years of her life, Lillian’s son, Tom, approached Mike Thomas,
Outagamie County Supervisor, for his thoughts on how end-of-life services for
area veterans might be improved. Both Wiltzius and Thomas are veterans of the
Vietnam War who knew one another through a prior business association.
Their discussions led to a meeting with James Strong, retired Army Major and
President of the Fox Valley Veterans Council, to further discuss possible
shortcomings of services for veterans as they approached end-of-life. After
several meetings, including a meeting with Outagamie County Executive,
Thomas Nelson, and his staff, it was determined that a task force should be
established to study the end-of-life needs of veterans and their related issues.
The purpose of such a study would be to determine if there were sufficient,
unique and differentiated needs justifying recommendations for expanded
services and/or a dedicated facility to serve area veterans at end-of-life.
Our Task Force findings and recommendations in our report begin with several
composite stories. Names have been changed to ensure privacy.
Stories
In her widely acclaimed book, Peace at Last, Deborah Grassman shares
poignant stories of veterans she worked with as a hospice nurse. Each story was
a thread in a tapestry that portrayed a picture of hope and need for veterans
approaching the end of their lives.
Here in our region of northeastern Wisconsin, we have many similar but untold
stories of veterans who, approaching the end of their lives, have their own unmet
needs related to their military service. Their sacrifices, often heroic, go unnoticed
at a time they are most vulnerable.
World War II
Harold had just turned nineteen years old when he joined the Army early in World
War II. He had graduated from high school two years earlier and had been
working for the Conservation Corp in northern Wisconsin when the war broke
out. His ambition to become a dentist would have to wait, as would his new girl
friend.
Harold served in the Pacific Theater as a medic for nearly three years during the
war. His first aid training as a Boy Scout during high school had led to that
assignment. It was a dangerous job and an ugly one. Harold was on a Naval
troop ship headed to invade Japan when the war ended.
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Four months later, he was stepping off a train into a bitter cold January day in
Wisconsin, Harold headed directly to see the young woman who had waited for
him. A month later, they were married.
Harold never went on to college to become a dentist. He wanted to put the war
behind him, as did so many other veterans. He found work in a paper mill that his
uncle was working at and stayed there until his retirement thirty years later.
Today, Harold lives in an assisted living facility with his wife of nearly seventy
years. No one there knows his story or what his needs are beyond what his aging
body demands.
Just recently, Harold has become restless and agitated. A Vietnam veteran, who
volunteers at the facility that Harold now lives in met with him. As they began to
meet frequently, a trusted friendship formed and Harold began to open up about
his experiences as a medic in the South Pacific.
Harold had been assigned to a mobile field hospital at an airbase in the
Philippines where the dead and wounded were brought. The dead were
processed for burial, as were many of the wounded that did not survive long
enough to be sent to a hospital ship. Many who did survive had their wounds
treated at the hospital, but the disposal of medical waste was significant.
Harold had not only processed and buried bodies and body parts from the
hospital, he was often tasked to retrieve bodies and remnants from the planes
that would crash on take off or landing at the air strip. When Harold came home,
he buried that past. He never joined a veteran service organization, went to
parades, or spoke in any detail to his family about his experiences.
Like many of his veteran counterparts, the war was over and it was time get on
with life. However life was now coming to an end and the memories were coming
alive, and Harold needed to deal with them.
Harold had suffered no physical wounds, but had been deeply wounded with the
work and memories he suffered during the war. Who would be there to help him
at the end of his life?
Outagamie County and its surrounding counties are home to over 3,000 World
War II veterans. Not all these veterans saw combat like Harold, but some did and
all of them have stories to tell, and many have unresolved memories and feelings
that rob them of their joy and dignity during their final days and months.
Currently, most assisted living facilities and nursing homes are challenged to
consistently identify and address the needs of veterans like Harold. These local
and regional facilities provide excellent care for the general population, but are
often unaware of special needs that their veteran residents may have.
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Korean War
Bob graduated from high school with ambitions to become a police officer. There
was a new war going on and he came from a proud Irish immigrant family with a
tradition of military service. His father had been in World War I as a cavalryman
in France, one of his older sisters was in the Army Air Force in World War II, and
all of his brothers-in-law had served.
Bob enlisted with the goal of becoming a Military Police Officer. He went through
basic training and advanced training as an MP, and was shipped to Korea. Being
19 years old, being an MP, and living in a tent seemed like a dream come true!
Bob’s dream in Korea was short lived. Letters home took a turn from reflecting
excitement and eagerness, to ones that reflected frustration and a desire to come
home to start his career over. There was no evading the story in his case.
Bob had been driving a jeep with his commanding officer from one military site to
another when the jeep hit a land mine. Both Bob and his commander were
thrown through the windshield. Bob survived with significant lacerations to his
face and body. The windshield had become a shattered mess with the explosion,
peppering his face with shards of glass and killing his commander.
Through out his life, as the police officer he had hoped to be, Bob had small
pieces of glass occasionally work to the surface of his face, reminding him of a
day he would never be allowed to forget. Bob never found true peace as he
neared the end of his life.
As he lay weak in bed during his last months, Bob would have memories flood
his mind, and with them feelings of guilt. Why him and not me? Why didn’t I see
the mine? Why didn’t I have the windshield down? Could I have done something
different? Bob died at home, in hospice care, with his feelings unresolved.
Korean War Era veterans, those among us 75 years of age and older,
compromise 27.5% of the total general population of this age group in our area,
or 11,860 out of 43,188 according to 2013 statistics. Not all these aging veterans
served in Korea. Some served in both WWII and Korea, many did serve in Korea,
while some served in Europe and many served throughout the United States.
The Korean War is often referred to as the “forgotten war”. Our parades often
recognize those who fought and served in WWII and in Vietnam, Iraq and
Afghanistan, but somehow Korean veterans are, or often feel, they have been
overlooked.
In war, there are no unwounded soldiers. —José Narosky
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Vietnam War
Jerry graduated from high school with honors. He left for college the following
fall, but after one year he felt out of place. He had no specific career in mind, and
it seemed that most of his friends were forgoing college to enter military service,
some voluntarily and many through the draft that had been instituted.
Jerry left college in the spring and waited to be called by the Outagamie County
Draft Board. It didn’t take long. Within weeks, he was saying goodbye to his
family, girl friend, and the few friends who still remained behind.
In spite of high aptitude test scores in his military induction screening exams,
Jerry was slotted for training in the infantry. Within four months of entry, he was a
graduate of both Basic Training and Infantry Advanced Training. He had orders
to ship out to Vietnam. He did have two weeks of leave before he was to report to
Fort Lewis, Washington for departure.
His leave was anything but smooth. At home his family celebrated his training
accomplishments, as Jerry had graduated at the top of his advanced class. But
at the airports and in the community Jerry was treated with suspicion and
contempt. His short hair was a give-away;he was seen as, or was about to
become a baby killer. Jerry would miss his family at home, but he was sensing
his real family was made up of the other soldiers like himself. No political agenda,
just a commitment to duty.
Jerry left for Vietnam with feelings of relief and apprehension. He would be with
his brothers in arms, but he was going somewhere and getting into something he
had never experienced before.
Six months later, Jerry was on a medivac flight from an I Corps jungle in Vietnam
to a field hospital in Long Binh. Once stabilized, he was sent on to a general
military hospital in Japan. After several weeks in Japan, Jerry was flown to
Walter Reed Hospital in the US where he would spend the next twelve months.
Jerry had been shot in the abdomen. The bullet had fragmented, shredding a
number of organs and his intestines. Jerry would recover from most of his
wounds after multiple surgeries, but family and friends felt something of him
never really came home.
Jerry suffered from early onset Post Traumatic Stress Disorder (PTSD) all of his
remaining life. He grew to distrust the federal government and the Veterans
Administration system, although he actively attended PTSD meetings.
Jerry died alone, with failed marriages and a string of odd jobs behind him.
Unable to make lasting relationships, Jerry died as so many Vietnam combat
veterans do; he went into hiding and died alone.
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His mind and emotions were a jungle of confusion, protected by self-medication
and isolation. Jerry had killed over 20 men before being shot himself. The quiet,
likeable boy from Appleton, Wisconsin came to rest without coming to peace.
While our region does a lot to acknowledge veterans with parades on holidays,
older veterans with unresolved issues have a tendency to isolate themselves,
especially as they near their own end of life.
Most veterans in our area between 64 and 75 years of age represent the
Vietnam war era, and most of those veterans actually served in Vietnam. In
2013, there were 15,637 known veterans in this age cohort living in our region. In
Outagamie County, there are over 4,000 Vietnam era veterans. They represent
28.8% of the total veterans population in Outagamie and surrounding counties.
Iraq & Afghanistan
Joel joined the Wisconsin Army National Guard during his second year of
college. It was his plan to complete basic training during the summer between his
sophomore and junior years of college. He would continue with Army ROTC
training, and complete his officer basic training between his junior and senior
years, graduating from college and entering active military service with a six-year
commitment.
It was great on paper. It was a plan that would allow him to complete college debt
free, earn as he learned and provide a job with a guaranteed income upon
graduation. War knows few exceptions and Joel was not going to be one of them.
After he completed basic training, Joel started his junior year of college. His
grades were good and his basic training had gone well with Joel graduating in
the top 10 percent of his class. In mid-November the Wisconsin Army National
Guard transportation unit to which Joel had been assigned received a premobilization notice. In sixty days, they would be called to active duty in the new
conflict that was boiling in the Middle East.
Joel was now caught between two options: stay in school and watch his unit go
to duty without him, or leave school to stay with the unit and serve with his
uniformed friends. New as they were, those friends could be gone for a year
serving the needs of soldiers on the front lines, and then returning with their
stories. If Joel stayed in college he would lose any semblance of shared
experience. On the other hand, if Joel would stay in school he could complete his
junior year, and then complete office training before his unit returned.
Joel’s choice of deploying with his unit was the first of three deployments Joel
would face in the next seven years. His college schooling was delayed, as was
his entry into officer training. And it was between his second and third
deployments that Joel got married and started a family.
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For Joel, the first deployment was an adventure. His second deployment was an
inconvenience, and his third deployment was major challenge.
Joel’s education was solid, his military contributions were notable, but his career
path was in shambles and his family finances were in disarray. Further, the
drawn down of military forces toward the end of he wars left Joel with a bleak
future as an officer. Continuing in the military would mean the risk of more
deployments, time away from family, and an uncertain civilian career and
financial future.
Today, there are estimated to be nearly 20,000 Persian Gulf, Iraq and
Afghanistan War veterans in Outagamie and surrounding counties. The oldest of
these veterans may also have served in Vietnam, and of these veterans, many
are still in Army Reserve and National Guard units scattered throughout
Wisconsin.
During World War II, combat and combat support veterans averaged 40 battles
per year. During Vietnam, the number of skirmishes for these soldiers increased
to 240 per year. It is believed that combat and combat support soldiers serving in
Iraq and Afghanistan have been exposed to even more hostilities. The results are
telling.
After WWII, the Veterans Administration adjudicated nearly 10% of soldiers with
permanent disabilities. After the Korean War, the percentage increased to 25%.
After the Vietnam War, figures show that 50% of those who served have
permanent disabilities, with rating levels increasing by age. It is anticipated that
the percentage of veterans with a disability rating for soldiers who served during
the Persian Gulf, Iraq and Afghanistan Wars will reach 80%.
“Honor to the solider, and sailor everywhere, who bravely bears his county’s
cause. Honor to him … who braves for the common good the storms of Heaven
and the storms of battle.” —Abraham Lincoln
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Our Task Force Perspectives
The preceding stories are not unique. There are thousands more stories like
these from veterans throughout Outagamie County and our region.
These stories are representative and illustrate three conditions the Task Force
discovered that are related to veterans in our area:
First - Assessing and treating individual needs personalizes existing home- and
facility-based palliative and end-of-life care that the general population in our
area receives. We are blessed with exceptional end-of-life caregivers and
organizational leaders. However, even the best providers cannot develop and
offer services when the unique needs that veterans have are not known. Existing
support of veterans during serious illness and end-of-life is lacking in addressing
a comprehensive, consistent approach to the assessment and treatment of their
spiritual, emotional, mental and physical needs. Furthermore, most programs do
not consistently teach and retrain staff to optimally support veterans.
Second - The specialized care needs of veterans at end-of-life are significant
and the number of veterans requiring such unique services are growing.
Increased battlefield survival rates of injured veterans, unique concussive
disorders from improvised explosive devices, numerous and emerging physical
conditions due to exposure to known chemical agents such as Agent Orange in
Vietnam and unknown agents in the Gulf War, and, disruptive psychological
conditions, including but not limited to early and delayed onset PTSD, are all
going to put higher service demands on area end-of-life caregivers and
institutional leaders.
Third - Many veterans could benefit from the availability of a continuum of care
health, education, social services support, and residential living opportunities
across their life span. While this study started with a disciplined, narrow focus on
end-of-life care, it became apparent that the needs of most veterans at end-of-life
are immutably linked to their needs across their life span.
“As we express our gratitude, we must never forget that the highest appreciation
is not to utter words, but to live by them.” —John F. Kennedy
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Our Task Force Recommendations
The number of veterans in our immediate geography is significant. Outagamie
County alone boasts nearly 14,000 veterans, with four times that number when
we add neighboring counties. Because of differentiated needs between veterans
and the general population, several unique efforts are already underway to
support veterans.
Veterans Courts have been established to address the higher percentage of
veterans who have been incarcerated. Nationally and regionally, homeless
programs address the comparatively high percentage of veterans who are on the
streets. Yet health care is an altogether different matter.
The federal Department of Veteran Affairs (VA) has expanded the number of
Community Day Clinics and Regional Veterans Hospitals nationally to address
the daily health care needs of disabled veterans who are able to conform to the
requirements of day-to-day living, yet congress has restricted the number of VA
hospital beds for veterans who have long term needs, and has authorized no
beds for community needs of aging veterans. Additionally, many veterans who
are in greatest need do not trust the federal VA, often for good reason.
What happens to the veteran with special end-of-life needs who can no
longer address those needs independently?
Our area offers very good palliative and end-of-life care that addresses complex
healthcare for the general population. However, no place currently exists in our
communities for the veteran whose health is in rapid or non-reversible decline,
has unique care needs associated with his or her military service, or who could
benefit from association with other veterans. As good as local, home- and facilitybased end-of-life services are, it appears that these existing end-of-life services
may not fully address the optimal care our veterans need-- occasionally stripping
from them the dignity to which they are entitled.
Two More Stories
Vietnam
John is a veteran who returned from serving in Vietnam at the height of the war.
One day he was “in country” (Vietnam), and literally a day later, he was home.
He processed out of the Army in Oakland, California, and got on a plane to
Chicago where an old high school friend met him and drove him back to the Fox
Valley.
John seemed to readapt to civilian life quickly. He returned to college, graduated
with honors, got a job, married and began a family. All seemed normal, but
underneath, John had buried parts of his soul. He self-medicated with alcohol
frequently, and was given to bouts of self-doubt and private, angry outbursts.
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Over time, John received some counseling, which helped significantly. However,
as he neared retirement, John began to have renewed feelings of doubt and new
feelings of guilt. He wondered why others were killed or injured, why he was so
“lucky”, and why he had survived. Old memories began to surface.
John began experiencing delayed onset PTSD. Today he longs to be with others
like himself, but is reluctant at the same time. He may not realize that his desire
for the closure and resolution of his misplaced guilt is common among his peers.
Several studies by the task force indicated that veterans experiencing life
transitions prefer to be with other veterans for support and understanding. While
we found this to be the case at end-of-life, it is also the case for many veterans
experiencing life changes of any significance. Whether returning from
deployment, entering higher education for career training, retiring from
employment, and entering end-of-life, veterans prefer to be around other
veterans.
World War II
Lillian, with whom we started, had graduated from high school at 17 years old,
just before WWII broke out. She had quickly gotten a job with Bell Telephone as
a switchboard operator. As the war progressed and her friends and family were
directly affected, Lillian made her decision to join the Womens Army Air Corps.
Lillian was inducted into the WAACS from her hometown in New Jersey and sent
to Ft. Oglethorpe, Georgia for training. From there, she was stationed at Enid
Army Airbase in Oklahoma, where she worked as an aircraft dispatcher. Enid
was a training center for B-25 pilots. It was there that Lillian met her future
husband, Ralph.
Shortly after the war, Lillian and Ralph were married. After a decade living in
Marinette, Wisconsin, she and her husband and their young family moved to
Appleton to start a business. Over the years, Ralph became disabled and would
die at age 63, followed by their youngest daughter who was two months later by
a drunk driver. Lillian was left to care for herself at age 57.
With a small veteran survivor pension, she would manage well until she became
disabled, receiving her own small veterans pension and social security payment.
Lillian lived until she was 90 and one-half years of age. She claimed that the
highlight of her life in later years was her Old Glory Honor Flight when she was
86 year old. Her status as a veteran had come to mean everything to her.
At the time Lillian passed, there were 34 other veterans living in the facility that
she lived in. Some of these veterans were in post-surgery rehabilitation, some
were in assisted living, and others were in the skilled nursing portions of the
facility.
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While Lillian received excellent care, and was acknowledged by flags and
veteran status signs in her room, no effort by the staff or organization was ever
made to bring those 35 veterans together.
There is no blame suggested in acknowledging this missed fraternal opportunity,
only an indication of the lack of awareness of a common need expressed by
veterans. While only a small proportion of the general population nationally are
veterans, our region boasts a disproportionately large percentage of the
population who are veterans.
Today, one in four patients dying in skilled nursing facilities are veterans, yet
veterans make up less than 10% of the general population as a whole. Only 4%
of veterans die within the VA system (VA hospital or VA hospice), while 56 % of
veterans die while in non-VA facilities. Our area will experience a continued rise
of veterans dying in skilled nursing facilities.
Our Continued Recommendations
The following is a continuation of our Task Force recommendations drawn from
our discoveries and the stories we have offered. We have explored the needs,
challenges, options and resources for veterans at end-of-life. We have confirmed
that veterans have both similar and unique end-of-life needs compared to the
general population. We have confirmed that veterans prefer being with other
veterans as they receive services, especially at end-of-life. And unexpectedly, we
have found that veterans have related and unique needs across the life span.
Based on our research, we further recommend:
1. Community-based organizations providing palliative and end-of-life care
differentiate such care based on veteran status and related veteran needs.
Beyond celebrating holidays, we encourage these organizations to: offer
unique entry and progress processes, specialize veteran-based treatment
programs, and conduct specialized staff training in order to provide
specialized end-of-life palliative or hospice services. Needed
organizational services can include:
 Enrollment coordination with the VA and/or CVSO
 Veteran exclusive group events and regularly scheduled meetings
 Dedicated rooms and/or wings for veteran residency
 Specialized counseling for PTSD, TBI, MTS, and service related
depression
 Pre- and Post- death life celebrations with family and veterans
Summary: End-of-life care providers should modify current
admissions and support processes, policies, and practices to
accommodate the specific needs of veterans for both institutional
and home care.
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2. Professional and volunteer staff serving existing community organizations
that provide end-of-life care should be adequately trained to meet the
special needs of veterans. Such needs include but are not limited to:
 Initial and delayed PTSD
 Disorders stemming from agent orange
 Traumatic brain injury (TBI) and concussive disorders
 Relational and survivor depressions
 Gulf war syndrome (GWS) & burn pit respiratory disorders
 Atypical anxiety disorder
 Military sexual trauma (MST)
Summary: Staff training programs specifically aimed at the veteran
population need to be required, instituted and monitored.
3. Effort should be taken to address the misconceptions that abound about
end-of-life care and other services available through the Department of
Veterans Administration (VA) and Wisconsin Department of Veterans
Affairs (WDVA). While certain end-of-life services can be funded by the
VA and offered by certified providers, the VA does not offer direct-toveteran VA community-based services or facilities outside of current VA
facilities in Milwaukee and Waupaca. Further, most county veteran service
offices (CVSOs) are unable to proactively and collaboratively provide
information to veterans about end-of-life.
Summary: County veteran service offices should conduct direct mail
information initiatives to all veterans age 64 and older, informing them
of end-of-life options and resources through the VA, clearing up
misconceptions. Further, federal and state elected officials should
support collaborative efforts to expand information services to veterans
and their families.
4. A comprehensive and efficient residential model of independent and
assisted living should be designed and constructed to serve veterans and
veteran families, including veterans at end-of-life. Multiple models of
residential living facilities for veterans exist, and many exist independent
of the VA. Such facilities are segmented and range from independent
living, assisted living, skilled nursing, palliative and hospice-care
exclusively for veterans and/or veterans and their spouse. We did not find
a comprehensive facility for all veterans across the life span to exist in the
United States.
Summary: Our region can and should create and collaboratively support a
comprehensive independent and assisted living facility for veterans across
the life span, to include end-of-life veteran housing, whether by
repurposing an existing facility, or through new construction.
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Task Force Endorsed Opportunity
A Vision for Our Veterans
A Veterans Village with an Honor Home
“Let us be a community that asks no more of all veterans in need, including our
aging veterans but the opportunity to recognize them by preserving their dignity,
privacy, and legacy, especially in their final time.
Let us build a facility that is a home for veterans as they return from the
battlefields, or as they find themselves in need, as they are experiencing nonrecoverable health decline, and approach the end of their lives.
Let us construct a Veterans Village that provides homes for optimal living, for
educational opportunity, and for health care…one that is a model of compassion,
respect, quality, efficiency, inclusion and collaboration.
And let that facility we build be a locally controlled enterprise for all veterans,
including the aging and disabled veterans…a village that is self-sustaining, and is
a repository and archive of historical, locally significant military artifacts.
Finally, let us add to our Community Foundation, a fund meant to honor and
support veteran residents of this Veterans Village and Honor Home.”
Veterans Honor Home Task Force 2015
"Freedom is never more than one generation away from extinction. We didn't
pass it to our children in the bloodstream. It must be fought for, protected, and
handed on for them to do the same, or one day we will spend our sunset years
telling our children and our children's children what it was once like in the United
States where men were free."
—Ronald Reagan
Such an opportunity exists today.
The Outagamie County Housing Authority currently owns and rents residential
property that can be re-purposed and expanded to create a Veterans Village,
offering permanent and temporary housing for veterans across the life span,
including an end-of-life Veterans Honor Home.
Architects at Hoffman Planning, Design and Construction have dedicated
substantial pro-bono time to the design of this concept, as seen in attached
drawings.
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It is the view of this task force that such a concept should be actively pursued
collaboratively with area healthcare, human services, veteran services and
community organizations.
The Veterans Village concept allows for independent, transitional, and assisted
living apartments (homes) for veterans and their families across the life span.
The specific residential property that is being considered is located close to the
John H. Bradley Veterans Clinic and nearby to Fox Valley Technical College,
which hosts the largest population of student veterans in Wisconsin.
CONCEPTUAL ILLUSTRATION I
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CONCEPTUAL ILLUSTRATION II
CONCEPTUAL ILLUSTRATION III
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Task Force Members
Our task force, consisting of the following community members, assumed the
name of Veterans Honor Home Task Force. We developed and adopted
guidelines to ensure focus and direction. Our overarching objective was to
gather and evaluate information that would lead to any justified recommendations
that would serve the cause of veterans who were approaching end-of-life.
Our research led us to a much broader understanding of veteran needs, while
confirming the need for specialized end-of-life care for veterans. Members
included:
Jodi Braun – ThedaCare
Mark De Bruin* – Ex-Officio for Outagamie County Executive
Robert Keller* – JJ Keller & Associates
Amanda Krueger – American National Bank Fox Cities
Joe Mauthe - Housing Partnership of the Fox Cities
Daniel Lange – Veterans Administration
Jessy Lundin – Home Depot
Bob Pedersen – Goodwill NCW
Tanya Rabec – Outagamie County Supervisor
Jim Strong* – Fox Valley Veterans Council President
Mike Thomas* - Outagamie County Supervisor
Terry Timm* – Thrivent Financial
Tom Wiltzius* – enVision Performance Solutions
Anna Mallo – Task Force Recorder and Administrative Liaison
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*Veteran
(After some months, De Bruin and Rabec resigned due to personal health issues
and Lundin relocated due to employment.)
Local Contributors:
Steve Wille, Hoffman Planning Design and Construction
Jim Lincoln, Outagamie County Housing Authority
Kari Kuiper, Outagamie County Housing Authority
Lisa Schneider, Redevelopment Resources
ADDENDUM
Data Overview
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•
•
•
•
Outagamie County has nearly 14,000 residents with honorable military
service based on 2013 data
o Approximately 90% of these veterans are male and 10% are female.
o WWII Era
<1,000
o Korea
>1,000
o Vietnam
>4,000
o Persian Gulf
<3,000
o Iraq & Afghanistan
>1,000*
(* Does not include projected military RIFs in 2014 and 2015.)
There are 52,480 Veterans in Outagamie, Brown, Waupaca, Winnebago
and Calumet counties
22.6% of the veterans in this population are 75 years of age or older
(11,860)
o Veterans compromise 27.5% of the total population 75 years of age or
older (11,860/43,188=27.5%...many times the national average)
o Veterans between ages 64 through 75 years of age also represent a
significant portion the veteran population at 15,637 or approximately
28.8% of all veterans
o These veterans may have served in Vietnam and/or the first Persian
Gulf War and are likely to have even more significant end-of-life care
requirements than previous age cohorts
Veterans who have served multiple deployments in Iraq and Afghanistan
are already exhibiting unique physical and psychological needs that will
likely carry into end-of-life time frames for them
Veterans have health care needs across their life spans that are both
similar to and unique from the general population, including end-of-life.
Influences are:
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•
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o TBI and concussive disorders
o Agent orange disorders (type II diabetes, leukemia, ischemic heart
disorder, skin lesions and rashes, etc.)
o Initial or delayed PTSD and depression
o Respiratory dysfunctions (chemical, biological, particulate)
o Relationship disorders
o Military sexual trauma (MST)
o Gulf war syndrome
o Atypical anxiety disorder
Near end-of-life, veterans have an increasing desire to be near family,
remain in their community, and associate with other veterans
No local healthcare or skilled nursing facility specializes in uniquely
veterans care during non-recoverable health decline
The largest segments of the veteran population are just entering or are
nearing retirement age
According to information published by the Disabled American Veterans
(DAV), approximately ten percent of World War II veterans survived with
claimed and acknowledged disabilities by the federal Veterans
Administration (VA). It is currently estimated that nearly 50% of Vietnam
war veterans have acknowledged war related disabilities and that nearly
80% of veterans of the Iraq and Afghanistan Wars would claim and
receive war related disability acknowledgements from the VA.
•
The decline of battlefield mortalities due to quick and effective medical
care is a large reason for the increase in survival of war related injuries.
Another large reason for the increase in percentages of veterans
qualifying for disability has to do with the nature or causes of the
disabilities. Chemical defoliants such as agent orange and concussive
disorders from improvised explosive devices (IEDs) have led to significant
and disabling physical and psychological disorders.
•
While most of the war wounds that WWII veterans survived with were
obvious physically, a growing percentage of chemical, biological and
respiratory wounds are not obviously until decades elapse, according to
the DAV.
Nationally, veterans represent disproportionate percentages of life span
needs and care requirements compared to the general population.
The percentages of veterans adjudicated as disabled by the Veterans
Administration, according to the DAV*, have grown significantly by era:
•
•
WWII
Korea
Vietnam
Iraq/Afghanistan
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10%
25%
50%
80%
•
For combat veterans, there has been a significant increase in battle
exposure, leading to increased disability.
WWII
Vietnam
Iraq/Afghanistan
•
40 battles per year
240 battles per year
Undetermined, but likely high
In addition to physical disability, forms of posttraumatic stress disorder
(PTSD) are evident for both combat and non-combat veterans.
PTSD is defined in the DSM-IV and DSM-V:
o Exposure to a traumatic event experienced with fear, horror, or
helplessness
o Trauma consistently re-experienced
o Avoidance of associated trauma
PTSD can be evident as a veteran returns for deployment, decades after
deployment and return, or during the days or weeks before death. Among the
observable behaviors are:








Suspicion
Anxiety
Agitation/Anger
Estrangement
Unfulfilled longings (for life not lived)
Guilt (for killing, for not killing, for not being killed)
Shame (as above, and for not stopping killings)
Helplessness
PTSD, unresolved guilt, anger and/or hopelessness contribute to veterans being
more isolated, stoic, and hyper-vigilant thereby increasing the need for
specialized end-of-life services.
Resources
Publications from:
• US Department of Veterans Affairs
• Wisconsin Department of Veterans Affairs
• American Legion
• Disabled American Veterans
• Veterans of Foreign Wars
• Vietnam Veterans of America
• Peace at Last by Deborah Grassman
• The Hero within by Deborah Grassman
• Dreams Unfulfilled by Jan Scruggs
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Independent Research:
Sg2 – Palliative Care/Hospice//Strategy and Management//ThedaCare
Veterans Village Concepts:
• Outagamie County Housing Authority
• Hoffman Planning Design and Construction
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