Scott T. Shreve, DO
National Director of Hospice and Palliative Care, The Department of Veteran Affairs; Clinical Associate Professor, Penn State College of Medicine, PA.
Who has most influenced your work and what impact has he or she had?
“Would you help us build a hospice program here at Lebanon?” “There’s no funding for the program but the Chief of Staff says we can go ahead”.
Many years ago as a newly minted geriatrician, I got the offer of a lifetime. I just didn’t know it at the time. The hospice “unit” was a few beds at the end of a ward. Not a very pretty ward either. The Nurse Manager and Chaplain recruiting me for the job shared “none of the other docs want to do it”. How could I resist such an offer? I couldn’t. This nurse manager knew (and demanded) her team provide outstanding care for the Veterans on her unit, as a place of dignity that would leave a legacy of comfort for their families. Barb Kohr was a Nurse Manager extraordinaire and I am forever grateful for her patient tutoring of me over the years as I learned to care for and deeply love the Veterans and families we were honored to have on our hospice unit. Excellence on Barb Kohr’s unit had little to do with quality indicators on a spreadsheet. She was “hands on” and from frequent clinical rounds with staff, she knew every Veteran and most of their families. The hospice unit grew, became more homelike, was featured in a VA video and nurtured dozens of staff, including me, on the value of ‘being present” and doing the hard work of respecting and caring for the diversity of humanity in our paths.
What does it mean to be named a Visionary in Hospice and Palliative Medicine?
This is an unexpected honor but in other ways is a validation of the hard work put forth by many, not just me, to address the care needs of Veterans with advanced illness. Who could be more deserving than Veterans to get quality palliative and hospice care? While it may not be a popular statement these days, “I’m so proud I work in the federal government”. As with all federal institutions, there is frustrating bureaucracy and strategic priorities change with each administration but for the last decade, the Department of Veterans Affairs has led the nation in building a quality palliative care program with interdisciplinary teams at every medical center, a national quality measure that incorporates the “voices of Veterans” into improvement activities and a culture that “sees” the value of early palliative care. Our VA program hasn’t had to worry about the inadequate reimbursement for palliative care in the private sector as we’ve worked to engage and enlighten facility leaders in the broader value of palliative care teams such that when targeted funding for these teams evaporated in 2012, the teams kept growing. Being named a Visionary has given me hope that one day other healthcare systems and our nation will see the immense value of palliative care for patients, their families and the community.
What is your vision for the future of Hospice and Palliative Medicine?
Imagine every hospice and palliative care program in the country asking “are you a Veteran?” and following up on this by having specialized expertise to address Veteran-specific issues such as those high performing programs in our We Honor Veterans initiative (www.WeHonorVeterans.org). Take this vision a bit further to have VA palliative care teams working collaboratively with community hospice programs to deliver concurrent care, simultaneous Medicare Hospice Benefit services along with VA palliative care services that aren’t routinely offered by community hospices. Go another step further in this vision to include widespread access to community/home based palliative care programs similar to VA’s Home Based Primary Care. In this way, Veterans with advanced illness and their families would be supported throughout the trajectory of their illness, in a manner that aligns with their values, their care needs and the associated functional decline of advancing illness.
Scott T. Shreve, DO is one of 30 individuals who have been named a Visionary in Hospice and Palliative Medicine by AAHPM for their 30th Anniversary in 2018. Learn more about the Visionary recognition and view a list of all current and past Visionaries.