Daily Editors' Notes

Who these people are: Nursing home care for Vietnam vets

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Tim Mullaney
Tim Mullaney

Here's a conundrum.

The rate of post-traumatic stress among Vietnam veterans is high and has climbed in recent years, with the 9/11 attacks and the Iraq War serving as triggers. This potentially increases the caregiving burden on families as these veterans age, and increases veterans' need for long-term care.

Yet, as New York Times blogger Paula Span pointed out in a post Friday, vets' PTSD can be worsened by a nursing home environment with “people in uniforms, intercoms, semi-authoritarian routines and schedules.”

This is just one of many challenges facing nursing homes that are seeing more residents who served in Vietnam. Other challenges are even harder to define. They involve societal attitudes and perceptions about this generation. While World War II veterans are lauded as the Greatest Generation, the legacy of Vietnam is far more complicated. And the generation itself was marked by deep divisions between those carrying the flag into battle and those burning it on college campuses.

Eleanor Krassen Covan, Ph.D., is a voice providing authoritative guidance for long-term care providers on these issues. As professor of gerontology and sociology, and gerontology coordinator at the University of North Carolina-Wilmington, she has the formidable academic and clinical background to speak about how to provide the best care for aging veterans. As someone who “embraced the idealism of the flower children” yet went on to marry a Vietnam veteran, she has a unique and valuable personal experience to draw on as well.

Vets caring for vets

First, some good news.

“I don't think the picture is as dismal as what we might think,” Covan told me.

Covan is a strong believer in long-term care facilities run by the Department of Veterans Affairs. Here, too, she has personal experience. Her father-in-law, a WWII vet, was a resident at what was arguably the best facility in his community, yet he did not receive the care he needed, Covan said. Like many veterans, he had a gruff manner and did not respond well to taking orders from staff. He did much better in a VA-run facility, where staff members —many of them vets themselves — were trained specifically in caring for veterans.

Covan acknowledged that caregivers in private-sector nursing homes are sometimes given relevant training. However, she said, “this is not something someone can learn in an in-service training or a two-hour workshop.” The lesson here is basic. As Covan put it: “You need a match of service providers and clients, whether they're veterans or anybody else.”

Now, some bad news.

VA is currently an agency stretched to its limits, and is not equipped to handle the long-term care needs of aging Vietnam veterans, Covan said. Increasing home care and adult day care programs for veterans could be one good move since these are more affordable long-term care options that should be available to those who do not need to reside in a nursing home, she suggested.

The private sector also could step in here, but Covan cautions that nursing homes need to be created specifically with veterans' needs in mind. This could mean avoiding mixed populations — and that goes for staff as well as residents. Getting predominantly male staff largely composed of veterans might sound challenging from a recruitment angle, but there is positive movement on this front. For residents, being among other veterans is “calming,” Covan said, and it can be an effective way of mitigating PTSD symptoms.

“They watch each other's backs,” she said. “They'll have a better adjustment.”

Know, and care for, the whole person

Covan is eloquent in speaking about the broader social issues. While her marriage shows that old barriers between hawks and doves are not permanent, she noted, “A case study of me and my husband is not a very common case.”

She recently wrote about her marriage, and she said that negative comments she received on the article tended to be from people who still stereotype her as a radical peacenik who was out of touch — people who “can't imagine how anyone could be like me and not know any Vietnam vets in '67, '68, '69.”

But Covan was not a radical, she said. She was on the side of peace, but was really “just somebody in the crowd.” She thinks the media deepened divisions and cemented stereotypes that we still cling to because it was newsworthy to cover flag burnings in tandem with villages burning in the jungle. The challenge facing long-term care providers is the same challenge facing all of us: getting beyond these stereotypes and seeing Vietnam vets — and former flower children — for who they actually are today.

To this end, nursing homes should concentrate on knowing and treating the whole person, Covan said. She praises facilities that have photo books for each resident, which tell the whole life story of that person. When staff can participate in care at this level, she said, “that's the best.” But the current system sometimes results in staff members who are overworked and underpaid, without the time needed to provide the holistic care that is always ideal, and which may be especially important in the case of Vietnam veterans, whose trauma has always been made even worse because they are misunderstood.

“The group of Vietnam veterans have not been understood at any time in their lives after their experience in Vietnam,” Covan said. “We as a society didn't make an effort to understand who they are. We don't know who these people are.”

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Daily Editors' Notes

McKnight's Daily Editor's Notes features commentary on the latest in long-term care news. Entries are written by Editorial Director John O'Connor on Monday and Friday; Staff Writer Tim Mullaney on Tuesday, Editor James M. Berklan on Wednesday and Senior Editor Elizabeth Newman on Thursday.

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