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Caring for Veterans at the End of Life

What families and hospice teams should know

Written and reviewed by Dr. G, a board-certified hospice & palliative medicine physician

Last reviewed:

11 min read

Why veterans need different care

Military service shapes a person for life, often right up to the very end. For many veterans, it is the source of their deepest pride: the friendships, the sense of having been part of something larger than themselves. For some, it also left marks, through injuries, toxic exposures, and memories that resurface as illness progresses.

As a physician who has cared for veterans in their final months, I have seen many veterans wanting to talk about their service. When care goes well, that service to country is honored. When it doesn't, it is usually for one of two reasons: hospice teams that miss what service means, or families who miss benefits they earned because no one told them.

This article addresses both: what veterans and families should know, and what hospice teams should do.

Service as a source of strength

The end of life is a time of looking back, and for many veterans, service is a chapter they are proud of. Good hospice care makes room for it.

  • Identity. Serious illness takes away many of the roles a person has held: worker, provider, independent adult. Military service is one identity it cannot take. Asking about a veteran's branch and service can restore a sense of dignity at a time when so much else feels lost.
  • Resilience. Veterans have faced fear and hardship before. Many draw on that experience to meet serious illness with remarkable courage and calm.
  • Camaraderie. The bonds formed in service often outlast every other friendship. A call from an old unit member or a visit from a veteran volunteer can bring deep comfort.
  • Legacy. Many veterans want their story preserved for their grandchildren. Hospice teams can help through life review, recorded stories, letters, or the Library of Congress Veterans History Project.

"Tell me about your service" is one of the most powerful questions anyone at the bedside can ask. Then listen. The answer is often what the veteran most wants to be remembered for.

For families: eight facts about hospice benefits

Is hospice a VA health benefit? Yes. Any veteran enrolled in VA health care qualifies when clinically eligible, with a life expectancy of six months or less. [1]

Does the VA charge copays for hospice? No. The VA charges nothing for hospice in any setting, whether it provides the care or pays a community hospice to provide it. [1]

Can a veteran keep receiving treatment while on hospice? Often, yes, if the VA is paying for hospice. Since 2009, the VA has allowed concurrent care, so a veteran may continue some treatments for the illness, such as palliative chemotherapy or radiation, alongside hospice. Decisions are made case by case with VA physicians. Standard Medicare hospice generally requires giving up curative treatment for the terminal illness. [2]

Will the VA pay for a nursing home during hospice? Many VA medical centers will cover nursing home care for a veteran on VA-paid hospice who needs that level of care, through a VA Community Living Center or a contracted community nursing home. Medicare hospice does not pay for nursing home room and board. Availability varies, so ask a VA social worker. [3]

Can a veteran use Medicare instead of the VA for hospice? Yes. Veterans with Medicare, Medicaid, or private insurance may use any of them for hospice, and choosing Medicare does not affect VA eligibility. Because of concurrent care and nursing home coverage, VA-paid hospice is sometimes the better option. Compare before deciding.

Can VA hospice be provided at home? Yes. The VA contracts with local hospices, so most veterans can receive care at home or in a nursing or assisted living facility. [1]

Does VA disability pay mean the veteran is enrolled in VA health care? No. Receiving VA disability pay does not enroll a veteran in VA health care. Apply with VA Form 10-10EZ before a crisis. [5]

What happens if a veteran on Medicare hospice goes to a VA hospital? A veteran on Medicare hospice who is admitted to a VA hospital generally must revoke the Medicare hospice benefit first. [4]

Free help is available from VA social workers, your state veterans agency, and accredited veterans service officers. Be wary of anyone who charges to file a VA claim. [9]

Read how Medicare hospice benefits compare.

Choosing a hospice: questions to ask

  • Do you ask every patient about military service?
  • Are you part of a veterans partnership, such as a Hospice-Veteran Partnership or We Honor Veterans, and what does your veterans program include? [10]
  • Is your staff trained in PTSD, moral injury, and military sexual trauma?
  • Do you have veteran volunteers?
  • Do you accept VA-paid hospice, including veterans still receiving VA treatment under concurrent care?
  • Will you help us connect with a veterans service officer?

More questions to ask a hospice, and how to choose a hospice.

What to watch for at the bedside

Trauma can resurface. Serious illness and pain can reopen memories a veteran kept closed for decades. Post-traumatic stress disorder (PTSD) may flare after years of quiet, or be identified for the first time late in life. Nightmares, flashbacks, hypervigilance, agitation, or talk of combat are common signs, and they are often mistaken for delirium or terminal restlessness. Hospice staff should approach from the front, announce themselves, keep lights on and exits visible, and avoid restraints. Involve chaplains, social workers, and VA mental health early; enrolled veterans can keep receiving VA mental health care while in hospice.

Moral injury needs to be heard. Some veterans carry guilt for what they did, saw, or survived. It can look like refusing comfort or feeling undeserving of care. These veterans need space to speak honestly about what they carry. Forgiveness, reconciliation, and simply being heard are part of good end-of-life care.

Military sexual trauma affects women and men. Many survivors never reported it. Bathing and intimate care can be distressing. Hospice staff should ask about caregiver gender preferences, explain each step before touching, and let the veteran keep control.

Stoicism hides pain. Veterans often say "I'm fine" when they aren't, or refuse medication to stay alert and in control. Hospice staff should look for nonverbal signs of pain, like grimacing, guarding, restlessness, and poor sleep, rather than relying on "I'm fine." Involving the veteran and family in the care plan is essential. Explaining exactly what each medication does, and inviting them to help manage it, builds the trust that makes comfort possible.

Small details, big difference. Hospice staff should check hearing first, because hearing loss is common among veterans and is easily mistaken for confusion. A respectful, nonjudgmental conversation about traumatic brain injury and substance use helps guide safe medication choices. And hospice staff should ask every family with firearms in the home to secure them, since serious illness, medications, delirium, and depression can all affect judgment.

Service-connected illness: the issue families miss most

A veteran's terminal illness may be connected to service. The VA presumes certain conditions were caused by service, so the veteran does not have to prove it. Common examples: [6]

  • Agent Orange (Vietnam era): prostate, lung, and bladder cancer, multiple myeloma, ischemic heart disease, type 2 diabetes, Parkinson's disease, and since the 2022 PACT Act, high blood pressure. The PACT Act also added Thailand, Laos, Cambodia, Guam, and American Samoa as qualifying locations.
  • Burn pits (Gulf War and post-9/11): more than 20 conditions, including respiratory, brain, and gastrointestinal cancers.
  • Camp Lejeune (1953 to 1987): several cancers and Parkinson's disease.
  • Asbestos (often Navy and shipyard service): mesothelioma and lung disease.

Near the end of life, this can matter to both the veteran and their spouse. When a veteran dies of a service-connected condition, survivors may qualify for Dependency and Indemnity Compensation, a monthly tax-free payment. Survivors may also qualify if the veteran was rated totally disabled for a required period, often 10 years, before death. [6, 7]

If a claim has not been filed, connect the family with a veterans service officer now. Clear documentation of the diagnosis and exposure history in the medical record helps.

After death: a family checklist

  • Find the DD-214. The funeral home and the VA will both need the veteran's discharge papers.
  • Request burial and memorial benefits. Eligible veterans can receive burial in a national cemetery, a government headstone or marker, a burial flag, and a Presidential Memorial Certificate. The VA manages more than 150 national cemeteries across the country. [8]
  • Ask for military funeral honors. The funeral director usually arranges the flag folding and Taps.
  • File for the burial allowance. The VA partially reimburses funeral costs, more for a service-connected death. File within two years. [8]
  • Apply for survivor benefits. Ask a veterans service officer about Dependency and Indemnity Compensation and the Survivors Pension. [7]
  • Use bereavement support. Hospice grief support continues after the death, and VA Vet Centers offer counseling to eligible family members. Read about grief and bereavement support.

For hospice teams: six practices that matter

  • Ask "Have you ever served in the military?" rather than "Are you a veteran?" That question can miss Guard members, reservists, women, and peacetime veterans. Record their branch, era, combat history, exposures, VA enrollment, and disability rating.
  • Know your VA partners. Identify the hospice and palliative care coordinator at your local VA medical center. Learn how VA-paid referrals, concurrent care, and contracted nursing home placements work. A veteran still receiving VA chemotherapy or radiation can be on VA-paid hospice, so don't turn them away. Keep VA physicians informed even when Medicare pays.
  • Join a veterans partnership. Look for a Hospice-Veteran Partnership in your state or community: a coalition of VA facilities, community hospices, and state hospice organizations working to improve end-of-life care for veterans. Your state hospice organization can tell you whether one serves your area. [10] Nationally, We Honor Veterans ended its VA contract in 2024 and is now a members-only program of the National Alliance for Care at Home. [11, 12] Whichever you use, build in veteran screening, staff training, community partnerships, and regular review.
  • Train every role. Aides, volunteers, and chaplains need the same grounding as nurses: trauma-informed care, moral injury, military culture, toxic exposures, and benefits basics.
  • Recruit veteran volunteers. Veterans often tell another veteran what they have never told family. VFW, American Legion, and DAV posts are good places to start.
  • Honor service, on the veteran's terms. A pinning ceremony, certificate, or salute can mean a great deal, especially to Vietnam veterans who never had a welcome home. Always ask first; some prefer a quiet thank-you.

At FindHospices.com, families can search hospices nationwide and compare Medicare quality ratings and caregiver reviews side by side. It is free and independent.

Veterans gave this country their best years. They deserve care at the end that understands where they have been.

This article is for general education and is not medical, legal, or benefits advice. VA rules and amounts change. Confirm details with the VA or a veterans service officer.

References

References accessed October 9, 2026. VA rules and amounts can change. Confirm current details with the VA, a veterans service officer, Medicare, or the hospice team.

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