Jolene Renda recalled her reaction when stories of a Veterans Administration “death book” hit the news in August.

“I thought it was kind of sensationalist because there was a lot of talk about ‘death panels,’” Renda said. “It was unfortunate that the palliative care community didn’t speak out more.”

Renda is the regional Palliative Care Coordinator for seven VA Hospitals in the upper Midwest, including Tomah. From Dec. 2-4, she conducted three days of training on end-of-life care for nursing assistants at the Tomah VA. It’s part of a three-year project to train all VA employees, including non-medical personnel, on how to deal with end-of-life issues.

The issue exploded into the news last August. Jim Towey, director of the White House Office of Faith-Based Initiatives for four years under the Bush Administration, alleged that a VA publication called “Your Life, Your Choices” was a “hurry-up-and-die message” for sick and disabled veterans.

“One can only imagine a soldier surviving the war in Iraq and returning without all of his limbs only to encounter a veteran’s health-care system that seems intent on his surrender,” Towey wrote.

Renda said the opposite is true.

“The VA’s mission is to honor a veteran’s wishes for end-of-life care,” Renda said. “We try to find out how aggressively they want to us to manage their illness. For some, that means aggressive intervention. For others, it means, ‘keep me comfortable.’ This is really about enhancing their quality of life and managing symptoms.”

Chris Wontor, a registered nurse at the VA, said financial considerations never play a role in end-of-life counseling.

“The staff is an advocate for patients,” Wontor said. “In the private sector, it may be looked upon as a financial issue, but we give veterans whatever they need. I don’t think I’ve ever been in a situation where a patient’s wishes isn’t the prime imperative.”

Renda acknowledged that hospice and palliative care are relatively new concepts in medicine. Hospice is defined as care of an individual who is likely to die within six months if the illness takes its normal course. Palliative is defined as care for the seriously ill but without the six-month timeframe.

“Twenty-five years ago, it was difficult to find anyone who would talk about end-of-life planning,” Renda said. “Now, people are more willing to talk about what they want.”

Renda gave the example of a terminally ill veteran who requested to take a Canadian fishing trip. He went to Canada for three weeks, returned home and lived two more months.

Veterans she counsels are more likely to be concerned about too much intervention at the end of life than being neglected for financial reasons. She said it’s important to address end-of-life preferences well in advance of a debilitating or terminal illness and that “you can’t do it in six questions.”

The training sessions had 17 different stations that included such topics as nutrition, pet therapy, music therapy and massage therapy. There was also training for dealing with bereaved families.

The VA’s goal is to have every nurse trained by the end of 2010.