Ask Americans if someone in their family served in the military, and the answer is probably no. After all, fewer than 1 percent of Americans serve these days.
But ask if one of their grandfathers served, and you'll likely get a different answer. Between World War II and the wars in Korea and Vietnam, millions of men were drafted into service — and both men and women volunteered.
Now, that generation of veterans is getting older. And as many of them near the end of their lives, aging into their 80s and 90s, the demand for hospice care has been growing with them. That means that the Department of Veterans Affairs is spending a lot more on what's known as end-of-life care.
"I think they call it end-of-life care," notes Thomas O'Neill, a 68-year-old resident at the St. Albans VA hospital in Queens, N.Y. "But whatever it is ... they treat you like gold. If you're going to be sick, this is the place to be."
O'Neill served a year in Vietnam, from 1966 to 1967, at a time when the war was killing more Americans in a year than the total U.S. casualties from Iraq and Afghanistan combined.
"The only good thing was the nighttime, because you knew another day closer to coming home," he says. "To be honest with you, I was scared. I was very scared the whole year — and I don't think I was the only one."
When he came home, he didn't talk to anyone about the war. O'Neill says he nearly drank himself into the grave. In 2011, he finally went to the VA to treat the post-traumatic stress disorder he'd been enduring for 40 years. Last year, he learned he has terminal cancer.
"They can tell you you got three months. They don't really know," he says. "I came to terms with this. I'm not happy with the diagnosis, but I came to terms with it."
Coming to terms with the end of life can be a bit different for veterans, says Dr. Alice Beal, who directs VA palliative care for most of New York City.
"If a veteran's been in combat, a veteran's likely to have killed," Beal says. "I think no matter what your culture is, when you meet your maker — even if it's been to save your buddy, to save your life, to save your country — it's just a burden the rest of us haven't even thought of."
Sometimes that means vets want to tell their stories at the end of life, Beal says. Sometimes the stories come unbidden.
"If you've had blood on your hands, it comes up," she says. "People who have PTSD, maybe have not had it unmasked their whole life, but as they're dying, all of a suddenly they get flashbacks."
Beal says the goal in hospice is to make life as good as it can be for as long as possible; that usually means focusing on relieving pain for the last weeks or months of life.
The hospice ward is a contradiction: It's brightly decorated, and at the entrance there's a fish tank and an electric fireplace. But there's also usually a room recently vacated, with an American flag draped on the bed and a lantern on the nightstand honoring a veteran who passed on.
"It's a real tossup between respect and release. Around here we tend to be full of life," Beal says. "But you don't want to be too joyful in the presence of a family who is grieving."
All VA facilities now have a palliative care team, but only a fraction of veterans enter VA hospice, according to Dr. Scott Shreve, who directs VA hospice care nationwide. Shreve says the vast majority prefer to stay in their communities and near family instead.
Volunteers with We Honor Veterans sometimes show up to find elderly veterans who haven't mentioned much about serving in the military to their family or community, like 92-year-old Florence Keliher, in Hallowell, Maine.
"I served during World War II in the Army Nurse Corps. I was on Tinian, the little island in the South Pacific," Keliher says. "We had a ward full of patients — airplane crashes and things like that. They flew from Tinian to Japan to bomb. Some had trouble taking off sometimes."
Keliher's son, Pat, who lives up the road, says he never heard much about his mother's time at war until a grandchild asked to type up some of Keliher's stories:
"The patients we nursed in the wards on afternoon duty broke our hearts. It sounds like a cliche, but they were so young. Malaria, horrible burns. ... I was only 23 years old, but I felt much older than the patients I tended, some of whom called for their mothers in their distress."
Besides Keliher's kids and grandchildren, a volunteer with Beacon Hospice also visits her regularly as part of the We Honor Veterans campaign. They play cribbage and swap stories.
Shreve says only half the community hospices nationwide are taking advantage of the We Honor Veterans program, which is free. He'd like to see more of them get on board. That's because half a million veterans will be needing end-of-life care each year for the next five years.
RENEE MONTAGNE, HOST:
In a century that has embroiled America into two long wars, it's been much talked about that few Americans actually serve, less than 1 percent in fact, and that is more remarkable when set against past wars - World War II and Korea - when millions of men were drafted and both men and women volunteered. We're going to meet one of those veterans in this report by NPR's Quil Lawrence on what it takes to care for them near the end of their lives.
QUIL LAWRENCE, BYLINE: You've seen places like Woodland Assisted Living in Hallowell, Maine - little white cupola with a weathervane, circular driveway, no steps, an automatic sliding door.
UNIDENTIFIED MAN: B-15. B-15.
LAWRENCE: And, yes, there is bingo.
UNIDENTIFIED MAN: N-42.
LAWRENCE: But it's not for everyone.
FLORENCE KELIHER: I'm not a bingo player. I love cribbage.
LAWRENCE: Cribbage was sort of the official game of anyone who was on a ship in World War II, like Florence Keliher.
KELIHER: I served during World War II in the Army Nurse Corps, and I was on Tinian, the little island in the South Pacific.
LAWRENCE: Keliher sailed across the Pacific to Tinian in 1945, a year after the U.S. took the island and set up an airstrip and a hospital.
KELIHER: We had a ward full of patients - airplane crashes and things like that. They flew from Tinian to Japan to bomb. Some of them had trouble taking off sometimes. I didn't call my work hard because I did a lot of chatting and things like that.
LAWRENCE: Keliher came home to Maine and worked as a VA nurse for 30 years. Now she's 92, and she needs some nursing help herself these days. So do a lot of veterans.
SCOTT SHREVE: This past year, out of all American deaths, 1 in 4 have been a veteran.
LAWRENCE: Dr. Scott Shreve directs hospice care for the VA nationwide. The VA took notice about 10 years ago when millions of World War II and Korea vets reached old age. One result has been a program called We Honor Veterans. Shreve says it's set up to help hospice workers ask patients the right questions.
SHREVE: Are you a veteran? How did that military experience impact your life? And how can we help work with you in perhaps dealing with some very difficult and intrusive memories as you come to the end of your life?
LAWRENCE: At the end of life, for example, PTSD can sometimes show up for the first time. VA hospitals have palliative care and hospice wards, but the vast majority of vets aren't in those hospitals; they stay near their families. The program aims to reach them where they live - people like Florence Keliher, who lives up the road from her son, Pat.
PAT: I've got the girls this weekend, so I'll bring them by.
LAWRENCE: Pat stops in all the time, sometimes brings the grandchildren. They talk, but only in recent years has Florence said much about the war.
KELIHER: I don't remember talking about it. Do you remember hearing me tell a story?
PAT: Not until you wrote it down that one time. That's the first time I'd ever read it.
LAWRENCE: Her grandson typed up her stories about crawling under bullets in basic training and 16 days on a ship to the South Pacific, and about caring for young men as they lay dying of war wounds or malaria, calling out for their mothers. And now she's got more people she can talk with about all that.
KATHERYN ZWICKER: Hey, there. How are you?
ZWICKER: I haven't forgot about our cribbage game.
LAWRENCE: That's Katheryn Zwicker, she's a hospice volunteer who comes by as part of the We Honor Veterans campaign.
ZWICKER: We share an interest in reading, and we've swapped books and stories.
KELIHER: She has some interesting stories, too.
ZWICKER: Not as good as yours.
LAWRENCE: But only half the community hospices nationwide are taking advantage of the free program. VA officials say they'd like to get more on board. That's because half a million vets will be needing end-of-life care every year for the next five years. Quil Lawrence, NPR News. Transcript provided by NPR, Copyright NPR.