Bravo Zulu: Getting to a Job ‘Well Done’ in Dementia Care and Support

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While care partner training in the context of dementia is becoming increasingly sensitive to the needs of different cultures or groups, it is still rare to find culturally-sensitive supports for former military personnel.

So when the Nevada Department of Veterans Services reached out to Dementia Friendly Nevada co-facilitator Dr. Jennifer Carson to create a training for its Veterans-in-Care initiative, she was all in — and all ears.

About half of America’s 20 million veterans are over 65 and, increasingly, support for these elder veterans—often living with disabilities—is provided by civilian healthcare providers who have little if any military cultural competence.

In order to build a training programs centered on veterans, it was first necessary to learn how caring for veterans — including veterans with dementia — is different than caring for civilian elders. For Carson, it turned out to be far more educational, and subtle, than she ever imagined.

Veterans were clearly a population with specific needs, and military service was central to their identities as elders. To do their jobs well, care partners of veterans would need to learn about their military past, and thus would need to ask questions.

What was their military experience? Which branch did they serve in? When and where did they serve? What their MOS (military occupational specialty)? How did military service affect their lives? Have they experienced post-traumatic stress?

“It’s not just enough to know this elder was a veteran,” says Carson. “We have to go deeper.”

Veterans are steeped in a culture that rewards overcoming physical and emotional pain are often less likely to cry, report discomfort, or ask for help. With that in mind, Carson worked with the Nevada Department of Veterans Services

office along with the Nevada State Veterans Home in Boulder City, NV, to create a training that would eventually support Nevada’s more than 200,000 veterans.

The person- and relationship-centered training was given the moniker Bravo Zulu, originally a naval signal for “job well done!” Since its inception, the “Bravo Zulu” signal has been delivered via flag hoist or radio by senior United States Navy, Marine Corps, or Coast Guard troops to acknowledge outstanding performance.

The Bravo Zulu training itself furnishes learners with a deep understanding of veteran experiences and communication, including a segment on “Military Culture 101.” Care partners learn that when someone is frightened, it’s instinctive to offer human touch or a hug, however since veterans may misinterpret physical contact as threat—which can trigger trauma—uttering military phrases can be just as useful, such as “You’re safe,” “I’m not leaving you,” “It’s all clear,” or “Stand down.”

Central to the Bravo Zulu curriculum is the concept that in order to be a good care partner, it is essential to treat elders like VIPS: Value their personhood, relationships and culture; treat them as unique Individuals; look at the world from the Perspective of the person; and provide a positive and supportive Social environment.

So far, Carson has offered the free 12-hour relationship-based training six times. Recently, with support from a Geriatrics Workforce Enhancement Program (GWEP) grant via the Sanford Center on Aging at the University of Nevada, Reno, Carson is now working with Dementia Friendly Nevada’s six community action groups to provide the training across the state.

“Through the GWEP, we can now offer Bravo Zulu four times a year for five years. We plan to alternate urban and rural offerings, providing community members, many of whom are family care partners, with free, comprehensive dementia education close to home,” reports Carson.

In 2019, she trained members of Dementia Friendly Pahrump along with Age- and Dementia-Friendly Winnemucca. In 2020, she will provide the training in partnership with Dementia Friendly Elko, Dementia Friendly Washoe County, Dementia Friendly Southern Nevada Urban, and a second offering with Winnemucca.

Originally developed with Nevada veterans in mind, Bravo Zulu can also be customized for care partners of all elders, replacing veteran culture with other cultural considerations.

Carson is especially thankful for the opportunity to learn about an underserved population.

“I’ve learned so much through developing and teaching this course,” she says. “For 30 years I’ve been providing care and support to veterans without really understanding military culture. But now that I know better, I will do better.”