VA Long-Term Care:

Data Gaps Impede Strategic Planning for and Oversight of State Veterans' Nursing Homes

GAO-06-264: Published: Mar 31, 2006. Publicly Released: Mar 31, 2006.

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The Department of Veterans Affairs (VA) provides or pays for veterans' nursing home care in three settings: VA-operated nursing homes, privately owned nursing homes in the community from which VA purchases services, and state veterans' nursing homes. VA supports state veterans' nursing homes in a number of ways, including reimbursement for a portion of the cost of providing nursing home services to veterans, issuance of policy guidance, and oversight of their nursing home operations. GAO was asked to determine the extent to which VA collects information on veterans in state veterans' nursing homes and the type of care they receive, to assess whether VA's reimbursement policy has been applied consistently, and to identify revenue sources such homes use.

VA does not compile information on key characteristics of veterans receiving care in state veterans' nursing homes: veterans' length of stay, priority group status for VA hospital and outpatient services, age, and gender. VA needs such information for strategic planning, in order to develop baseline data of characteristics of veterans in state veterans' nursing homes and the care provided to them, which can help VA estimate the proportion of nursing home need it currently meets and the need it may be asked to meet as the number of older veterans changes over time. Based on visits to four states--Florida, Maine, Oklahoma, and Pennsylvania--GAO obtained information on key characteristics of state veterans' nursing home populations, which showed that these populations differed to varying degrees across the states. For example, state veterans' nursing homes in three of the four states generally were providing long-stay care (90 days or more), but 60 percent of stays in state veterans' nursing homes in Maine were short (less than 90 days). GAO also found that certain aspects of VA's per diem reimbursement policy had not been applied consistently. For example, a VA medical center in one of the four states GAO visited approved reimbursement only for care provided to veterans admitted to state veterans' nursing homes who have had wartime military service. VA's policy does not limit reimbursement on this basis. GAO also found that VA headquarters officials have not been consistent in explaining to VA medical centers whether they could approve reimbursement to state veterans' nursing homes for care provided to veterans determined to have lowest priority for VA hospital and outpatient services. In the states that GAO visited, state veterans' nursing homes rely on VA and non-VA revenue sources to varying degrees. In fiscal year 2004, per diem reimbursement from VA accounted for about one-fourth to one-third of revenues used for veterans' care. In addition to revenue from VA, state veterans' nursing homes in two of the four states GAO visited received reimbursement from Medicare and Medicaid for inpatient nursing home care provided to veterans. State veterans' nursing homes in three of the four states received funding directly from their states, ranging from 54 percent to 10 percent of revenues used for veterans' care in fiscal year 2004. In all the states GAO examined, the remainder of revenues comes from veterans' resources, such as Social Security and private pensions.

Status Legend:

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  • Review Pending-GAO has not yet assessed implementation status.
  • Open-Actions to satisfy the intent of the recommendation have not been taken or are being planned, or actions that partially satisfy the intent of the recommendation have been taken.
  • Closed-implemented-Actions that satisfy the intent of the recommendation have been taken.
  • Closed-not implemented-While the intent of the recommendation has not been satisfied, time or circumstances have rendered the recommendation invalid.
    • Review Pending
    • Open
    • Closed - implemented
    • Closed - not implemented

    Recommendations for Executive Action

    Recommendation: To help ensure that VA can conduct adequate strategic planning for nursing home care and strengthen its administration and oversight of the state veterans' nursing homes, the Secretary of Veterans Affairs should direct the Under Secretary for Health to clarify that state veterans' nursing homes may receive reimbursement from VA for services provided to veterans who have either wartime or peacetime military service.

    Agency Affected: Department of Veterans Affairs

    Status: Closed - Implemented

    Comments: The VHA Office of Patient Care Services will coordinate the development and issuance of an information letter to VA medical centers of jurisdiction by the end of FY 2006 to clarify reimbursement policy on state veterans' nursing homes.

    Recommendation: To help ensure that VA can conduct adequate strategic planning for nursing home care and strengthen its administration and oversight of the state veterans' nursing homes, the Secretary of Veterans Affairs should direct the Under Secretary for Health to compile available data on the priority group status of veterans in state veterans' nursing homes, and explore with these nursing homes options for estimating the number of unenrolled veterans in each priority group.

    Agency Affected: Department of Veterans Affairs

    Status: Closed - Implemented

    Comments: VA now collects priority group status information on state veterans' nursing home patients on a structured and routine basis.

    Recommendation: To help ensure that VA can conduct adequate strategic planning for nursing home care and strengthen its administration and oversight of the state veterans' nursing homes, the Secretary of Veterans Affairs should direct the Under Secretary for Health to compile and report data on the age and gender of veterans admitted to state veterans' nursing homes.

    Agency Affected: Department of Veterans Affairs

    Status: Closed - Implemented

    Comments: VA now collects demographic information on state veterans' nursing home patients, including data on patient age and gender.

    Recommendation: To help ensure that VA can conduct adequate strategic planning for nursing home care and strengthen its administration and oversight of the state veterans' nursing homes, the Secretary of Veterans Affairs should direct the Under Secretary for Health to clarify VA policy regarding whether state veterans' nursing homes may receive reimbursement from VA for nursing home services provided to new Priority Group 8 veterans admitted to state veterans' nursing homes.

    Agency Affected: Department of Veterans Affairs

    Status: Closed - Implemented

    Comments: The VHA Office of Patient Care Services will coordinate the development and issuance of an information letter to VA medical centers of jurisdiction by the end of FY 2006 to clarify reimbursement policy on state veterans' nursing homes.

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