Armed Forces Retirement Home:

Health Care Oversight Should Be Strengthened

GAO-07-790R: Published: May 30, 2007. Publicly Released: May 30, 2007.

Additional Materials:

Contact:

Kathleen M. King
(202) 512-3000
contact@gao.gov

 

Office of Public Affairs
(202) 512-4800
youngc1@gao.gov

The Armed Forces Retirement Home (AFRH), an independent executive branch entity, operates two continuing care retirement communities (CCRC). It provides care in three settings--independent living, assisted living, and a nursing home--and also operates a health and dental clinic for residents. The responsibilities of a CCRC generally include (1) appropriately transitioning residents from independent living to other settings as their care needs increase, (2) ensuring the availability of appropriate health services as residents progress to higher-level settings, and (3) ensuring residents' access to community-based or on-site health care. The law establishing AFRH sets forth the framework for its oversight and management. The NDAA for Fiscal Year 2006 required GAO to assess the regulatory oversight and monitoring of health care and nursing home care services provided by AFRH. As discussed with the committees of jurisdiction, we focused our review on (1) the standards that could be used to monitor health care provided by AFRH and (2) the adequacy of DOD oversight of AFRH health care. To address these issues, we (1) identified existing standards applicable to health services in the three settings at AFRH and similar facilities; (2) discussed accreditation process and follow-up between accreditation surveys with officials from standard-setting organizations; (3) reviewed the statutory oversight structure for AFRH; (4) reviewed relevant DOD and AFRH reports related to oversight issues, including complaints; (5) interviewed DOD, DOD inspector general (IG), and service IG officials involved in oversight, including the Under Secretary's Principal Deputy (PDUS); (6) interviewed two civilian experts in health care for the elderly and retirement home administration serving on the AFRH-Washington Local Advisory Board; and (7) compared health care-related problems identified during Joint Commission accreditation reviews with those identified during service IG inspections.

Oversight of health care at AFRH is inadequate. Currently, there are no inspections of AFRH's independent and assisted living settings. Such oversight is important to ensure that residents are receiving appropriate care and are transitioned to other care settings as their care needs increase. Although the primary oversight responsibility for AFRH has been delegated to PDUS, this office's health care oversight has been limited and the sources of independent information to inform PDUS oversight have shortcomings. For example, the Joint Commission and service IG inspections occur triennially in the same year and, according to the PDUS, a Joint Commission inspection once every 3 years may be insufficient. In addition, PDUS shifted the focus of service IG inspections away from health care in 2005, but directed the service IGs to review Joint Commission accreditation reports to ensure AFRH follow-up. Our review of service IG and Joint Commission inspection reports demonstrated that this decision may result in health care problems remaining unidentified. Moreover, according to the service IG team that conducted the 2005 AFRH inspection, it was not provided the data that it needed on Joint Commission findings, such as the full accreditation report, to enable it to provide adequate oversight. Although Local Boards have the potential to assist in the PDUS's oversight, they have not been allowed to fulfill their advisory roles to the COO, which could provide useful information to the PDUS. The PDUS response to the 2005 service IG inspection findings that the Local Boards were not fulfilling their advisory role has been limited. In March 2007, however, the PDUS directed the COO to find ways to effectively use the Local Boards.

Status Legend:

More Info
  • 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 improve health care oversight at AFRH, the Secretary of Defense should ensure that service IGs have access to all relevant data on Joint Commission inspections.

    Agency Affected: Department of Defense

    Status: Closed - Implemented

    Comments: GAO found that the service inspector general (IG) was not given access to the 2005 Joint Commission accreditation report so that it could follow with the the Armed Forces Retirement Home to ensure that it was taking appropriate corrective actions. We recommended that DOD ensure that the service IGs have access to all relevant data on Joint Commission inspections. In responding to our draft report, DOD indicated that it will ensure that service IG teams have access to all relevant data on all independent accreditation inspections.

    Recommendation: To improve health care oversight at AFRH, the Secretary of Defense should ensure that service IG inspections do not occur in the same year as Joint Commission accreditation.

    Agency Affected: Department of Defense

    Status: Closed - Implemented

    Comments: As we recommended, DOD has taken steps to ensure that service inspector general (IG)inspections of the Armed Forces Retirement Home (AFRH) do not occur in the same year as accreditation. At the time we issued our report, the Joint Commission accredited the nursing home and clinic at AFRH but there was no external oversight of independent or assisted living. To address this gap in oversight, AFRH is contracting with the Commission on Accreditation of Retirement Facilities/Continuing Care Accreditation Commission (CARF-CCAC)to inspect AFRH in 2008. After this accreditation cycle is complete, DOD will work with the accrediting body to ensure accreditation surveys and IG inspections are done in alternating years.

    Recommendation: To improve health care oversight at AFRH, the Secretary of Defense should refocus service inspector general (IG) inspections on health care, particularly in the independent and assisted living settings, which are not covered by external accreditation.

    Agency Affected: Department of Defense

    Status: Closed - Implemented

    Comments: To improve the health care oversight at the Armed Forces Retirement Home (AFRH), we recommended that the Secretary of Defense refocus the service inspector general inspections on health care, particularly the in the independent and assisted living settings, which are not covered by external accreditation. On June 2, 2007, AFRH leadership met with the Commission on Accreditation of Retirement Facilities/Continuing Care Accreditation Commission (CARF/CCAC) and requested they provide accreditation services and survey independent, assisted living, and long-term care during the summer 2008 timeframe. DOD also initiated a dialogue with the U.S. Army Inspector General's office to ensure a comprehensive medical review is included as part of their triennial inspection to be conducted in 2008, consistent with statute. They will have access to CARF-CCAC standards.

    Recommendation: To improve health care oversight at AFRH, the Secretary of Defense should ensure that the Local Boards are allowed to fulfill their advisory roles.

    Agency Affected: Department of Defense

    Status: Closed - Implemented

    Comments: GAO found that statutorily created local advisory boards at the Armed Forces Retirement Home were not fulfilling their advisory role. In responding to our draft report, DOD indicated that it would appoint new members to the local boards, outline their expected roles and responsibilities, and ensure appropriate follow-up. In July 2007, DOD indicated that it had approved a revised local advisory board(s) construct and member ship appointment letters would be issued soon. The new board(s) will meet in September 2007.

    Apr 21, 2014

    Mar 5, 2014

    Feb 26, 2014

    Dec 27, 2013

    Dec 17, 2013

    Dec 16, 2013

    Nov 5, 2013

    Sep 23, 2013

    Sep 11, 2013

    Jul 16, 2013

    Looking for more? Browse all our products here