VA Health Care:

Assuring Quality Care for Veterans in Community and State Nursing Homes

HRD-88-18: Published: Nov 12, 1987. Publicly Released: Nov 12, 1987.

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In response to a congressional request, GAO reviewed the: (1) compliance of eight Veterans Administration (VA) medical centers with VA quality assurance requirements for community and state nursing homes caring for veterans; and (2) extent to which the centers used quality assurance information available from states and other sources.

GAO found that the centers: (1) evaluated 70 percent of the community nursing homes and all but one of the state veterans' homes annually, as required; (2) performed only 62 percent of required monthly patient monitoring visits at community nursing homes and were not routinely sending nurses on these visits; (3) conducted only 38 percent of their annual evaluations within the required 90-day period before contract renewal; and (4) did not routinely use quality-of-care information from state agencies in their evaluations.

Recommendations for Executive Action

  1. Status: Closed - Implemented

    Comments: VA complied with this recommendation by creating a new chapter to M-5, Part II, Chapter 3, subparagraphs 3.07i and 3.10d on July 19, 1988. Subparagraph 3.07i states that "evaluation process will be completed every 12 months and no later than 45 days prior to expiration of contract." Subparagraph 3.10d states that "a VA nurse will provide a followup visit at least once every 60 days."

    Recommendation: The Administrator of Veterans Affairs should direct the Chief Medical Director to specify: (1) that annual evaluations of community nursing homes be made within 45 days of contract renewal dates; and (2) the frequency with which nurses must visit veterans placed in community nursing homes.

    Agency Affected: Veterans Administration

  2. Status: Closed - Implemented

    Comments: VA developed Standards, Criteria, Evaluative Algorithms, and Measuring Instruments for the Community Nursing Home Program. The instrument will be used in the SERF program by regional QA staff.

    Recommendation: The Administrator of Veterans Affairs should direct the Chief Medical Director to require the regional offices to place increased emphasis on centers' compliance with the program's quality assurance requirements during their cyclical systematic reviews.

    Agency Affected: Veterans Administration

  3. Status: Closed - Implemented

    Comments: Changes were made to M-5, Part II, Chapter 3. Subparagraph 3.02c(5) will respond to this recommendation.

    Recommendation: The Administrator of Veterans Affairs should direct the Chief Medical Director to require medical centers to regularly exchange quality-of-care information with state and other agencies responsible for regulating, monitoring, and accrediting community nursing homes.

    Agency Affected: Veterans Administration

 

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