From the U.S. Government Accountability Office, www.gao.gov

Transcript for: Veterans' Long-Term Care

Description: Hear about the challenges facing the Department of Veterans
Affairs as the number of veterans eligible for long-term care grows.

Related GAO Work: GAO-20-284, VA Health Care: Veterans' Use of Long-Term
Care Is Increasing, and VA Faces Challenges in Meeting the Demand

Released: February 2020

[ Background Music ]

[Sharon Silas:] Veterans' use of long-term care programs has been
increasing and VA is projecting it will continue to increase through
2037. 

[Matt Oldham:] Welcome to GAO's Watchdog Report, your source for news
and information from the US Government Accountability Office. I'm Matt
Oldham. The number of veterans using long-term care services through
Veterans Affairs is growing, and as more veterans continue to be
eligible for long-term care, costs will grow, as well. Sharon Silas, a
Healthcare Director with GAO, is joining me to talk about a report on
the challenges the VA faces meeting this increasing demand. Thanks for
joining me, Sharon.

[Sharon Silas:] Thanks for having me.

[Matt Oldham:] So, how does the VA provide long-term care?

[Sharon Silas:] Well, the VA provides long-term care through two
programs. One is an institutional program which consists of primarily
traditional residential facilities like nursing homes, and then
non-institutional care, which are long-term care programs where veterans
can get assistance with daily living activities, such as eating or
dressing, and they can get that care in their home or in their
communities. But the placement in a particular long-term care program
really depends on a number of factors. It depends on the veteran's
clinical needs, their disability rating, personal preferences, and then,
of course, program availability, which will really be dependent on the
VA's medical center that the veteran is attending.

[Matt Oldham:] And so, what do projections say about the future for this
long-term care the VA provides?

[Sharon Silas:] Well, what we found in our review was that veterans' use
of long-term care programs has been increasing, and VA is projecting it
will continue to increase through 2037. As of 2018, there were about a
half-million veterans using long-term care programs. That was an
increase of 14% since 2014, and most of this growth was in the
non-institutional programs, so the long-term care where veterans can
receive care in their homes or in their community. And much of that was
driven by post-9/11 veterans. VA is also projecting utilization and
expenditures to continue to increase for most of their long-term care
programs, and they're estimating the expenditures to top out around $14
billion by 2037.

[Matt Oldham:] Does the increase in these costs, does the increase in
the number of veterans who are eligible for long-term care, does it
bring any challenges?

[Sharon Silas:] Yes, it does. In our report, we identified a number of
challenges that VA is facing in meeting the demand for long-term care.
For some of these challenges, which we identify as key challenges in the
report, those challenges aren't unique to VA. They're actually
challenges that other healthcare systems are facing. And although VA was
recognizing that they were going to have to address these challenges,
and had taken some steps to address them, it was not really clear what
progress VA is making. Three of the key challenges that we describe in
our report are addressing workforce shortages in long-term care, which
is particularly problematic in rural areas; aligning care
geographically, so locating long-term care programs where the
demographics show the need is; meeting needs for specialty care, so this
would be veterans that have issues with dementia or behavioral issues,
trying to find the right environment for them to receive care.

[ Music ]

[Matt Oldham:] So, it sounds like while the cost of VA's long-term care
is projected to rise, at least through 2037, challenges exist, like
staffing issues or caring for veterans in rural areas. Sharon, what can
the VA do about these challenges?

[Sharon Silas:] Well, VA told us that competing priorities have really
been an issue in terms of them being able to really focus and plan to
address some of these key challenges that we discuss in the report. And
so, we made a recommendation that they develop measurable goals to
address those three key challenges.

[Matt Oldham:] And then, last question. What's the bottom line of this
report?

[Sharon Silas:] So, the bottom line is, is that some of the challenges
that I've highlighted today will be incredibly difficult to address
without good planning. So really, in order for VA to effectively address
these challenges, they need to develop these measurable goals and to
show their progress, and that will help them to ensure that they're well
positioned to effectively meet the growing demand for veterans'
long-term care.

[Matt Oldham:] Sharon Silas was talking about the growing number of
veterans eligible for long-term care services and the challenges the VA
faces as demand grows. Thank you for your time, Sharon.

[Sharon Silas:] Thank you.

[Matt Oldham:] And thank you for listening to the Watchdog Report. To
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