VA Long-Term Care:

Oversight of Nursing Home Program Impeded by Data Gaps

GAO-05-65: Published: Nov 10, 2004. Publicly Released: Nov 10, 2004.

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The Department of Veterans Affairs (VA) operates a $2.3 billion nursing home program that provides or pays for veterans' care in three settings: VA nursing homes, community nursing homes, and state veterans' nursing homes. The Veterans Millennium Health Care and Benefits Act (Millennium Act) of 1999 and VA policy require that VA provide nursing home care to veterans with a certain eligibility. Congress has expressed a need for additional data to conduct oversight of VA's nursing home program. Specifically, for all VA nursing home settings in fiscal year 2003, GAO was asked to report on (1) VA spending to provide or pay for nursing home care, (2) VA workload provided or paid for, (3) the percentage of nursing home care that is long and short stay, and (4) the percentage of veterans receiving care required by the Millennium Act or VA policy.

In fiscal year 2003, VA spent 73 percent of its nursing home resources on VA nursing homes--almost $1.7 billion of about $2.3 billion--and the remaining 27 percent on community and state veterans' nursing homes. Half of VA's average daily nursing home workload of 33,214 in fiscal year 2003 was for state veterans' nursing homes, even though this setting accounted for 15 percent of VA's overall nursing home expenditures. In large part, this is because VA pays about one-third of the cost of care in state veterans' nursing homes. Community nursing homes and VA nursing homes accounted for 13 and 37 percent of the workload, respectively. About one-third of nursing home care in VA nursing homes in fiscal year 2003 was long-stay care (90 days or more). Long-stay services include those needed by veterans who cannot be cared for at home because of severe, chronic physical or mental impairments such as the inability to independently eat or the need for supervision because of dementia. The other two-thirds was short-stay care (less than 90 days), which includes services such as postacute care needed for recuperation from a stroke. VA lacks similar data for community and state veterans' nursing homes. About one-fourth of veterans who received care in VA nursing homes in fiscal year 2003 were served because the Millennium Act or VA policy requires that VA provide or pay for nursing home care of veterans with a certain eligibility. All other veterans received care at VA's discretion. VA lacks data on comparable eligibility status for community and state veterans' nursing homes even though these settings combined accounted for 63 percent of VA's overall workload. Gaps in data on length of stay and eligibility in these two settings impede program oversight.

Recommendations for Executive Action

  1. Status: Closed - Implemented

    Comments: At the time of our recommendation in November 2004, VA stated that it concurred with the recommendation in principle, but did not specify plans to collect such data. In July 2008, VA reported that community nursing home length of stay are reviewed annually and on as needed basis by the Office of Geriatrics and Extended Care. VA also reported that the State Home Per Diem Program Office receives a monthly report on veterans' length of stay in state veterans' nursing homes.

    Recommendation: To help ensure that VA can provide adequate program monitoring and planning for nursing home care and to improve the completeness of data needed for congressional oversight, the Secretary of Veterans Affairs should direct the Under Secretary for Health to, for community nursing homes and state veterans' nursing homes, collect and report data on the number of veterans who have long and short stays, comparable to data VA currently collects on VA nursing homes.

    Agency Affected: Department of Veterans Affairs

  2. Status: Closed - Implemented

    Comments: At the time of our recommendation in November 2004, VA stated that it concurred with the recommendation in principle, but did not specify plans to collect such data. In July 2008, VA reported that community nursing home eligibility data are collected and reviewed annually and on an as-needed basis by the Program Manager for Community-Based Care, Office of Geriatrics and Extended Care in light of the requirements of the Millennium Act and VA Nursing Home Eligibility Policy. VA also noted that as of May, 2008, the State Home Per Diem Program is receiving data on state veterans' nursing home veterans' priority group.

    Recommendation: To help ensure that VA can provide adequate program monitoring and planning for nursing home care and to improve the completeness of data needed for congressional oversight, the Secretary of Veterans Affairs should direct the Under Secretary for Health to, for community nursing homes and state veterans' nursing homes, collect and report data on the number of veterans in these homes that VA is required to serve based on the requirements of the Millennium Act or VA's policy on nursing home eligibility, comparable to data VA currently collects on VA nursing homes.

    Agency Affected: Department of Veterans Affairs

 

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