VA Health Care:

Financial and Quality Control Changes Needed in Domiciliary Care

HRD-87-57: Published: Jun 18, 1987. Publicly Released: Jun 18, 1987.

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GAO reviewed the Veterans Administration's (VA) domiciliaries to determine whether they: (1) enforced VA financial eligibility criteria for domiciliary care; (2) performed and documented required physical examinations; and (3) developed individual treatment plans for eligible veterans.

GAO found that: (1) 29 percent of the veterans at the domiciliaries it reviewed exceeded the monthly income limit, and domiciliary officials stated that they rarely rejected needy veterans for care, regardless of income; (2) neither VA nor Congress has raised the income limit since 1980, despite radical increases in the costs of living and medical care; (3) when Congress revised eligibility criteria for other VA programs, it did not do so for the domiciliary program; (4) VA did not perform required physical examinations on about 13 percent of the veterans at domiciliaries it reviewed; (5) VA did not develop therapeutic treatment plans for about 22 percent of the veterans; and (6) VA officials stated that VA performed examinations but did not document them, which could restrict VA ability to ensure the quality of care.

Recommendations for Executive Action

  1. Status: Closed - Implemented

    Comments: Public Law 100-322 raised the income limitation for determining eligibility to receive domiciliary care from $415.00 per month to an amount equal to the prevailing pension rate plus aid and attendance, currently $828.00 per month. Implementing instructions to the field are in process.

    Recommendation: The Administrator of Veterans Affairs should amend VA regulations to raise the monthly income limit for domiciliary care. The regulations should also allow for: (1) automatic adjustments to tie the limit to cost-of-living changes; and (2) taking the veteran's family size into account.

    Agency Affected: Veterans Administration

  2. Status: Closed - Implemented

    Comments: A VA directive dated June 1987 required VA officials to enforce the program requirements contained in VA Manual M5, part IV, which implements the GAO recommendations.

    Recommendation: The Administrator of Veterans Affairs should direct the Chief Medical Director to enforce compliance with quality assurance procedures. Specifically, the domiciliaries should: (1) perform all required medical examinations; (2) develop required therapeutic treatment plans within the established time frames; and (3) document medical diagnoses, planned treatment, and treatment results in patients' medical records.

    Agency Affected: Veterans Administration


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