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.
Recommendations for Executive Action
|Department of Defense||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.|
|Department of Defense||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.|
|Department of Defense||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.|
|Department of Defense||To improve health care oversight at AFRH, the Secretary of Defense should ensure that the Local Boards are allowed to fulfill their advisory roles.|