Armed Forces Retirement Home: Health Care Oversight Should Be Strengthened
Highlights
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
Recommendations for Executive Action
| Agency Affected | Recommendation | Status Sort descending |
|---|---|---|
| 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. |
Closed – Implemented
To improve the health care oversight at the Armed Forces Retirement Home (AFRH), we recommended that the Secretary of Defense refocus the service inspector general inspections on health care, particularly the in the independent and assisted living settings, which are not covered by external accreditation. On June 2, 2007, AFRH leadership met with the Commission on Accreditation of Retirement Facilities/Continuing Care Accreditation Commission (CARF/CCAC) and requested they provide accreditation services and survey independent, assisted living, and long-term care during the summer 2008 timeframe. DOD also initiated a dialogue with the U.S. Army Inspector General's office to ensure a comprehensive medical review is included as part of their triennial inspection to be conducted in 2008, consistent with statute. They will have access to CARF-CCAC standards.
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| 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. |
Closed – Implemented
As we recommended, DOD has taken steps to ensure that service inspector general (IG)inspections of the Armed Forces Retirement Home (AFRH) do not occur in the same year as accreditation. At the time we issued our report, the Joint Commission accredited the nursing home and clinic at AFRH but there was no external oversight of independent or assisted living. To address this gap in oversight, AFRH is contracting with the Commission on Accreditation of Retirement Facilities/Continuing Care Accreditation Commission (CARF-CCAC)to inspect AFRH in 2008. After this accreditation cycle is complete, DOD will work with the accrediting body to ensure accreditation surveys and IG inspections are done in alternating years.
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| 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. |
Closed – Implemented
GAO found that the service inspector general (IG) was not given access to the 2005 Joint Commission accreditation report so that it could follow with the the Armed Forces Retirement Home to ensure that it was taking appropriate corrective actions. We recommended that DOD ensure that the service IGs have access to all relevant data on Joint Commission inspections. In responding to our draft report, DOD indicated that it will ensure that service IG teams have access to all relevant data on all independent accreditation inspections.
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| 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. |
Closed – Implemented
GAO found that statutorily created local advisory boards at the Armed Forces Retirement Home were not fulfilling their advisory role. In responding to our draft report, DOD indicated that it would appoint new members to the local boards, outline their expected roles and responsibilities, and ensure appropriate follow-up. In July 2007, DOD indicated that it had approved a revised local advisory board(s) construct and member ship appointment letters would be issued soon. The new board(s) will meet in September 2007.
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