VA Long-Term Care: Service Gaps and Facility Restrictions Limit Veterans' Access to Noninstitutional Care
GAO-03-487
Published: May 09, 2003. Publicly Released: May 22, 2003.
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Highlights
In April 2002, at the request of the Senate Committee on Veterans' Affairs, we testified on variation in the availability of VA's noninstitutional long-term care services. Congress expressed concern that this variation could mean that some veterans did not have access to noninstitutional services because of gaps in service availability and because of the restrictions that some facilities might place on veterans' use of these services, such as limiting the amount of service a veteran may receive. To address these concerns, we updated and expanded our previous work to determine (1) whether veterans' access to six noninstitutional services is limited by service availability and restrictions on use and (2) if access is limited, what factors, contribute to limited access.
Recommendations
Recommendations for Executive Action
| Agency Affected | Recommendation | Status |
|---|---|---|
| Department of Veterans Affairs | To increase access to noninstitutional long-term care services and make access more even across networks and facilities, the Secretary of Veterans Affairs should direct the Under Secretary for Health to ensure that facilities follow VA's eligibility standards when determining veteran eligibility for noninstitutional long-term care services. |
Closed – Not Implemented
In previous updates VA had mentioned monitoring electronic waiting lists to ensure ongoing compliance, but now reports that such efforts are better directed in monitoring VISN workload activity in relation to assigned targets. VA states that reports on home & and community-based care (H&CBC) census levels in comparison to targets are generated for each network on a monthly basis and are shared with the Deputy Under Secretary for Health for Operations and Management and VISN leadership. As of September 2007, the agency has a particular focus on H&CBC workload in selected networks which had experienced difficulty in reaching target levels over the past three years. While these efforts could be useful in addressing the recommendation, they do not ensure that facilities follow VA's eligibility standards when determining eligibility for noninstitutional long-term care services.
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| Department of Veterans Affairs | To increase access to noninstitutional long-term care services and make access more even across networks and facilities, the Secretary of Veterans Affairs should direct the Under Secretary for Health to define and provide guidance on noninstitutional respite care. |
Closed – Implemented
VA issued a respite care handbook (VHA Handbook 1140.2) on May 15, 2003. The handbook provides a definition of respite care and gives guidance on the provision of respite care in noninstitutional settings. The handbook states that VA may provide noninstitutional respite care in-home as well as in adult day health care facilities. In-home respite care can be provided by homemaker/home health aide programs. In addition, the handbook clarifies that "a day" of noninstitutional respite is defined as any single day in which respite is provided for up to six hours of care in the home and greater than four hours of care in an adult day health care center.
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| Department of Veterans Affairs | To increase access to noninstitutional long-term care services and make access more even across networks and facilities, the Secretary of Veterans Affairs should direct the Under Secretary for Health to specify in VA policy whether home-based primary care, homemaker/home health aide, and skilled home health care are to be available to all enrolled veterans. |
Closed – Implemented
VA published an information letter on October 1, 2003, which clarified that, according to VA policy, home-based primary care, homemaker/home health aide, and skilled home health care are to be available for all enrolled, eligible veterans in need of such services. Facilities may directly provide or purchase these services for veterans. The letter was distributed to all facilities through email and is available on the VA web site.
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| Department of Veterans Affairs | To increase access to noninstitutional long-term care services and make access more even across networks and facilities, the Secretary of Veterans Affairs should direct the Under Secretary for Health to refine current performance measures to help ensure that all VA facilities provide veterans with access to required noninstitutional services. |
Closed – Not Implemented
VA reports that it has created a mandate that all Veterans Affairs Medical Centers (VAMC) operate a minimum number (six of eight or seven of nine) of home-based long-term care services. VA reports it also expanded its oversight and monitors for low performing networks. While these actions could be useful in addressing GAO's recommendation, it does not ensure that all services are offered at all facilities as required.
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Topics
Elder careHealth care costsHealth care facilitiesHome health care servicesLong-term careVeterans benefitsVeteransRespite careMedical facilitiesPrimary care