VA Health Care: Additional Data Needed to Inform the COVID- 19 Response in Community Living Centers
Fast Facts
About 9,000 veterans a day receive nursing home care in 134 VA community living centers. We reviewed the data VA has on COVID-19 cases and deaths at these facilities.
Since November 2020, the 5 highest case rates at these facilities ranged from 38% to 59% of residents. The 5 highest death rates ranged from 6% to 11% of residents.
The VA has been compiling and reviewing resident COVID-19 data by facility since November, but it hasn't been doing the same for facility staff.
We recommended that VA regularly compile and review staff COVID-19 data by facility.
Highlights
What GAO Found
Since November 2020, the Department of Veterans Affairs (VA) has had facility-specific data on Coronavirus Disease 2019 (COVID-19) cases and deaths among residents in Community Living Centers (CLC), which are VA-owned and -operated nursing homes. According to officials, VA compiles and reviews these data on at least a monthly basis. Officials stated that they report these data to VA leadership if they determine that the data indicate a change to current policy or practice related to the response to the pandemic in CLCs is needed. Based on GAO's analysis, these data indicate that the five highest cumulative case rates among VA's 134 individual CLCs ranged from 38 to 59 percent of total residents, and the five highest cumulative death rates ranged from 6 to 11 percent of total residents, for the period March 1, 2020, through February 14, 2021.
While VA has facility-specific data on COVID-19 cases and deaths among CLC residents, the agency does not have such data for CLC staff. Officials indicated it is challenging to identify staff who worked in a CLC in existing employee data on COVID-19. However, Centers for Disease Control and Prevention (CDC) guidance recommends that officials should have data on public health emergencies by specific populations and by locality to develop appropriate responses. GAO's prior work also identified the importance of reporting COVID-19 data by demographic group and geographic location.
Until VA has such facility-specific data for CLC staff, compiled and reviewed on a regular basis and reported to leadership as needed, VA will not have complete information on the extent of the pandemic in CLCs. VA could use facility-specific staff data to monitor the extent of morbidity and mortality in CLCs individually, regionally, or nationally among both residents and staff; identify local or regional trends in infection rates among both populations; and oversee whether CLCs have taken appropriate steps to mitigate the spread of COVID-19 to protect both veterans and employees in this nursing home setting. VA could then better allocate resources when and where they are needed most. This type of surveillance—that is, facility-specific data collection and reporting—is critical for VA to manage not just the current pandemic but also future infectious disease outbreaks among the vulnerable CLC population. GAO recommends that the Department of Veterans Affairs Under Secretary for Health compile and review facility-specific COVID-19 data on Community Living Center staff cases and deaths on a regular basis to inform the agency's response to the pandemic or future infectious disease outbreaks. VA concurred with GAO's recommendation in principle.
Why GAO Did This Study
VA provides or pays for nursing home care for approximately 9,000 veterans per day in three nursing home settings, including in 134 VA-owned and -operated CLCs. The health and safety of the nation's nursing home residents—often in frail health and living in close proximity to one another—has been of particular concern since the emergence of COVID-19, a new and highly contagious respiratory disease causing severe illness and death, particularly among the elderly. VA has issued guidance on national surveillance (data collection and reporting) of COVID-19 case growth across the VA health care system to inform resource allocation, maximize clinical care, and predict future trends in the pandemic.
The CARES Act includes a provision that GAO monitor the federal response to the pandemic. In this report, GAO examined the extent to which VA has data on COVID-19 cases and deaths among CLC residents and staff. Future GAO work will address more broadly selected CLCs' experiences responding to the pandemic and VA's oversight of this response.
To examine this issue, GAO interviewed VA officials about and analyzed the available data on COVID-19 cases and deaths among CLCs. GAO evaluated the available data against CDC guidance on national surveillance of public health events, such as the COVID-19 pandemic, among other criteria.
Recommendations
GAO recommends that the Department of Veterans Affairs Under Secretary for Health compile and review facility-specific COVID-19 data on Community Living Center staff cases and deaths on a regular basis to inform the agency’s response to the pandemic or future infectious disease outbreaks. VA concurred with GAO’s recommendation in principle.
Recommendations for Executive Action
| Agency Affected | Recommendation | Status |
|---|---|---|
| Office of the Under Secretary for Health | The Department of Veterans Affairs Under Secretary for Health should compile and review facility-specific COVID-19 data on Community Living Center staff cases and deaths on a regular basis to inform the agency's response to the pandemic or future infectious disease outbreaks. (Recommendation 1) |
The Department of Veterans Affairs (VA) concurred with our recommendation in principle. Specifically, VA agreed with the importance of tracking COVID-19 cases and deaths among its medical center staff but noted the difficulty of disaggregating these data by Community Living Center (CLC) staff-which the agency reiterated in subsequent follow-up in July 2022 and March 2023. Notably, we made this recommendation in June 2021, one year after the beginning of the COVID-19 pandemic and when nursing home staff were at elevated risk for contracting COVID-19 while working in these facilities or transmitting the virus to residents. However, as we approach the fourth year since the beginning of the pandemic, the recommendation remains unimplemented. In May 2023, the World Health Organization declared an end to the COVID-19 pandemic. Although VA continues to track COVID-19 among its medical center staff, officials told us that since early 2021 the agency's attention has shifted to vaccination efforts. As such, at this point, any VA effort to identify an information technology solution that would allow it to accurately disaggregate data on COVID-19 cases and deaths by CLC staff could detract resources the agency would otherwise use to support veteran care or more current information technology needs, such as its electronic health record transition. As such, we are closing this recommendation as no longer valid.
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