Summary

VA Long-Term Care: Service Gaps and Facility Restrictions Limit Veterans' Access to Noninstitutional Care

GAO-03-487  May 9, 2003

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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.

Veterans' access to the six noninstitutional long-term care services in our study is limited by the lack of service availability and restrictions on their use. Of VA's 139 facilities, 126 do not offer all six of the services. Veterans have the least access to noninstitutional respite care, which is not offered by 106 VA facilities. By contrast, skilled home health care is not offered at 7 facilities. Furthermore, veterans' access to care is more limited than these numbers suggest, because even when facilities offer these services they often do so in only parts of the geographic area they serve. In fact, for four of the six services--noninstitutional respite care, home-based primary care, adult day health care, and noninstitutional geriatric evaluation--the majority of facilities either do not offer the service or do not offer the service in the entire geographic area they serve. Veterans' access may be further limited by restrictions that individual facilities set for use of services they offer. For example, 9 facilities, in conflict with VA's eligibility standards, limited veterans' access to noninstitutional services based on their level of disability related to military service. Further, restrictions placed by many facilities on the number of veterans who can receive noninstitutional services have resulted in veterans at 57 of VA's 139 facilities being placed on waiting lists for noninstitutional services. VA's lack of emphasis on increasing access to noninstitutional long-term care services and a lack of guidance on the provision of these services have contributed to service gaps and individual facility restrictions. VA headquarters has not emphasized increasing access to these services by establishing measurable performance goals as it has for other priorities such as maintaining workloads in VA nursing homes. Without such performance measures, field officials faced with competing priorities have chosen to use available resources to address other priorities. VA has implemented a performance measure for fiscal year 2003 that encourages networks to increase veterans' use of five of the six noninstitutional services, but it does not require networks to ensure that all network facilities provide veterans access to noninstitutional services. Moreover, VA has not provided facilities with adequate guidance on the provision of noninstitutional respite care, even though most have had little experience in providing the service. Some networks and facilities are confused about how to provide the service and as a result some are not providing the service. VA has also not provided adequate guidance on which noninstitutional services are required. In particular, VA has not specified whether the home health services requirement includes one, all, or some combination of home-based primary care, homemaker/home health aide, and skilled home health care. In the absence of VA headquarters guidance on what home health services are required, VA facilities vary in their interpretations of what services they must provide.

Subject Terms

Elder care
Health care costs
Health care facilities
Home health care services
Long-term care
Veterans benefits