Summary

The Department of Veterans Affairs (VA) reported spending $1.6 billion in fiscal year 1995 on nursing home care for nearly 80,000 veterans--about 14 percent of the estimated demand by veterans for such care. VA provides nursing home care in its own facilities, contracts with community nursing homes, and pays state veterans' homes part of the cost to care for veterans. All veterans are eligible for nursing home care essentially on a first-come, first-served basis within VA's budget constraints. As the number of veterans aged 65 and older increases to 9.3 million by the year 2000, the demand for nursing home care will likely rise. The funds for VA nursing home care, however, are expected to be limited. This report provides information on the (1) distribution of veterans in VA, community, and state nursing homes; (2) costs to VA for these nursing homes; (3) factors affecting VA's use of community and state veterans' nursing homes; and (4) relative quality of the care provided by VA, community, and state veterans' homes.

GAO found that: (1) the number of veterans receiving VA-financed or -provided nursing home care increased from 72,889 in 1985 to 79,373 in 1995, though the costs of these services increased from about $710 million to $1.6 billion in the same period; (2) among veterans currently receiving VA-financed or -provided nursing home care, 40 percent receive such care in VA nursing homes, 36 percent in state veterans nursing homes, and 24 percent in community nursing homes; (3) VA records for fiscal year 1995 indicate that VA's daily per patient cost was $213.17 for veterans in VA nursing homes, $118.12 for veterans in community nursing homes, and $35.37 for veterans in state veterans homes; (4) some of the cost differences are attributable to differing patient mix and staffing patterns among the facility types, but the precise cost differences cannot be determined because of weaknesses in VA's cost data; (5) several factors influence VA decisions on where to place nursing home patients; (6) VA's use of state veterans homes is limited by the number of such beds available and by some states' criteria for admitting veterans to these homes; (7) the VA nursing homes GAO visited appeared to provide more comprehensive care to veterans than most of the community and state veterans nursing homes GAO visited; (8) although the care provided in the community and state homes GAO visited generally met quality standards, GAO identified quality-of-care issues at both types of homes; and (9) although VA has initiated efforts to improve its data on the cost of providing and purchasing nursing home care, the availability of nursing home beds in local markets, and the adequacy of VA reimbursement rates to purchase quality nursing home care for veterans, better information is still needed for VA to make informed resource management decisions.