VA Long-Term Care: Oversight of Community Nursing Homes Needs Strengthening

A letter report issued by the General Accounting Office with an abstract that begins "The Department of Veterans Affairs (VA) spent about $1.9 billion--or about 10 percent of its health care budget--to provide nursing home care to veterans in fiscal year 2000. VA will likely see increasing demand for nursing home care during the next decade. The number of veterans age 85 and older is expected to triple--from 422,000 veterans in 2000 to nearly 1.3 million in 2010. Among the very old, the prevalence of chronic health conditions and disabilities increases markedly. In addition, VA is required to provide long-term care to some veterans, which may further increase veterans' demand for nursing home care. Almost 73 percent of VA's nursing home care in fiscal year 2000 went to VA's 134 nursing homes; the rest went to state-owned and operated veterans' nursing homes (15 percent) or to community nursing homes under local or national contract to VA (12 percent). VA generally requires its medical center staff to conduct annual inspections of state veterans' homes and community nursing homes; it also requires monthly staff visits to veterans in community nursing homes. However, VA plans to change its oversight of community nursing homes, eliminating the requirement for annual VA inspections and instead relying on Medicare and Medicaid certification inspections done by state agencies under contract to the Centers for Medicare and Medicaid Services (CMS). This report reviews (1) VA's policies for overseeing state veterans' homes and community nursing homes, including the mechanisms available to VA to ensure that nursing homes correct problems, and the extent to which VA has followed these policies and (2) planned changes in VA's oversight policies and the strategies to implement them. GAO found that VA's adherence to its oversight policies for state veterans' homes and community nursing homes has been mixed because of a lack of VA monitoring and oversight. VA medical staff are required to inspect each state veterans' home annually, and of the 86 inspections reviewed by GAO, about 85 percent were done within the time frame or shortly thereafter. VA lacks a departmentwide approach to monitoring medical centers' community nursing home oversight activities and enforcing VA's oversight policies--particularly regarding locally contracted homes, which make up about 75 percent of the community nursing homes under contract to VA--and individual medical centers vary in how well they have overseen community nursing homes. Under its planned policy change, VA would eliminate the requirement for annual inspections of community nursing homes and instead would rely on Medicare and Medicaid certification inspections. Local VA medical centers' staff will review state inspection reports and CMS data to evaluate community nursing homes. However, the quality of state inspections of nursing homes varies, and CMS is unable to accurately assess state inspection results in all cases.