GAO Report to Congressional Requesters

VA LONG TERM CARE: Service Gaps and Facility Restrictions Limit Veterans' Access to Non-institutional Care

With the aging of the veteran population, the Department of Veterans Affairs (VA) is likely to see a significant increase in demand for long-term care. In response to recent GAO findings that variation exists in availability of non-institutional services across VA, GAO was asked to update and expand its previous work to determine (1) whether veterans access to six non-institutional services is limited by service availability and restrictions on use and (2) if access is limited, what factors contribute to limited access. GAO surveyed VAs 139 medical facilities, visited 4 of them and updated information collected from a fifth facility visited during earlier work, and interviewed headquarters and field officials.

Veterans access to the six non-institutional services we reviewed is limited by service gaps and facility restrictions. Of VAs 139 facilities, 126 do not offer all six of these services: adult day health care, geriatric evaluation, respite care, home-based primary care, homemaker/home health aide, and skilled home health care. Veterans have the least access to respite care, which is not offered at 106 facilities. By contrast, skilled home health care is not offered at 7 facilities. Veterans access is more limited than these numbers suggest, however, because even when facilities offer these services they often do so in only part of the geographic area they serve. In fact, for four of the six services the majority of facilities either do not offer the service or do not provide access to all veterans living in their geographic service area. Veterans access may be further limited by restrictions that individual facilities set for use of services they offer. For example, at least 9 facilities limit veterans eligibility to receive noninstitutional services based on their level of disability related to military service, which conflicts with VAs eligibility standards. Further, restrictions placed by many facilities on the number of veterans who can receive noninstitutional services have resulted in veterans at 57 of VAs 139 facilities being placed on waiting lists for noninstitutional services.