GAO: VA hospitals limit vets’ access to long-term care services

A majority of veterans hospitals do not offer all of the long-term care services mandated by a 1999 law, according to a new report from the General Accounting Office.

The Veterans Millennium Health Care and Benefits Act of 1999 required that the Veterans Affairs Department provide three noninstitutional or off-site health care services for veterans: adult day health care, geriatric evaluation, and respite care, or short-term, temporary care. But a recent GAO investigation found that the majority of VA medical facilities either did not offer the services or only provided a service for a portion of the geographic area they served.

"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," GAO said in its report, "VA Long-Term Care: Service Gaps and Facility Restrictions Limit Veterans' Access to Noninstitutional Care" (03-487).

While most of VA's 139 facilities offered other long-term care services, such as home health care and home health aid services, just 33 offered respite care, one of the services mandated by the Millennium Act. More than 50 VA health facilities did not offer geriatric evaluation and more than 40 did not offer adult day health care.

And though VA caregivers can arrange for veterans to receive the mandated services through other sources using a case management system, VA leadership has yet to issue guidance on that approach and does not monitor whether its facilities are even taking advantage of that option, GAO found.

"VA has not provided sufficient guidance to clear up confusion at facilities as to how noninstitutional respite care services are provided or to make clear which home health services facilities must provide," the report said.

The watchdog agency also discovered that some VA facilities limited access to the three services by imposing their own eligibility criteria for accessing the services, such as whether or not the veteran's disability is due to a service-related injury. "These restrictions conflict with VA eligibility standards and result in inequitable access for veterans enrolled at these facilities," the report said.

To remedy the situation, GAO recommended VA officials specify in department policy which services facilities are required to provide, ensure that hospital officials adhered strictly to VA's eligibility standards, and tweak performance measurements to guarantee that VA facilities are providing access to all the required long-term care services.

In a written response, VA Secretary Anthony Principi said he agreed with GAO's recommendations.