Veterans' Health Care

In fiscal year 1994, the Department of Veterans Affairs (VA) provided home health care to more than 40,000 veterans at a cost of $64 million to VA and millions more to Medicare. By providing them with home health care, VA allows these veterans to continue living at home and in their communities, rather than receive care in institutions. Veterans may need home health care for various reasons. Some veterans may have chronic health problems, such as heart disease, and require periodic visits, while others may be discharged from VA medical centers following surgery and need dressings changed or medications administered. The number of veterans needing home health care is expected to grow as the veteran population ages and as VA discharges patients from its hospitals to reduce the costs of hospitalization. This report provides information on (1) the characteristics and the services of the home health care programs that VA uses, (2) the available data on program costs, and (3) the way in which VA ensures that veterans receive quality service.

GAO found that: (1) most veterans receive home health care services from community-based providers through either the VA fee-based program or Medicare's home health care benefit; (2) most veterans in these programs receive short-term home health care services for acute medical conditions, while some veterans receive long-term care for chronic conditions; (3) VA provides in-home physician, nursing, social work, and dietician services to veterans with chronic conditions through its Hospital-Based Home Care (HBHC) program; (4) VA makes decisions about using HBHC programs based on its perception of relative costs, since comparable cost data are not available; (5) HBHC program costs are based on data developed by hospitals that support the programs, while VA reported fee-based program costs represent payments made to providers and exclude certain administrative costs; (6) VA monitors the quality of care provided by HBHC programs more directly than it does community-based care; and (7) licensing and certification assessments of community-based providers provide VA assurance that care is provided by qualified sources, but VA is ultimately responsible for ensuring the quality of care in its programs.