VA Long-Term Care
Service Gaps and Facility Restrictions Limit Veterans' Access to Noninstitutional Care
Gao ID: GAO-03-487 May 9, 2003
In April 2002, at the request of the Senate Committee on Veterans' Affairs, we testified on variation in the availability of VA's noninstitutional long-term care services. Congress expressed concern that this variation could mean that some veterans did not have access to noninstitutional services because of gaps in service availability and because of the restrictions that some facilities might place on veterans' use of these services, such as limiting the amount of service a veteran may receive. To address these concerns, we updated and expanded our previous work to determine (1) whether veterans' access to six noninstitutional services is limited by service availability and restrictions on use and (2) if access is limited, what factors, contribute to limited access.
Veterans' access to the six noninstitutional long-term care services in our study is limited by the lack of service availability and restrictions on their use. Of VA's 139 facilities, 126 do not offer all six of the services. Veterans have the least access to noninstitutional respite care, which is not offered by 106 VA facilities. By contrast, skilled home health care is not offered at 7 facilities. Furthermore, veterans' access to care is more limited than these numbers suggest, because even when facilities offer these services they often do so in only parts of the geographic area they serve. In fact, for four of the six services--noninstitutional respite care, home-based primary care, adult day health care, and noninstitutional geriatric evaluation--the majority of facilities either do not offer the service or do not offer the service in the entire geographic area they serve. Veterans' access may be further limited by restrictions that individual facilities set for use of services they offer. For example, 9 facilities, in conflict with VA's eligibility standards, limited veterans' access to noninstitutional services based on their level of disability related to military service. Further, restrictions placed by many facilities on the number of veterans who can receive noninstitutional services have resulted in veterans at 57 of VA's 139 facilities being placed on waiting lists for noninstitutional services. 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. VA headquarters has not emphasized increasing access to these services by establishing measurable performance goals as it has for other priorities such as maintaining workloads in VA nursing homes. Without such performance measures, field officials faced with competing priorities have chosen to use available resources to address other priorities. VA has implemented a performance measure for fiscal year 2003 that encourages networks to increase veterans' use of five of the six noninstitutional services, but it does not require networks to ensure that all network facilities provide veterans access to noninstitutional services. Moreover, VA has not provided facilities with adequate guidance on the provision of noninstitutional respite care, even though most have had little experience in providing the service. Some networks and facilities are confused about how to provide the service and as a result some are not providing the service. VA has also not provided adequate guidance on which noninstitutional services are required. In particular, VA has not specified whether the home health services requirement includes one, all, or some combination of home-based primary care, homemaker/home health aide, and skilled home health care. In the absence of VA headquarters guidance on what home health services are required, VA facilities vary in their interpretations of what services they must provide.
Recommendations
Our recommendations from this work are listed below with a Contact for more information. Status will change from "In process" to "Open," "Closed - implemented," or "Closed - not implemented" based on our follow up work.
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GAO-03-487, VA Long-Term Care: Service Gaps and Facility Restrictions Limit Veterans' Access to Noninstitutional Care
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Report to Congressional Requesters:
United States General Accounting Office:
GAO:
May 2003:
VA LONG-TERM CARE:
Service Gaps and Facility Restrictions Limit Veterans' Access to
Noninstitutional Care:
GAO-03-487:
GAO Highlights:
Highlights of GAO-03-487, a report to Congressional Requesters
Why GAO Did This Study:
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 noninstitutional services across VA, GAO was
asked to update and expand its previous work to determine (1) whether
veterans‘ access to six noninstitutional services is limited by
service availability and restrictions on use and (2) if access is
limited, what factors contribute to limited access. GAO surveyed VA‘s
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.
What GAO Found:
Veterans‘ access to the six noninstitutional services we reviewed is
limited by service gaps and facility restrictions. Of VA‘s 139
facilities, 126 do not offer all six of these services¾adult 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 VA‘s 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 VA‘s 139 facilities being placed on waiting lists for noninstitutional services.
[See PDF for image]
[End of figure]
VA‘s lack of emphasis on increasing access to noninstitutional long-
term care services has contributed to service gaps and individual
facility restrictions that limit access to care. Without emphasis
from VA headquarters on the provision of noninstitutional services,
field officials faced with competing priorities have chosen to use
available resources to address other priorities. While VA has
implemented a performance measure for fiscal year 2003 that encourages
networks to increase veterans‘ use of five of the six noninstitutional
services, it does not require networks to ensure that all facilities
provide veterans access to noninstitutional services.
What GAO Recommends:
GAO is recommending that VA:
* ensure that facilities follow VA‘s eligibility standards when
determining veteran eligibility for noninstitutional long-term care
services, and
* refine current performance measures to help ensure that all VA
facilities provide veterans with access to required noninstitutional
services.
VA concurred with the recommendations.
www.gao.gov/cgi-bin/getrpt?GAO-03-487.
To view the full report, including the scope
and methodology, click on the link above.
For more information, contact Cynthia A. Bascetta at (202) 512-7101.
[End of section]
Contents:
Letter:
Results in Brief:
Background:
Veterans' Access Is Limited by Gaps in Service Availability and
Facility Restrictions on Service Use:
Lack of Emphasis, Inadequate Guidance, and Other Factors Contribute to
Limited Access:
Conclusions:
Recommendations for Executive Action:
Agency Comments:
Appendix I: VA Noninstitutional Long-Term Care Services in
Our Review:
Appendix II: Scope and Methodology:
Appendix III: Availability and Utilization of Six Noninstitutional
Long-Term Care Services by VA Medical Facility or Health Care System:
Appendix IV: Comments From the Department of Veterans Affairs:
Appendix V: GAO Contact and Staff Acknowledgments:
GAO Contact:
Acknowledgments:
Related GAO Products:
Tables:
Table 1: VA Long-Term Care Workload and Expenditures, by Care Setting,
Fiscal Year 2002:
Table 2: Noninstitutional Services in Our Review Offered by the Five VA
Facilities We Visited:
Table 3: Availability and Utilization of Six Noninstitutional Long-Term
Care Services at VA Medical Facilities (July 2002):
Figures:
Figure 1: Noninstitutional Long-Term Care Services at VA's 139 Medical
Facilities:
Figure 2: Noninstitutional Long-Term Care Services, Based on Geographic
Areas, at VA's 139 Medical Facilities:
Abbreviations:
HCS: health care system:
VA: Department of Veterans Affairs:
United States General Accounting Office:
Washington, DC 20548:
May 9, 2003:
The Honorable Bob Graham
Ranking Minority Member
Committee on Veterans' Affairs
United States Senate:
The Honorable Lane Evans
Ranking Minority Member
Committee on Veterans' Affairs
House of Representatives:
The Honorable John D. Rockefeller IV
United States Senate:
The Department of Veterans Affairs (VA) spent about $23 billion on
health care in fiscal year 2002, including about $3.3 billion on long-
term care. Demand for VA long-term care is likely to increase
significantly during the next decade. Because of the aging of the
veteran population, VA estimates that the number of veterans age 85 and
older--those most in need of long-term care--will more than double,
from about 640,000 currently to about 1.3 million in 2012. Due to
changes in VA's eligibility standards more older veterans will be
eligible to receive VA health care, including long-term care services.
In recent years, VA has increased the proportion of its long-term care
spending on care in noninstitutional settings, such as veterans' own
homes. This is consistent with the preference of many veterans and
others to receive care in their homes or in other settings, such as
adult day health care centers, that are less restrictive than
institutions. For example, some veterans receive assistance in their
homes with bathing and dressing provided by home health aides. However,
VA has traditionally provided the bulk of veterans' long-term care in
institutional settings, such as nursing homes, which is reflected in
VA's spending for long-term care services. In fiscal year 2001, more
than 90 percent of VA's long-term care spending was for institutional
long-term care.
In November 1999, the Congress passed the Veterans Millennium Health
Care and Benefits Act (Millennium Act),[Footnote 1] which required that
VA provide veterans access to three servicesæadult day health care,
geriatric evaluation, and respite care. VA chose to meet the Millennium
Act requirements by issuing a directive in October 2001 requiring that
facilities provide adult day health care, noninstitutional geriatric
evaluation, and noninstitutional respite care to veterans in need of
such services.[Footnote 2]
In April 2002, at the request of the Senate Committee on Veterans'
Affairs, we testified on variation in the availability of VA's
noninstitutional long-term care services.[Footnote 3] Your offices
expressed concern that this variation could mean that some veterans did
not have access to noninstitutional services because of gaps in service
availability and because of the restrictions that some facilities might
place on veterans' use of these services, such as limiting the amount
of service a veteran may receive. To address these concerns, you asked
us to update and expand our previous work[Footnote 4] to determine (1)
whether veterans' access to six noninstitutional services is limited by
service availability and restrictions on use and (2) if access is
limited, what factors contribute to limited access. The six
noninstitutional services you asked us to examine are the three that VA
requires as a result of the Millennium Actæ adult day health care,
geriatric evaluation, and respite careæand three additional
noninstitutional services--home-based primary care, skilled home
health care, and homemaker/home health aide. See appendix I for
information on these six noninstitutional long-term care services.
To do our work, we surveyed each of VA's 139 medical facilities to
obtain data on the types of services offered and the number of veterans
receiving the six noninstitutional long-term care services,[Footnote 5]
and where access to services was limited, we identified the reasons why
services were limited. We compared these survey data to the data we
obtained in our fall 2001 survey of VA long-term care services to
determine the extent to which availability had changed since that
survey. To gain an understanding of facilities' noninstitutional long-
term care operations we also interviewed VA officials in headquarters
and in each of VA's 21 network offices,[Footnote 6] visited 4 VA
medical facilities--located in Memphis, Tennessee; Richmond, Virginia;
Tucson, Arizona; and Walla Walla, Washingtonæand updated information
collected from a fifth facility in Albany, New York, which we visited
for our previous report on noninstitutional services. These five
facilities were chosen based on variation in both the number and type
of noninstitutional services they offered. In addition, we evaluated
directives and regulations and other guidance related to these six
noninstitutional services issued by VA headquarters, networks, and
individual facilities. For a complete description of our scope and
methodology, see appendix II. Our work was conducted from June 2002
through April 2003 in accordance with generally accepted government
auditing standards.
Results in Brief:
Veterans' access to the six noninstitutional long-term care services in
our study is limited by the lack of service availability and
restrictions on their use. Of VA's 139 facilities, 126 do not offer all
six of the services. Veterans have the least access to noninstitutional
respite care, which is not offered by 106 VA facilities. By contrast,
skilled home health care is not offered at 7 facilities. Furthermore,
veterans' access to care is more limited than these numbers suggest,
because even when facilities offer these services they often do so in
only parts of the geographic area they serve. In fact, for four of the
six servicesænoninstitutional respite care, home-based primary care,
adult day health care, and noninstitutional geriatric evaluationæthe
majority of facilities either do not offer the service or do not offer
the service in the entire geographic area they serve. Veterans' access
may be further limited by restrictions that individual facilities set
for use of services they offer. For example, 9 facilities, in conflict
with VA's eligibility standards, limited veterans' access to
noninstitutional services based on their level of disability related to
military service. Further, restrictions placed by many facilities on
the number of veterans who can receive noninstitutional services have
resulted in veterans at 57 of VA's 139 facilities being placed on
waiting lists for noninstitutional services.
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. VA headquarters has not emphasized increasing access to
these services by establishing measurable performance goals as it has
for other priorities such as maintaining workloads in VA nursing homes.
Without such performance measures, field officials faced with competing
priorities have chosen to use available resources to address other
priorities. VA has implemented a performance measure for fiscal year
2003 that encourages networks to increase veterans' use of five of the
six noninstitutional services, but it does not require networks to
ensure that all network facilities provide veterans access to
noninstitutional services. Moreover, VA has not provided facilities
with adequate guidance on the provision of noninstitutional respite
care, even though most have had little experience in providing the
service. Some networks and facilities are confused about how to provide
the service and as a result some are not providing the service. VA has
also not provided adequate guidance on which noninstitutional services
are required. In particular, VA has not specified whether the home
health services requirement includes one, all, or some combination of
home-based primary care, homemaker/home health aide, and skilled home
health care. In the absence of VA headquarters guidance on what home
health services are required, VA facilities vary in their
interpretations of what services they must provide.
To help ensure that veterans have access to noninstitutional long-term
care services and that such services are offered uniformly throughout
VA, we are recommending that VA take actions to increase emphasis on
provision of these services, provide adequate guidance on their
provision, and ensure that VA's eligibility standards are used to
determine eligibility. VA concurred with our recommendations, discussed
preliminary actions it plans to take, and stated that it will provide a
detailed action plan to implement our recommendations after this report
is issued.
Background:
Changes in VA's eligibility standards have resulted in an increase in
the number of veterans who are eligible to receive VA health care,
including noninstitutional long-term care services. The Veterans'
Health Care Eligibility Reform Act of 1996[Footnote 7] authorized VA to
provide health care services not previously available to veterans
without service-connected disabilities or low incomes.[Footnote 8] As
required by the act and due to an anticipated increase in demand for VA
health care from these changes in eligibility, VA established an
enrollment system to manage veterans' access to care. This system
includes eight priority categories for enrollment, with higher priority
given to veterans with service-connected disabilities, lower incomes,
or other recognized statuses such as former prisoners of war. If
sufficient resources are not available to provide care that is timely
and acceptable in quality for all priority groups, the act requires VA
to limit enrollment nationally, consistent with the eight priority
groups. If needed, enrollment restrictions would begin with the lowest
priority category. On January 17, 2003, VA announced that it would no
longer enroll priority 8 veterans, those in the lowest priority
category, for the duration of the year.[Footnote 9]
VA long-term care includes a continuum of services for the delivery of
care to veterans needing assistance due to chronic illness or physical
or mental disability. Assistance with veterans' needs takes many forms
and is provided in varied settings, including institutional care in
nursing homes or in noninstitutional settings preferred by many
veterans, including in-home care services and community-based services
such as adult day health care centers. Long-term care also includes
respite care services that temporarily relieve a veteran's caregiver
from the burden of caring for a chronically ill and disabled veteran in
the home. VA offers long-term care services directly or through other
providers with which VA contracts.
VA provides most of its long-term care to veterans in institutional
settings, such as VA nursing homes or state-owned veterans' homes
rather than in noninstitutional settings. In fiscal year 2002, VA
served about 36 percent of its long-term care workload, or average
daily census, in noninstitutional settings (see table 1). That same
year noninstitutional care accounted for 9 percent of VA's long-term
care expenditures. In contrast, noninstitutional care accounted for
about 29 percent of Medicaid's long-term care expenditures in fiscal
year 2001, the most recent year for which data are available.[Footnote
10]
Table 1: VA Long-Term Care Workload and Expenditures, by Care Setting,
Fiscal Year 2002:
Long-term care setting: Institutional; Average daily census[A]: 43,363;
Total expenditures: $2,979,156,000.
Long-term care setting: Noninstitutional; Average daily census[A]:
24,126; Total expenditures: 283,098,000.
Long-term care setting: Total; Average daily census[A]: 67,489; Total
expenditures: $3,262,254,000.
Source: VA.
[A] The average daily census represents the total number of days of
inpatient care for institutional care and the total number of
outpatient encounters for noninstitutional care, each divided by the
number of days in the year. Thus, the figures represent VA's workload
during the year and not an unduplicated count of veterans in these
settings because some veterans receive more than one service.
[End of table]
VA has delegated decision making regarding financing and service
delivery for long-term care and other health care services to its 21
health care networks. VA allocates resources for health care to each of
the 21 networks primarily through the Veterans Equitable Resource
Allocation system, in which networks are funded through a formula
reflecting the number and types of veterans receiving care in the
network, including those receiving long-term care.[Footnote 11] In
turn, VA's networks have budget and management responsibilities that
include allocating resources received from headquarters to facilities
within their networks--including resources used to provide long-term
care services.
Veterans' Access Is Limited by Gaps in Service Availability and
Facility Restrictions on Service Use:
Veterans' access to the six noninstitutional services in our
reviewæadult day health care, geriatric evaluation, respite care, home-
based primary care, homemaker/home health aide, and skilled home health
care--is limited due to gaps in availability and facility restrictions
on use of the services. Of VA's 139 facilities, 126 do not offer all
six noninstitutional services. Facilities that do offer a service do
not always offer the service to veterans in the entire geographic area
the facility serves. Further, veterans' access to the six
noninstitutional services may be limited by restrictions that
individual VA facilities place on service use. Some of these facility
restrictions conflict with VA eligibility standards which state that
most services are to be available to all enrolled veterans regardless
of priority group. The restrictions include providing services only to
certain veterans or limiting the number of veterans who can use
services at any one time.
Access to Care Is Limited by Service Gaps Across VA:
Access to care is limited because many VA facilities do not offer the
six noninstitutional services in our review. Of VA's 139 facilities,
126 did not offer all of the six noninstitutional services in fall
2002, a pattern similar to that in fall 2001. (See fig. 1.) The least
commonly available service of the six we reviewed in 2001 and 2002 was
noninstitutional respite care. This service was not available at 110 of
VA's 139 facilities in fall 2001, and as of fall 2002, noninstitutional
respite care was not available at 106 of VA's 139 facilities. In
contrast, the most widely available service we reviewed was skilled
home health care, which was offered at all but 7 facilities. For a
complete list of the services each VA facility reported offering, see
appendix III.
Figure 1: Noninstitutional Long-Term Care Services at VA's 139 Medical
Facilities:
[See PDF for image]
Note: Includes services provided directly by facilities or through
contracts with other providers as of fall 2001 and fall 2002.
[End of figure]
Veterans' access to these services is further limited because among
facilities that offer services, many do so in only parts of the
geographic area they serve. Our fall 2002 survey showed that for four
of the six servicesæ noninstitutional respite care, home-based primary
care, adult day health care, and noninstitutional geriatric
evaluationæthe majority of the facilities either did not offer the
service or did not offer the service in the entire geographic area they
serve. As shown in figure 2, 42 facilities did not offer adult day
health care and an additional 76 facilities did not offer it in their
entire geographic service area. As a result, where veterans live in a
facility's geographic service area sometimes determines whether they
can access the services offered by the facility. The remaining 21
facilities reported that they offered adult day health care in all
parts of their geographic service areas.
Figure 2: Noninstitutional Long-Term Care Services, Based on Geographic
Areas, at VA's 139 Medical Facilities:
[See PDF for image]
Note: Includes services provided directly by facilities or through
contracts with other providers as of fall 2002.
[End of figure]
VA may also arrange for veterans to access three noninstitutional long-
term care services from non-VA sources even though VA does not pay for
these services. The Millennium Act and VA policy allow facilities to
make available to veterans the services required as a result of the
Millennium Actæadult day health care, noninstitutional respite care,
and noninstitutional geriatric evaluationæthrough other providers or
payers while still overseeing the care delivered using a case
management approach.[Footnote 12] However, VA headquarters has neither
issued guidance on the use of case management to meet this requirement
under the Millennium Act nor has it monitored the extent to which
facilities use this option. Further, the use of case management by VA
to make these three services available to veterans is limited by the
eligibility of veterans for these other sources of care. That is, if
veterans are not eligible for other sources of care, such as Medicaid
and Medicare, and VA does not provide the service, then veterans will
likely not have access to the three services.
Veterans' Access to Care Is Further Limited by Individual Facility
Restrictions:
Access to care is further limited by the restrictions that some
facilities place on the six noninstitutional services in our review.
These restrictions include (1) limiting services to veterans with
certain levels of service-connected disability, (2) limiting the amount
of service that veterans can receive, and (3) establishing a maximum
number of veterans who can receive a service at any time.
Some Facilities Limit Access to Services Based on Veterans' Service-
Connected Disability Levels:
We found that nine VA facilities imposed their own eligibility
restrictions on access to noninstitutional services based on veterans'
service-connected disabilities. We identified five of these nine
facilities through comments facilities made in our survey, although we
did not systematically ask facilities this question in our survey.
Because we did not systematically ask in our survey, it is possible
that additional facilities may impose similar eligibility restrictions.
Other VA facilities may have also instituted similar restrictions on
access. These restrictions conflict with VA eligibility standards and
result in inequitable access for veterans enrolled at these facilities.
VA's eligibility standards state that most services are to be available
to all enrolled veterans, regardless of priority group.[Footnote 13]
In our survey of VA's 139 facilities, 5 facilities provided additional
comments indicating that they limit certain services--including adult
day health care, homemaker/home health aide, skilled home health, and
respite care--to veterans with service-connected disabilities. Four of
the 5 facilities limit services to veterans with service-connected
disabilities of 70 percent or greater. In addition, one of the
facilities we visited provides homemaker/home health aide services to
veterans with service-connected disabilities of 70 percent or greater.
Another facility we visited provides the service primarily to veterans
with service-connected disabilities of 70 percent or greater or
veterans with service-connected disabilities of at least 60 percent for
a single condition; other veterans may receive the service, but only
for 6 months. In addition, one network official told us that 2
facilities in his network limit homemaker/home health aide services to
veterans with service-connected disabilities of 70 percent or greater
because under the Millennium Act VA must pay for nursing home care when
such veterans need it.[Footnote 14] According to this official, because
homemaker/home health aide services can keep veterans in their own
homes rather than in nursing homes, providing the service to such
veterans can delay the need for nursing home care and the resultant
financial obligation for the facilities.
Access Is also Limited by Restrictions on the Amount of Services
Provided:
The amount of service veterans receive may depend on which facility
provides their care. Facilities vary in the limits they set. Some
facilities restrict the amount of a noninstitutional service a veteran
can receive once the veteran has been authorized to receive care. For
example, a network official told us that one network facility offers
veterans up to 24 hours per week of homemaker/home health aide services
while a facility official in another network told us their facility
provides no more than 10 hours per week. A facility we visited in
another network does not place any restrictions on the amount of
homemaker/home health aide services provided.
Facility officials noted that they can serve more veterans if they
limit the amount of service provided to each veteran. One facility we
contacted provided veterans no more than 2 days per week of adult day
health care. Because of this restriction, veterans whose medical needs
require more adult day health care pay for the service themselves, find
another payer such as Medicaid, or forego the additional service. At
another facility we visited, veterans without service-connected
disabilities were limited to 2 full days or 3 half days per week
regardless of medical need. In 1998, this facility also reduced the
number of homemaker/home health aide hours provided each week from 21
to 8 in order to increase the number of veterans who could be provided
the service. At both facilities, officials emphasized that the purpose
of limits on the amount of service provided was to increase the number
of veterans who could receive at least some of the service.
Access at Many Facilities Is Restricted by Limits on the Number of
Veterans Served:
In our survey of VA facilities, 57 of 139 facilities reported
maintaining a list of veterans waiting for at least one of the services
in our review. These facilities told us in effect that they are not
meeting all their veterans' needs for noninstitutional services. Many
facilities place limits on the total number of veterans they serve by
establishing a budget cap--the maximum number of veterans who can
receive a particular service at any time. For three of the six services
in our study--home-based primary care, homemaker/home health aide, and
noninstitutional geriatric evaluation--most facilities reported in our
survey that despite offering the service, they were currently unable to
provide services to additional veterans within their budget caps.
Additional veterans needing services would have to wait until space or
resources became available.
Lack of Emphasis, Inadequate Guidance, and Other Factors Contribute to
Limited Access:
A lack of VA emphasis on increasing access to noninstitutional long-
term care services, inadequate VA guidance on providing these services,
and other factors have contributed to limited access for veterans. VA
had not provided measurable standards for the provision of these
services until fiscal year 2003 or oversight to monitor their provision
as it has for high-priority services. VA guidance on the provision of
noninstitutional long-term care services has left unclear to some
facilities how one service is to be defined and provided and whether
some of the services in our review are a part of what VA requires be
made available to veterans who need them. Other factors, such as
availability of contractors to provide a service, also contribute to
the lack of access for specific services.
VA Has Not Emphasized Increased Access to Noninstitutional Long-Term
Care Services:
VA network and facility officials told us that VA headquarters has not
emphasized increased access to noninstitutional long-term care services
but emphasized other priorities. As a result, these officials said they
use their resources for the priorities VA headquarters emphasizes
rather than noninstitutional services. For example, officials in 9 of
VA's 21 networks told us that VA headquarters' emphasis on the
performance measure that requires networks to maintain workload in VA
nursing homes has led them to devote resources to nursing home care
that they might otherwise have used to provide noninstitutional
services. One network director told us that the "pressure" from VA
headquarters to maintain nursing home utilization is much greater than
that to offer noninstitutional services. In another network, an
official at a VA facility not offering three of the services in our
study told us that these services were "victims of competition for
resources." In other words, the facility had not funded these three
noninstitutional services because facility officials had chosen to
devote resources to other services. Another network director told us
that, if forced to choose between funding different services, the
network would allocate resources to services included in a performance
measure.
One way VA emphasizes services is through performance measures, which
VA establishes to monitor network officials' progress toward meeting
certain VA strategic goals, such as increasing veteran access to
services. VA has demonstrated that requiring network officials to meet
measurable performance standards can promote change. For example, since
their inception in fiscal year 1996 VA performance measures have
included a measure for providing immunizations to prevent pneumonia to
veterans age 65 and older and those at high risk of the disease. VA
increased the percentage of veterans in this population who received
the immunization from 26 percent in fiscal year 1996 to 81 percent in
fiscal year 2002.
In October 2002, VA introduced a performance measure for
noninstitutional long-term care which requires all networks to provide
noninstitutional services to a portion of their enrolled veterans
needing such servicesæ14.4 percent in fiscal year 2003 and 16 percent
in fiscal year 2006.[Footnote 15] The fiscal year 2003 goal for this
measure will require the majority of networks to increase utilization
of their noninstitutional services. The performance measure includes
five of the services in our review but does not include
noninstitutional geriatric evaluation. However, the performance
measure does not require networks to ensure that veterans can access
noninstitutional long-term care services at all network facilities.
Instead, network targets can be achieved in the current performance
measure if networks increase utilization at facilities that already
offer noninstitutional services.
VA Has Provided Inadequate Guidance on the Provision of
Noninstitutional Respite Care:
VA headquarters has provided inadequate guidance to networks and
facilities on the provision of noninstitutional respite care to address
confusion in the field about what this service is and how it should be
provided. This confusion exists, in part, because VA has limited
experience with noninstitutional respite care and VA traditionally
provided respite care in institutions such as nursing homes.
Noninstitutional respite care, by contrast, is provided only in
noninstitutional settings, such as a veteran's own home.
Although noninstitutional respite care has been required by VA for over
a year, VA has not issued adequate guidance on the provision of
noninstitutional respite care and VA staff told us they were unsure how
to develop a noninstitutional respite care service. VA issued a
directive in October 2001 that requires all facilities to provide
noninstitutional respite care to veterans in need of the service yet it
inadequately defines noninstitutional respite care and does not provide
facilities with information regarding how to provide the service. For
example, the directive states that noninstitutional respite care may be
provided in a home or other noninstitutional settings. However, it does
not specify which noninstitutional settings may be used for the purpose
of respite care. In fact, officials in 6 of the 21 networks we
contacted indicated that there was confusion in their networks about
how to establish noninstitutional respite care programs and 1 of these
networks reported this was the reason facilities in the network were
not providing the service. Further, in our survey, six facilities
reported that they offer noninstitutional respite care in community
nursing homes, which are institutional settings, thus not meeting the
requirement for noninstitutional respite care. VA headquarters
officials said they are developing a handbook that will define and
provide guidance on the provision of noninstitutional respite care.
VA Guidance Does Not Specify Which Home Health Services Are Required:
VA requires that facilities offer a home health service benefit as part
of VA's medical benefits package.[Footnote 16] VA headquarters
officials told us that the home services benefit includes home-based
primary care, homemaker/home health aide, and skilled home health care.
However, VA policy does not specify whether one, some combination, or
all three home health services are required under the home health
services benefit. Currently 138 out of VA's 139 facilities offer at
least one of these three home health services, 59 facilities offer two
of the three services, and 66 facilities offer all three. Without clear
guidance to facilities on what services they must make available in
order to fulfill the home health services benefit, facilities vary in
their interpretation of what is included in the benefit and
headquarters cannot ensure that veterans have access to the services to
which they are entitled.
Because facilities and networks vary in their interpretation of what is
included in the home health services benefit, facilities do not
uniformly offer the same home health services. For example, at one
facility we visited, an official told us that the facility interpreted
the home health services benefit to mean that veterans must have access
to skilled home health care--which the facility made available to all
veterans. The facility restricted veterans' access to its homemaker/
home health aide and home-based primary care services because facility
officials did not believe these services were required under the home
health benefit. Similarly, in another network an official told us that
the network interpreted the home health services benefit to include all
three home care servicesæhome-based primary care, homemaker/home health
aide, and skilled home health care. As a result, access to these three
services varies according to facility interpretation of what is
required. Without clear guidance to facilities on what services they
must make available in order to fulfill the home health care services
requirement, headquarters cannot ensure that veterans have access to
the home health services to which they are entitled and veterans are
likely to experience variation in the benefits package.
Other Factors Limit the Availability of Noninstitutional Services:
Other factors limiting access to services include lack of contractors,
difficulty hiring needed staff, and limitations imposed due to
distances VA staff can travel. The lack of contractors is particularly
important in adult day health care, where 62 facilities that either did
not provide adult day health care at all or only did so in parts of
their geographic service areas reported that they experienced
difficulty in finding local contractors to provide the service. In
addition, 63 facilities cited insufficient facility staff as the reason
for not offering geriatric evaluation or only offering it to a portion
of their geographic service area. Officials in VA headquarters told us
that many facilities have been unable to recruit clinically trained
geriatric staff, such as geriatricians and geriatric nurse
practitioners, needed to operate this service.
For home-based primary care, 94 facilities that did not offer the
service at all or did not do so in all parts of their geographic
service area reported that they did not do so because many veterans
live outside of the facility's home-based primary care service area. VA
guidance limits the service to veterans who live within a locally
established radius of the facility because home-based primary care
staff travel from the facility to veterans' homes to deliver
care.[Footnote 17]
Conclusions:
Veterans' access to the six noninstitutional long-term care services we
reviewed is limited and highly variable across the country. Extensive
gaps in services exist at many facilities either because they do not
offer the services or do not offer it in all parts of their service
areas. Moreover, individual facility restrictions on veterans' use of
services means that access may be further restricted. These include
facility restrictions based on veterans' levels of service-connected
disability that are inconsistent with VA eligibility standards.
Facility restrictions have resulted in waiting lists for services at
many facilities. The end result is that veterans' access to these
services is often limited or nonexistent based on where they live.
Shortfalls and unevenness in veterans' access to noninstitutional long-
term care services have resulted because VA headquarters has not
provided adequate guidance and emphasis on making these services
available. 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. As a result, facilities vary in their
interpretation of which services to provide, creating unevenness in
their availability. Furthermore, VA has not sufficiently emphasized the
importance of providing these services to encourage networks and
facilities to make them a priority in their overall service continuum.
In particular, VA has not developed a performance measure that would
help ensure the provision of these services consistently across VA
facilities.
Recommendations for Executive Action:
To increase access to noninstitutional long-term care services and make
access more even across networks and facilities, we recommend that the
Secretary of Veterans Affairs direct the Under Secretary for Health to:
* ensure that facilities follow VA's eligibility standards when
determining veteran eligibility for noninstitutional long-term care
services;
* define and provide guidance on noninstitutional respite care;
* specify in VA policy whether home-based primary care, homemaker/home
health aide, and skilled home health care are to be available to all
enrolled veterans; and:
* refine current performance measures to help ensure that all VA
facilities provide veterans with access to required noninstitutional
services.
Agency Comments:
In commenting on a draft of our report, VA agreed with our findings and
conclusions and concurred with our recommendations. VA stated that it
will add eligibility sections in each new directive and handbook it
issues concerning noninstitutional long-term care programs and develop
performance measures to underscore the importance VA places on its
noninstitutional long-term care programs. VA, however, did not provide
details on how it plans to address our recommendations, but instead
stated that it will provide a detailed action plan to implement our
recommendations in response to the issuance of this report. VA's
written comments are in appendix IV.
As agreed with your office, unless you publicly announce its contents
earlier, we will plan no further distribution of this report until 30
days after its date. At that time, we will send copies to interested
congressional committees and other parties. We also will make copies
available to others upon request. In addition, the report is available
at no charge on the GAO Web site at http://www.gao.gov. If you or your
staffs have any questions about this report, please call me at (202)
512-7101. Another contact and key contributors are listed in appendix
V.
Cynthia A. Bascetta
Director, Health Care--Veterans' Health and Benefits Issues:
[End of section]
Appendix I: VA Noninstitutional Long-Term Care Services in Our Review:
* Adult day health care: health maintenance and rehabilitative services
provided to frail elderly veterans in an outpatient setting during part
of the day.
* Geriatric evaluation: evaluation of veterans with particular
geriatric needs, generally provided by VA through one of two services:
(1) geriatric evaluation and management, in which interdisciplinary
health care teams of geriatric specialists evaluate and manage frail
elderly veterans, and (2) geriatric primary care, in which outpatient
primary care, including medical and nursing services, preventive health
care services, health education, and specialty referral, is provided to
geriatric veterans.
* Home-based primary care: primary health care, delivered by a VA
physician-directed interdisciplinary team of VA staff including nurses
and other healthcare professionals to homebound (often bedbound)
veterans for whom return to an outpatient clinic is not practical.
* Homemaker/home health aide: personal care, such as grooming,
housekeeping, and meal preparation services, provided in the home to
veterans who would otherwise need nursing home care. It does not
include skilled professional services.
* Respite care: services provided to temporarily relieve the veteran's
caregiver from the burden of caring for a chronically ill and severely
disabled veteran in the home. Noninstitutional settings for respite
care include veterans' own homes.
* Skilled home health care: medical services provided to veterans at
home by non-VA health care providers.
[End of section]
Appendix II: Scope and Methodology:
We reviewed the Department of Veterans Affairs' (VA) provision of six
noninstitutional long-term care services in order to update and expand
our previous work to determine (1) whether veterans' access to six
noninstitutional services is limited by service availability and
restrictions on use and (2) if access is limited, what factors
contribute to limited access. The six services we reviewed include the
three services VA chose to require all facilities to provide to meet
the Millennium Act requirements--adult day health care,
noninstitutional geriatric evaluation, and noninstitutional respite
care--and three additional noninstitutional services--home-based
primary care, skilled home health care, and homemaker/home health aide.
To determine if veterans' access to the six noninstitutional long-term
care services is limited and if it is limited, to what extent, we sent
an electronic mail survey to VA's 139 medical facilities in September
2002. We asked facilities to indicate which of the six services they
offered and, for each service they offered, asked them to provide the
number of veterans currently receiving or authorized to receive the
service and the number of veterans who received the service during July
2002.[Footnote 18] The month of July 2002 was chosen because workload
data were likely to be available at the time the survey was completed
by VA staff. We also asked facilities to indicate whether each offered
service was available to veterans living in all parts of their
geographic service areas. We compared these survey data to the data we
obtained in our fall 2001 survey of VA long-term care services to
determine the extent to which availability had changed since that
survey. We also compared our current survey results to information
provided by VA headquarters, and where we noted differences we
contacted facility officials to clarify their survey responses.
To determine the factors that contribute to limited access to the six
noninstitutional long-term care services we asked survey respondents to
indicate the reasons why their facilities do not offer certain services
and what factors influence the number of veterans using the services
they do offer. We also conducted telephone interviews of officials in
each of VA's 21 network offices to assess the role each network plays
in deciding what noninstitutional services network facilities will
offer and what criteria facilities will use in allocating services.
To augment information collected through our survey and telephone
interviews, we visited four VA medical facilities to interview VA
officials and clinicians on veteran demand for noninstitutional
services and reasons for variation in access to the six
noninstitutional services. We also updated information we collected
from a site we visited during our earlier work on VA's noninstitutional
services.[Footnote 19] As shown in table 2, the five facilities
included in this report--Albany, New York; Memphis, Tennessee;
Richmond, Virginia; Tucson, Arizona; and Walla Walla,
Washingtonæreflect differences in the number and type of
noninstitutional long-term care services offered.
Table 2: Noninstitutional Services in Our Review Offered by the Five VA
Facilities We Visited:
VA facility: Albany, New York; Number of services in our review offered
at the time of our visit: 5; Home-based primary care: Yes;
Homemaker/home health aide: Yes; Skilled home health care: Yes;
Adult day health care: Yes; Geriatric evaluation: Yes; Respite care: No.
VA facility: Memphis, Tennessee; Number of services in our review
offered at the time of our visit: 4; Home-based primary care: Yes;
Homemaker/home health aide: Yes; Skilled home health care: Yes;
Adult day health care: No; Geriatric evaluation: Yes; Respite care: No.
VA facility: Richmond, Virginia; Number of services in our review
offered at the time of our visit: 2; Home-based primary care: No;
Homemaker/home health aide: No; Skilled home health care: Yes; Adult
day health care: No; Geriatric evaluation: Yes; Respite care:
No.
VA facility: Tucson, Arizona; Number of services in our review offered
at the time of our visit: 6; Home-based primary care: Yes;
Homemaker/home health aide: Yes; Skilled home health care: Yes;
Adult day health care: Yes; Geriatric evaluation: Yes;
Respite care: Yes.
VA facility: Walla Walla, Washington; Number of services in our review
offered at the time of our visit: 2; Home-based primary care: No;
Homemaker/home health aide: Yes; Skilled home health care: Yes;
Adult day health care: No; Geriatric evaluation: No; Respite care:
No.
Source: GAO.
[End of table]
We selected the Memphis and Tucson VA facilities to visit because each
offered at least four of the six services and had similar numbers of
veterans enrolled. However, the number of veterans using their services
differed substantially, which allowed us to explore the reasons for
observed differences in service utilization. The Albany facility
offered five of the six services and is located in a network that has
extensive noninstitutional service offerings. In contrast, the Richmond
and Walla Walla facilities were selected because they each offered two
services; further, we selected the Walla Walla facility because it is
located in a sparsely populated area.
We met with officials in VA's Geriatrics and Extended Care Strategic
Healthcare Group and obtained documents on VA's noninstitutional long-
term care services, including service descriptions, policies, guidance,
and other information. In addition, we interviewed the Deputy Under
Secretary for Health for Operations and Management to determine the
level of oversight that this office provides regarding the
noninstitutional long-term care services offered by VA facilities,
including the implementation and tracking of network performance
measures related to noninstitutional care.
[End of section]
Appendix III: Availability and Utilization of Six Noninstitutional Long-
Term Care Services by VA Medical Facility or Health Care System:
Table 3 provides information on the availability and utilization of the
six noninstitutional long-term care services reported by VA's 139
medical facilities and health care systems for the month of July
2002.[Footnote 20]
Table 3: Availability and Utilization of Six Noninstitutional Long-Term
Care Services at VA Medical Facilities (July 2002):
VA medical facility or health care system (HCS): Network 1 (Boston):
VA medical facility or health care system (HCS): Bedford; Number of
veterans receiving service[A]: Home-based primary care: 13; Number of
veterans receiving service[A]: Homemaker/: home health aide: 35; Number
of veterans receiving service[A]: Skilled home health care: --; Number
of veterans receiving service[A]: Adult day health care: 27; Number of
veterans receiving service[A]: Geriatric evaluation: 22; Number of
veterans receiving service[A]: Respite care: [Empty].
VA medical facility or health care system (HCS): Boston HCS; Number of
veterans receiving service[A]: Home-based primary care: [Empty]; Number
of veterans receiving service[A]: Homemaker/: home health aide: 107;
Number of veterans receiving service[A]: Skilled home health care: 65;
Number of veterans receiving service[A]: Adult day health care: 96;
Number of veterans receiving service[A]: Geriatric evaluation: 20;
Number of veterans receiving service[A]: Respite care: [Empty].
VA medical facility or health care system (HCS): Connecticut HCS;
Number of veterans receiving service[A]: Home-based primary care: 132;
Number of veterans receiving service[A]: Homemaker/: home health aide:
53; Number of veterans receiving service[A]: Skilled home health care:
77; Number of veterans receiving service[A]: Adult day health care: 22;
Number of veterans receiving service[A]: Geriatric evaluation: 115;
Number of veterans receiving service[A]: Respite care: [Empty].
VA medical facility or health care system (HCS): Manchester; Number of
veterans receiving service[A]: Home-based primary care: 44; Number of
veterans receiving service[A]: Homemaker/: home health aide: 19; Number
of veterans receiving service[A]: Skilled home health care: 26; Number
of veterans receiving service[A]: Adult day health care: 7; Number of
veterans receiving service[A]: Geriatric evaluation: [Empty]; Number of
veterans receiving service[A]: Respite care: [Empty].
VA medical facility or health care system (HCS): Northampton; Number of
veterans receiving service[A]: Home-based primary care: [Empty]; Number
of veterans receiving service[A]: Homemaker/: home health aide: 101;
Number of veterans receiving service[A]: Skilled home health care: 48;
Number of veterans receiving service[A]: Adult day health care: 26;
Number of veterans receiving service[A]: Geriatric evaluation: [Empty];
Number of veterans receiving service[A]: Respite care: [Empty].
VA medical facility or health care system (HCS): Providence; Number of
veterans receiving service[A]: Home-based primary care: 55; Number of
veterans receiving service[A]: Homemaker/: home health aide: 14; Number
of veterans receiving service[A]: Skilled home health care: 52; Number
of veterans receiving service[A]: Adult day health care: 8; Number of
veterans receiving service[A]: Geriatric evaluation: [Empty]; Number of
veterans receiving service[A]: Respite care: [Empty].
VA medical facility or health care system (HCS): Togus; Number of
veterans receiving service[A]: Home-based primary care: [Empty]; Number
of veterans receiving service[A]: Homemaker/: home health aide: 86;
Number of veterans receiving service[A]: Skilled home health care: 500;
Number of veterans receiving service[A]: Adult day health care: 1;
Number of veterans receiving service[A]: Geriatric evaluation: 6;
Number of veterans receiving service[A]: Respite care: [Empty].
VA medical facility or health care system (HCS): White River
Junction[B]; Number of veterans receiving service[A]: Home-based
primary care: [Empty]; Number of veterans receiving service[A]:
Homemaker/: home health aide: 12; Number of veterans receiving
service[A]: Skilled home health care: 49; Number of veterans receiving
service[A]: Adult day health care: 45; Number of veterans receiving
service[A]: Geriatric evaluation: 26; Number of veterans receiving
service[A]: Respite care: [Empty].
VA medical facility or health care system (HCS): Network 2 (Albany):
VA medical facility or health care system (HCS): Albany; Number of
veterans receiving service[A]: Home-based primary care: 159; Number of
veterans receiving service[A]: Homemaker/: home health aide: 62; Number
of veterans receiving service[A]: Skilled home health care: 22; Number
of veterans receiving service[A]: Adult day health care: 107; Number of
veterans receiving service[A]: Geriatric evaluation: 613; Number of
veterans receiving service[A]: Respite care: [Empty].
VA medical facility or health care system (HCS): Bath; Number of
veterans receiving service[A]: Home-based primary care: 177; Number of
veterans receiving service[A]: Homemaker/: home health aide: 115;
Number of veterans receiving service[A]: Skilled home health care:
[Empty]; Number of veterans receiving service[A]: Adult day health
care: 14; Number of veterans receiving service[A]: Geriatric
evaluation: [Empty]; Number of veterans receiving service[A]: Respite
care: 0.
VA medical facility or health care system (HCS): Canandaigua; Number of
veterans receiving service[A]: Home-based primary care: 132; Number of
veterans receiving service[A]: Homemaker/: home health aide: 186;
Number of veterans receiving service[A]: Skilled home health care:
[Empty]; Number of veterans receiving service[A]: Adult day health
care: 33; Number of veterans receiving service[A]: Geriatric
evaluation: 15; Number of veterans receiving service[A]: Respite care:
[Empty].
VA medical facility or health care system (HCS): Syracuse; Number of
veterans receiving service[A]: Home-based primary care: 273; Number of
veterans receiving service[A]: Homemaker/: home health aide: 147;
Number of veterans receiving service[A]: Skilled home health care: 37;
Number of veterans receiving service[A]: Adult day health care: 45;
Number of veterans receiving service[A]: Geriatric evaluation: 216;
Number of veterans receiving service[A]: Respite care: [Empty].
VA medical facility or health care system (HCS): Western New York HCS;
Number of veterans receiving service[A]: Home-based primary care: 263;
Number of veterans receiving service[A]: Homemaker/: home health aide:
285; Number of veterans receiving service[A]: Skilled home health care:
68; Number of veterans receiving service[A]: Adult day health care:
120; Number of veterans receiving service[A]: Geriatric evaluation: 26;
Number of veterans receiving service[A]: Respite care: [Empty].
VA medical facility or health care system (HCS): Network 3 (Bronx):
VA medical facility or health care system (HCS): Bronx; Number of
veterans receiving service[A]: Home-based primary care: 120; Number of
veterans receiving service[A]: Homemaker/: home health aide: 15; Number
of veterans receiving service[A]: Skilled home health care: 21; Number
of veterans receiving service[A]: Adult day health care: [Empty];
Number of veterans receiving service[A]: Geriatric evaluation: 93;
Number of veterans receiving service[A]: Respite care: [Empty].
VA medical facility or health care system (HCS): Hudson Valley HCS;
Number of veterans receiving service[A]: Home-based primary care: 71;
Number of veterans receiving service[A]: Homemaker/: home health aide:
48; Number of veterans receiving service[A]: Skilled home health care:
6; Number of veterans receiving service[A]: Adult day health care: 3;
Number of veterans receiving service[A]: Geriatric evaluation: [Empty];
Number of veterans receiving service[A]: Respite care: [Empty].
VA medical facility or health care system (HCS): New Jersey HCS; Number
of veterans receiving service[A]: Home-based primary care: 132; Number
of veterans receiving service[A]: Homemaker/: home health aide: 262;
Number of veterans receiving service[A]: Skilled home health care: 45;
Number of veterans receiving service[A]: Adult day health care: 6;
Number of veterans receiving service[A]: Geriatric evaluation: [Empty];
Number of veterans receiving service[A]: Respite care: [Empty].
VA medical facility or health care system (HCS): Northport; Number of
veterans receiving service[A]: Home-based primary care: 47; Number of
veterans receiving service[A]: Homemaker/: home health aide: 64; Number
of veterans receiving service[A]: Skilled home health care: 32; Number
of veterans receiving service[A]: Adult day health care: 12; Number of
veterans receiving service[A]: Geriatric evaluation: 49; Number of
veterans receiving service[A]: Respite care: [Empty].
VA medical facility or health care system (HCS): New York Harbor HCS;
Number of veterans receiving service[A]: Home-based primary care: 210;
Number of veterans receiving service[A]: Homemaker/: home health aide:
219; Number of veterans receiving service[A]: Skilled home health care:
16; Number of veterans receiving service[A]: Adult day health care:
156; Number of veterans receiving service[A]: Geriatric evaluation:
1,136; Number of veterans receiving service[A]: Respite care: [Empty].
VA medical facility or health care system (HCS): Network 4
(Pittsburgh):
VA medical facility or health care system (HCS): Altoona[B]; Number of
veterans receiving service[A]: Home-based primary care: [Empty]; Number
of veterans receiving service[A]: Homemaker/: home health aide:
[Empty]; Number of veterans receiving service[A]: Skilled home health
care: 12; Number of veterans receiving service[A]: Adult day health
care: [Empty]; Number of veterans receiving service[A]: Geriatric
evaluation: [Empty]; Number of veterans receiving service[A]: Respite
care: [Empty].
VA medical facility or health care system (HCS): Butler; Number of
veterans receiving service[A]: Home-based primary care: 36; Number of
veterans receiving service[A]: Homemaker/: home health aide: 123;
Number of veterans receiving service[A]: Skilled home health care:
[Empty]; Number of veterans receiving service[A]: Adult day health
care: 58; Number of veterans receiving service[A]: Geriatric
evaluation: [Empty]; Number of veterans receiving service[A]: Respite
care: [Empty].
VA medical facility or health care system (HCS): Clarksburg; Number of
veterans receiving service[A]: Home-based primary care: [Empty]; Number
of veterans receiving service[A]: Homemaker/: home health aide: 176;
Number of veterans receiving service[A]: Skilled home health care: 23;
Number of veterans receiving service[A]: Adult day health care: 6;
Number of veterans receiving service[A]: Geriatric evaluation: [Empty];
Number of veterans receiving service[A]: Respite care: [Empty].
VA medical facility or health care system (HCS): Coatesville; Number of
veterans receiving service[A]: Home-based primary care: [Empty]; Number
of veterans receiving service[A]: Homemaker/: home health aide: 80;
Number of veterans receiving service[A]: Skilled home health care: 0;
Number of veterans receiving service[A]: Adult day health care: 24;
Number of veterans receiving service[A]: Geriatric evaluation: [Empty];
Number of veterans receiving service[A]: Respite care: [Empty].
VA medical facility or health care system (HCS): Erie; Number of
veterans receiving service[A]: Home-based primary care: [Empty]; Number
of veterans receiving service[A]: Homemaker/: home health aide: 84;
Number of veterans receiving service[A]: Skilled home health care: 16;
Number of veterans receiving service[A]: Adult day health care: 3;
Number of veterans receiving service[A]: Geriatric evaluation: [Empty];
Number of veterans receiving service[A]: Respite care: 2.
VA medical facility or health care system (HCS): Lebanon; Number of
veterans receiving service[A]: Home-based primary care: [Empty]; Number
of veterans receiving service[A]: Homemaker/: home health aide: 2;
Number of veterans receiving service[A]: Skilled home health care: 7;
Number of veterans receiving service[A]: Adult day health care:
[Empty]; Number of veterans receiving service[A]: Geriatric evaluation:
67; Number of veterans receiving service[A]: Respite care: [Empty].
VA medical facility or health care system (HCS): Philadelphia; Number
of veterans receiving service[A]: Home-based primary care: [Empty];
Number of veterans receiving service[A]: Homemaker/: home health aide:
16; Number of veterans receiving service[A]: Skilled home health care:
17; Number of veterans receiving service[A]: Adult day health care:
[Empty]; Number of veterans receiving service[A]: Geriatric evaluation:
905; Number of veterans receiving service[A]: Respite care: [Empty].
VA medical facility or health care system (HCS): Pittsburgh HCS; Number
of veterans receiving service[A]: Home-based primary care: 133; Number
of veterans receiving service[A]: Homemaker/: home health aide: 129;
Number of veterans receiving service[A]: Skilled home health care: 87;
Number of veterans receiving service[A]: Adult day health care: 51;
Number of veterans receiving service[A]: Geriatric evaluation: 16;
Number of veterans receiving service[A]: Respite care: [Empty].
VA medical facility or health care system (HCS): Wilkes-Barre; Number
of veterans receiving service[A]: Home-based primary care: [Empty];
Number of veterans receiving service[A]: Homemaker/: home health aide:
30; Number of veterans receiving service[A]: Skilled home health care:
99; Number of veterans receiving service[A]: Adult day health care: 1;
Number of veterans receiving service[A]: Geriatric evaluation: 76;
Number of veterans receiving service[A]: Respite care: [Empty].
VA medical facility or health care system (HCS): Wilmington; Number of
veterans receiving service[A]: Home-based primary care: [Empty]; Number
of veterans receiving service[A]: Homemaker/: home health aide: 25;
Number of veterans receiving service[A]: Skilled home health care: 4;
Number of veterans receiving service[A]: Adult day health care:
[Empty]; Number of veterans receiving service[A]: Geriatric evaluation:
5; Number of veterans receiving service[A]: Respite care: [Empty].
VA medical facility or health care system (HCS): Network 5 (Baltimore):
VA medical facility or health care system (HCS): Martinsburg; Number of
veterans receiving service[A]: Home-based primary care: [Empty]; Number
of veterans receiving service[A]: Homemaker/: home health aide: 73;
Number of veterans receiving service[A]: Skilled home health care:
[Empty]; Number of veterans receiving service[A]: Adult day health
care: 16; Number of veterans receiving service[A]: Geriatric
evaluation: [Empty]; Number of veterans receiving service[A]: Respite
care: [Empty].
VA medical facility or health care system (HCS): Maryland HCS; Number
of veterans receiving service[A]: Home-based primary care: 220; Number
of veterans receiving service[A]: Homemaker/: home health aide: 273;
Number of veterans receiving service[A]: Skilled home health care: 52;
Number of veterans receiving service[A]: Adult day health care: 287;
Number of veterans receiving service[A]: Geriatric evaluation: 12;
Number of veterans receiving service[A]: Respite care: 3.
VA medical facility or health care system (HCS): Washington, DC; Number
of veterans receiving service[A]: Home-based primary care: 125; Number
of veterans receiving service[A]: Homemaker/: home health aide: 120;
Number of veterans receiving service[A]: Skilled home health care: 6;
Number of veterans receiving service[A]: Adult day health care: 85;
Number of veterans receiving service[A]: Geriatric evaluation: 292;
Number of veterans receiving service[A]: Respite care: [Empty].
VA medical facility or health care system (HCS): Network 6 (Durham):
VA medical facility or health care system (HCS): Asheville; Number of
veterans receiving service[A]: Home-based primary care: 35; Number of
veterans receiving service[A]: Homemaker/: home health aide: 90; Number
of veterans receiving service[A]: Skilled home health care: 22; Number
of veterans receiving service[A]: Adult day health care: 61; Number of
veterans receiving service[A]: Geriatric evaluation: 26; Number of
veterans receiving service[A]: Respite care: 61.
VA medical facility or health care system (HCS): Beckley; Number of
veterans receiving service[A]: Home-based primary care: [Empty]; Number
of veterans receiving service[A]: Homemaker/: home health aide:
[Empty]; Number of veterans receiving service[A]: Skilled home health
care: 10; Number of veterans receiving service[A]: Adult day health
care: [Empty]; Number of veterans receiving service[A]: Geriatric
evaluation: [Empty]; Number of veterans receiving service[A]: Respite
care: [Empty].
VA medical facility or health care system (HCS): Durham; Number of
veterans receiving service[A]: Home-based primary care: 47; Number of
veterans receiving service[A]: Homemaker/: home health aide: 37; Number
of veterans receiving service[A]: Skilled home health care: 130; Number
of veterans receiving service[A]: Adult day health care: [Empty];
Number of veterans receiving service[A]: Geriatric evaluation: 97;
Number of veterans receiving service[A]: Respite care: 1.
VA medical facility or health care system (HCS): Fayetteville (NC);
Number of veterans receiving service[A]: Home-based primary care:
[Empty]; Number of veterans receiving service[A]: Homemaker/: home
health aide: 19; Number of veterans receiving service[A]: Skilled home
health care: 18; Number of veterans receiving service[A]: Adult day
health care: 11; Number of veterans receiving service[A]: Geriatric
evaluation: 17; Number of veterans receiving service[A]: Respite care:
[Empty].
VA medical facility or health care system (HCS): Hampton; Number of
veterans receiving service[A]: Home-based primary care: [Empty]; Number
of veterans receiving service[A]: Homemaker/: home health aide: 27;
Number of veterans receiving service[A]: Skilled home health care: 29;
Number of veterans receiving service[A]: Adult day health care: 13;
Number of veterans receiving service[A]: Geriatric evaluation: 0;
Number of veterans receiving service[A]: Respite care: [Empty].
VA medical facility or health care system (HCS): Richmond; Number of
veterans receiving service[A]: Home-based primary care: [Empty]; Number
of veterans receiving service[A]: Homemaker/: home health aide:
[Empty]; Number of veterans receiving service[A]: Skilled home health
care: 101; Number of veterans receiving service[A]: Adult day health
care: 0; Number of veterans receiving service[A]: Geriatric evaluation:
1,800; Number of veterans receiving service[A]: Respite care: [Empty].
VA medical facility or health care system (HCS): Salem; Number of
veterans receiving service[A]: Home-based primary care: [Empty]; Number
of veterans receiving service[A]: Homemaker/: home health aide: 40;
Number of veterans receiving service[A]: Skilled home health care: 13;
Number of veterans receiving service[A]: Adult day health care: 71;
Number of veterans receiving service[A]: Geriatric evaluation: [Empty];
Number of veterans receiving service[A]: Respite care: 3.
VA medical facility or health care system (HCS): Salisbury; Number of
veterans receiving service[A]: Home-based primary care: [Empty]; Number
of veterans receiving service[A]: Homemaker/: home health aide: 35;
Number of veterans receiving service[A]: Skilled home health care: 100;
Number of veterans receiving service[A]: Adult day health care: 11;
Number of veterans receiving service[A]: Geriatric evaluation: [Empty];
Number of veterans receiving service[A]: Respite care: [Empty].
VA medical facility or health care system (HCS): Network 7 (Atlanta):
VA medical facility or health care system (HCS): Atlanta; Number of
veterans receiving service[A]: Home-based primary care: 90; Number of
veterans receiving service[A]: Homemaker/: home health aide: 51; Number
of veterans receiving service[A]: Skilled home health care: 52; Number
of veterans receiving service[A]: Adult day health care: 7; Number of
veterans receiving service[A]: Geriatric evaluation: 550; Number of
veterans receiving service[A]: Respite care: 7.
VA medical facility or health care system (HCS): Augusta; Number of
veterans receiving service[A]: Home-based primary care: 53; Number of
veterans receiving service[A]: Homemaker/: home health aide: 195;
Number of veterans receiving service[A]: Skilled home health care: 88;
Number of veterans receiving service[A]: Adult day health care: 2;
Number of veterans receiving service[A]: Geriatric evaluation: 56;
Number of veterans receiving service[A]: Respite care: [Empty].
VA medical facility or health care system (HCS): Birmingham; Number of
veterans receiving service[A]: Home-based primary care: 94; Number of
veterans receiving service[A]: Homemaker/: home health aide: 4; Number
of veterans receiving service[A]: Skilled home health care: 62; Number
of veterans receiving service[A]: Adult day health care: 0; Number of
veterans receiving service[A]: Geriatric evaluation: 27; Number of
veterans receiving service[A]: Respite care: 4.
VA medical facility or health care system (HCS): Central Alabama HCS;
Number of veterans receiving service[A]: Home-based primary care: 135;
Number of veterans receiving service[A]: Homemaker/: home health aide:
57; Number of veterans receiving service[A]: Skilled home health care:
48; Number of veterans receiving service[A]: Adult day health care:
[Empty]; Number of veterans receiving service[A]: Geriatric evaluation:
257; Number of veterans receiving service[A]: Respite care: [Empty].
VA medical facility or health care system (HCS): Charleston; Number of
veterans receiving service[A]: Home-based primary care: 96; Number of
veterans receiving service[A]: Homemaker/: home health aide: 57; Number
of veterans receiving service[A]: Skilled home health care: 92; Number
of veterans receiving service[A]: Adult day health care: 6; Number of
veterans receiving service[A]: Geriatric evaluation: 169; Number of
veterans receiving service[A]: Respite care: 10.
VA medical facility or health care system (HCS): Columbia (SC); Number
of veterans receiving service[A]: Home-based primary care: 35; Number
of veterans receiving service[A]: Homemaker/: home health aide: 53;
Number of veterans receiving service[A]: Skilled home health care: 82;
Number of veterans receiving service[A]: Adult day health care: 20;
Number of veterans receiving service[A]: Geriatric evaluation: [Empty];
Number of veterans receiving service[A]: Respite care: [Empty].
VA medical facility or health care system (HCS): Dublin; Number of
veterans receiving service[A]: Home-based primary care: [Empty]; Number
of veterans receiving service[A]: Homemaker/: home health aide: 68;
Number of veterans receiving service[A]: Skilled home health care: 127;
Number of veterans receiving service[A]: Adult day health care:
[Empty]; Number of veterans receiving service[A]: Geriatric evaluation:
[Empty]; Number of veterans receiving service[A]: Respite care:
[Empty].
VA medical facility or health care system (HCS): Tuscaloosa; Number of
veterans receiving service[A]: Home-based primary care: [Empty]; Number
of veterans receiving service[A]: Homemaker/: home health aide: 94;
Number of veterans receiving service[A]: Skilled home health care: 15;
Number of veterans receiving service[A]: Adult day health care:
[Empty]; Number of veterans receiving service[A]: Geriatric evaluation:
[Empty]; Number of veterans receiving service[A]: Respite care:
[Empty].
VA medical facility or health care system (HCS): Network 8 (Bay Pines):
VA medical facility or health care system (HCS): Bay Pines[B]; Number
of veterans receiving service[A]: Home-based primary care: 123; Number
of veterans receiving service[A]: Homemaker/: home health aide: 83;
Number of veterans receiving service[A]: Skilled home health care: 44;
Number of veterans receiving service[A]: Adult day health care: 23;
Number of veterans receiving service[A]: Geriatric evaluation: 857;
Number of veterans receiving service[A]: Respite care: [Empty].
VA medical facility or health care system (HCS): Miami[B]; Number of
veterans receiving service[A]: Home-based primary care: 224; Number of
veterans receiving service[A]: Homemaker/: home health aide: 75; Number
of veterans receiving service[A]: Skilled home health care: 54; Number
of veterans receiving service[A]: Adult day health care: 32; Number of
veterans receiving service[A]: Geriatric evaluation: 397; Number of
veterans receiving service[A]: Respite care: [Empty].
VA medical facility or health care system (HCS): N. Florida/S. Georgia
HCS[B]; Number of veterans receiving service[A]: Home-based primary
care: 248; Number of veterans receiving service[A]: Homemaker/: home
health aide: 270; Number of veterans receiving service[A]: Skilled home
health care: 30; Number of veterans receiving service[A]: Adult day
health care: 9; Number of veterans receiving service[A]: Geriatric
evaluation: 647; Number of veterans receiving service[A]: Respite care:
[Empty].
VA medical facility or health care system (HCS): San Juan; Number of
veterans receiving service[A]: Home-based primary care: 193; Number of
veterans receiving service[A]: Homemaker/: home health aide: 0; Number
of veterans receiving service[A]: Skilled home health care: 2; Number
of veterans receiving service[A]: Adult day health care: [Empty];
Number of veterans receiving service[A]: Geriatric evaluation: 569;
Number of veterans receiving service[A]: Respite care: [Empty].
VA medical facility or health care system (HCS): Tampa[B]; Number of
veterans receiving service[A]: Home-based primary care: 163; Number of
veterans receiving service[A]: Homemaker/: home health aide: 39; Number
of veterans receiving service[A]: Skilled home health care: 155; Number
of veterans receiving service[A]: Adult day health care: [Empty];
Number of veterans receiving service[A]: Geriatric evaluation: 300;
Number of veterans receiving service[A]: Respite care: [Empty].
VA medical facility or health care system (HCS): West Palm Beach;
Number of veterans receiving service[A]: Home-based primary care:
[Empty]; Number of veterans receiving service[A]: Homemaker/: home
health aide: 42; Number of veterans receiving service[A]: Skilled home
health care: 23; Number of veterans receiving service[A]: Adult day
health care: 2; Number of veterans receiving service[A]: Geriatric
evaluation: [Empty]; Number of veterans receiving service[A]: Respite
care: [Empty].
VA medical facility or health care system (HCS): Network 9 (Nashville):
VA medical facility or health care system (HCS): Huntington; Number of
veterans receiving service[A]: Home-based primary care: [Empty]; Number
of veterans receiving service[A]: Homemaker/: home health aide: 60;
Number of veterans receiving service[A]: Skilled home health care: 49;
Number of veterans receiving service[A]: Adult day health care:
[Empty]; Number of veterans receiving service[A]: Geriatric evaluation:
[Empty]; Number of veterans receiving service[A]: Respite care:
[Empty].
VA medical facility or health care system (HCS): Lexington; Number of
veterans receiving service[A]: Home-based primary care: 23; Number of
veterans receiving service[A]: Homemaker/: home health aide: 32; Number
of veterans receiving service[A]: Skilled home health care: 53; Number
of veterans receiving service[A]: Adult day health care: [Empty];
Number of veterans receiving service[A]: Geriatric evaluation: 52;
Number of veterans receiving service[A]: Respite care: 1.
VA medical facility or health care system (HCS): Louisville; Number of
veterans receiving service[A]: Home-based primary care: [Empty]; Number
of veterans receiving service[A]: Homemaker/: home health aide: 29;
Number of veterans receiving service[A]: Skilled home health care: 469;
Number of veterans receiving service[A]: Adult day health care:
[Empty]; Number of veterans receiving service[A]: Geriatric evaluation:
46; Number of veterans receiving service[A]: Respite care: [Empty].
VA medical facility or health care system (HCS): Memphis[B]; Number of
veterans receiving service[A]: Home-based primary care: 112; Number of
veterans receiving service[A]: Homemaker/: home health aide: 73; Number
of veterans receiving service[A]: Skilled home health care: 227; Number
of veterans receiving service[A]: Adult day health care: [Empty];
Number of veterans receiving service[A]: Geriatric evaluation: 560;
Number of veterans receiving service[A]: Respite care: [Empty].
VA medical facility or health care system (HCS): Mountain Home; Number
of veterans receiving service[A]: Home-based primary care: [Empty];
Number of veterans receiving service[A]: Homemaker/: home health aide:
158; Number of veterans receiving service[A]: Skilled home health care:
42; Number of veterans receiving service[A]: Adult day health care: 14;
Number of veterans receiving service[A]: Geriatric evaluation: 15;
Number of veterans receiving service[A]: Respite care: [Empty].
VA medical facility or health care system (HCS): Tennessee Valley HCS;
Number of veterans receiving service[A]: Home-based primary care:
[Empty]; Number of veterans receiving service[A]: Homemaker/: home
health aide: 216; Number of veterans receiving service[A]: Skilled home
health care: 129; Number of veterans receiving service[A]: Adult day
health care: 13; Number of veterans receiving service[A]: Geriatric
evaluation: --; Number of veterans receiving service[A]: Respite care:
[Empty].
VA medical facility or health care system (HCS): Network 10
(Cincinnati):
VA medical facility or health care system (HCS): Chillicothe; Number of
veterans receiving service[A]: Home-based primary care: [Empty]; Number
of veterans receiving service[A]: Homemaker/: home health aide: 186;
Number of veterans receiving service[A]: Skilled home health care: 102;
Number of veterans receiving service[A]: Adult day health care: 3;
Number of veterans receiving service[A]: Geriatric evaluation: [Empty];
Number of veterans receiving service[A]: Respite care: [Empty].
VA medical facility or health care system (HCS): Cincinnati; Number of
veterans receiving service[A]: Home-based primary care: [Empty]; Number
of veterans receiving service[A]: Homemaker/: home health aide: 22;
Number of veterans receiving service[A]: Skilled home health care: 60;
Number of veterans receiving service[A]: Adult day health care: 71;
Number of veterans receiving service[A]: Geriatric evaluation: 26;
Number of veterans receiving service[A]: Respite care: [Empty].
VA medical facility or health care system (HCS): Cleveland; Number of
veterans receiving service[A]: Home-based primary care: 249; Number of
veterans receiving service[A]: Homemaker/: home health aide: 378;
Number of veterans receiving service[A]: Skilled home health care: 26;
Number of veterans receiving service[A]: Adult day health care: 9;
Number of veterans receiving service[A]: Geriatric evaluation: 288;
Number of veterans receiving service[A]: Respite care: [Empty].
VA medical facility or health care system (HCS): Columbus; Number of
veterans receiving service[A]: Home-based primary care: [Empty]; Number
of veterans receiving service[A]: Homemaker/: home health aide: 44;
Number of veterans receiving service[A]: Skilled home health care: 13;
Number of veterans receiving service[A]: Adult day health care: 25;
Number of veterans receiving service[A]: Geriatric evaluation: [Empty];
Number of veterans receiving service[A]: Respite care: [Empty].
VA medical facility or health care system (HCS): Dayton; Number of
veterans receiving service[A]: Home-based primary care: 53; Number of
veterans receiving service[A]: Homemaker/: home health aide: 275;
Number of veterans receiving service[A]: Skilled home health care: 179;
Number of veterans receiving service[A]: Adult day health care: 37;
Number of veterans receiving service[A]: Geriatric evaluation: 42;
Number of veterans receiving service[A]: Respite care: [Empty].
VA medical facility or health care system (HCS): Network 11 (Ann
Arbor):
VA medical facility or health care system (HCS): Ann Arbor; Number of
veterans receiving service[A]: Home-based primary care: [Empty]; Number
of veterans receiving service[A]: Homemaker/: home health aide: 88;
Number of veterans receiving service[A]: Skilled home health care: 13;
Number of veterans receiving service[A]: Adult day health care:
[Empty]; Number of veterans receiving service[A]: Geriatric evaluation:
54; Number of veterans receiving service[A]: Respite care: 0.
VA medical facility or health care system (HCS): Battle Creek; Number
of veterans receiving service[A]: Home-based primary care: 120; Number
of veterans receiving service[A]: Homemaker/: home health aide: 107;
Number of veterans receiving service[A]: Skilled home health care: 22;
Number of veterans receiving service[A]: Adult day health care: 31;
Number of veterans receiving service[A]: Geriatric evaluation: [Empty];
Number of veterans receiving service[A]: Respite care: 1.
VA medical facility or health care system (HCS): Danville; Number of
veterans receiving service[A]: Home-based primary care: 96; Number of
veterans receiving service[A]: Homemaker/: home health aide: 117;
Number of veterans receiving service[A]: Skilled home health care: --;
Number of veterans receiving service[A]: Adult day health care: 40;
Number of veterans receiving service[A]: Geriatric evaluation: [Empty];
Number of veterans receiving service[A]: Respite care: 0.
VA medical facility or health care system (HCS): Detroit; Number of
veterans receiving service[A]: Home-based primary care: 100; Number of
veterans receiving service[A]: Homemaker/: home health aide: 29; Number
of veterans receiving service[A]: Skilled home health care: 100; Number
of veterans receiving service[A]: Adult day health care: 1; Number of
veterans receiving service[A]: Geriatric evaluation: 5; Number of
veterans receiving service[A]: Respite care: [Empty].
VA medical facility or health care system (HCS): Indianapolis; Number
of veterans receiving service[A]: Home-based primary care: 111; Number
of veterans receiving service[A]: Homemaker/: home health aide: 109;
Number of veterans receiving service[A]: Skilled home health care: 49;
Number of veterans receiving service[A]: Adult day health care: 20;
Number of veterans receiving service[A]: Geriatric evaluation: 48;
Number of veterans receiving service[A]: Respite care: 0.
VA medical facility or health care system (HCS): Northern Indiana HCS;
Number of veterans receiving service[A]: Home-based primary care: 96;
Number of veterans receiving service[A]: Homemaker/: home health aide:
180; Number of veterans receiving service[A]: Skilled home health care:
87; Number of veterans receiving service[A]: Adult day health care: 1;
Number of veterans receiving service[A]: Geriatric evaluation: [Empty];
Number of veterans receiving service[A]: Respite care: 4.
VA medical facility or health care system (HCS): Saginaw; Number of
veterans receiving service[A]: Home-based primary care: [Empty]; Number
of veterans receiving service[A]: Homemaker/: home health aide: 31;
Number of veterans receiving service[A]: Skilled home health care: 15;
Number of veterans receiving service[A]: Adult day health care: 2;
Number of veterans receiving service[A]: Geriatric evaluation: 8;
Number of veterans receiving service[A]: Respite care: 2.
VA medical facility or health care system (HCS): Network 12 (Chicago):
VA medical facility or health care system (HCS): Chicago HCS[B]; Number
of veterans receiving service[A]: Home-based primary care: 94; Number
of veterans receiving service[A]: Homemaker/: home health aide: 30;
Number of veterans receiving service[A]: Skilled home health care: 52;
Number of veterans receiving service[A]: Adult day health care: 36;
Number of veterans receiving service[A]: Geriatric evaluation: 12;
Number of veterans receiving service[A]: Respite care: [Empty].
VA medical facility or health care system (HCS): Hines; Number of
veterans receiving service[A]: Home-based primary care: 183; Number of
veterans receiving service[A]: Homemaker/: home health aide: 64; Number
of veterans receiving service[A]: Skilled home health care: 90; Number
of veterans receiving service[A]: Adult day health care: 45; Number of
veterans receiving service[A]: Geriatric evaluation: 133; Number of
veterans receiving service[A]: Respite care: [Empty].
VA medical facility or health care system (HCS): Iron Mountain; Number
of veterans receiving service[A]: Home-based primary care: [Empty];
Number of veterans receiving service[A]: Homemaker/: home health aide:
12; Number of veterans receiving service[A]: Skilled home health care:
15; Number of veterans receiving service[A]: Adult day health care: 0;
Number of veterans receiving service[A]: Geriatric evaluation: [Empty];
Number of veterans receiving service[A]: Respite care: [Empty].
VA medical facility or health care system (HCS): Madison; Number of
veterans receiving service[A]: Home-based primary care: [Empty]; Number
of veterans receiving service[A]: Homemaker/: home health aide: 21;
Number of veterans receiving service[A]: Skilled home health care: --;
Number of veterans receiving service[A]: Adult day health care: 5;
Number of veterans receiving service[A]: Geriatric evaluation: 18;
Number of veterans receiving service[A]: Respite care: [Empty].
VA medical facility or health care system (HCS): Milwaukee; Number of
veterans receiving service[A]: Home-based primary care: 146; Number of
veterans receiving service[A]: Homemaker/: home health aide: 30; Number
of veterans receiving service[A]: Skilled home health care: 23; Number
of veterans receiving service[A]: Adult day health care: 60; Number of
veterans receiving service[A]: Geriatric evaluation: 60; Number of
veterans receiving service[A]: Respite care: [Empty].
VA medical facility or health care system (HCS): North Chicago; Number
of veterans receiving service[A]: Home-based primary care: 144; Number
of veterans receiving service[A]: Homemaker/: home health aide:
[Empty]; Number of veterans receiving service[A]: Skilled home health
care: 1; Number of veterans receiving service[A]: Adult day health
care: 19; Number of veterans receiving service[A]: Geriatric
evaluation: [Empty]; Number of veterans receiving service[A]: Respite
care: [Empty].
VA medical facility or health care system (HCS): Tomah; Number of
veterans receiving service[A]: Home-based primary care: [Empty]; Number
of veterans receiving service[A]: Homemaker/: home health aide: 5;
Number of veterans receiving service[A]: Skilled home health care: 1;
Number of veterans receiving service[A]: Adult day health care:
[Empty]; Number of veterans receiving service[A]: Geriatric evaluation:
[Empty]; Number of veterans receiving service[A]: Respite care:
[Empty].
VA medical facility or health care system (HCS): Network 15 (Kansas
City):
VA medical facility or health care system (HCS): Columbia (MO); Number
of veterans receiving service[A]: Home-based primary care: 134; Number
of veterans receiving service[A]: Homemaker/: home health aide: 55;
Number of veterans receiving service[A]: Skilled home health care: 18;
Number of veterans receiving service[A]: Adult day health care: 0;
Number of veterans receiving service[A]: Geriatric evaluation: [Empty];
Number of veterans receiving service[A]: Respite care: 3.
VA medical facility or health care system (HCS): Eastern Kansas HCS;
Number of veterans receiving service[A]: Home-based primary care:
[Empty]; Number of veterans receiving service[A]: Homemaker/: home
health aide: 61; Number of veterans receiving service[A]: Skilled home
health care: 54; Number of veterans receiving service[A]: Adult day
health care: 6; Number of veterans receiving service[A]: Geriatric
evaluation: 18; Number of veterans receiving service[A]: Respite care:
[Empty].
VA medical facility or health care system (HCS): Kansas City; Number of
veterans receiving service[A]: Home-based primary care: [Empty]; Number
of veterans receiving service[A]: Homemaker/: home health aide: 64;
Number of veterans receiving service[A]: Skilled home health care: 16;
Number of veterans receiving service[A]: Adult day health care: 3;
Number of veterans receiving service[A]: Geriatric evaluation: [Empty];
Number of veterans receiving service[A]: Respite care: [Empty].
VA medical facility or health care system (HCS): Marion; Number of
veterans receiving service[A]: Home-based primary care: [Empty]; Number
of veterans receiving service[A]: Homemaker/: home health aide: 31;
Number of veterans receiving service[A]: Skilled home health care: 215;
Number of veterans receiving service[A]: Adult day health care:
[Empty]; Number of veterans receiving service[A]: Geriatric evaluation:
[Empty]; Number of veterans receiving service[A]: Respite care:
[Empty].
VA medical facility or health care system (HCS): Poplar Bluff; Number
of veterans receiving service[A]: Home-based primary care: [Empty];
Number of veterans receiving service[A]: Homemaker/: home health aide:
38; Number of veterans receiving service[A]: Skilled home health care:
22; Number of veterans receiving service[A]: Adult day health care:
[Empty]; Number of veterans receiving service[A]: Geriatric evaluation:
[Empty]; Number of veterans receiving service[A]: Respite care:
[Empty].
VA medical facility or health care system (HCS): St. Louis; Number of
veterans receiving service[A]: Home-based primary care: 75; Number of
veterans receiving service[A]: Homemaker/: home health aide: 78; Number
of veterans receiving service[A]: Skilled home health care: 30; Number
of veterans receiving service[A]: Adult day health care: 10; Number of
veterans receiving service[A]: Geriatric evaluation: --; Number of
veterans receiving service[A]: Respite care: [Empty].
VA medical facility or health care system (HCS): Wichita[B]; Number of
veterans receiving service[A]: Home-based primary care: [Empty]; Number
of veterans receiving service[A]: Homemaker/: home health aide: 35;
Number of veterans receiving service[A]: Skilled home health care: 40;
Number of veterans receiving service[A]: Adult day health care: 9;
Number of veterans receiving service[A]: Geriatric evaluation: [Empty];
Number of veterans receiving service[A]: Respite care: [Empty].
VA medical facility or health care system (HCS): Network 16 (Jackson):
VA medical facility or health care system (HCS): Alexandria; Number of
veterans receiving service[A]: Home-based primary care: [Empty]; Number
of veterans receiving service[A]: Homemaker/: home health aide: 15;
Number of veterans receiving service[A]: Skilled home health care: 21;
Number of veterans receiving service[A]: Adult day health care: 7;
Number of veterans receiving service[A]: Geriatric evaluation: [Empty];
Number of veterans receiving service[A]: Respite care: [Empty].
VA medical facility or health care system (HCS): Central Arkansas
HCS[B]; Number of veterans receiving service[A]: Home-based primary
care: 187; Number of veterans receiving service[A]: Homemaker/: home
health aide: 145; Number of veterans receiving service[A]: Skilled home
health care: 31; Number of veterans receiving service[A]: Adult day
health care: 73; Number of veterans receiving service[A]: Geriatric
evaluation: 719; Number of veterans receiving service[A]: Respite care:
[Empty].
VA medical facility or health care system (HCS): Fayetteville (AR);
Number of veterans receiving service[A]: Home-based primary care:
[Empty]; Number of veterans receiving service[A]: Homemaker/: home
health aide: [Empty]; Number of veterans receiving service[A]: Skilled
home health care: 3; Number of veterans receiving service[A]: Adult day
health care: [Empty]; Number of veterans receiving service[A]:
Geriatric evaluation: [Empty]; Number of veterans receiving service[A]:
Respite care: [Empty].
VA medical facility or health care system (HCS): Gulf Coast HCS; Number
of veterans receiving service[A]: Home-based primary care: 75; Number
of veterans receiving service[A]: Homemaker/: home health aide: 51;
Number of veterans receiving service[A]: Skilled home health care: 134;
Number of veterans receiving service[A]: Adult day health care:
[Empty]; Number of veterans receiving service[A]: Geriatric evaluation:
195; Number of veterans receiving service[A]: Respite care: [Empty].
VA medical facility or health care system (HCS): Houston; Number of
veterans receiving service[A]: Home-based primary care: 92; Number of
veterans receiving service[A]: Homemaker/: home health aide: 36; Number
of veterans receiving service[A]: Skilled home health care: 60; Number
of veterans receiving service[A]: Adult day health care: 6; Number of
veterans receiving service[A]: Geriatric evaluation: 333; Number of
veterans receiving service[A]: Respite care: [Empty].
VA medical facility or health care system (HCS): Jackson; Number of
veterans receiving service[A]: Home-based primary care: [Empty]; Number
of veterans receiving service[A]: Homemaker/: home health aide: 35;
Number of veterans receiving service[A]: Skilled home health care: 115;
Number of veterans receiving service[A]: Adult day health care: 28;
Number of veterans receiving service[A]: Geriatric evaluation: [Empty];
Number of veterans receiving service[A]: Respite care: [Empty].
VA medical facility or health care system (HCS): Muskogee[B]; Number of
veterans receiving service[A]: Home-based primary care: [Empty]; Number
of veterans receiving service[A]: Homemaker/: home health aide:
[Empty]; Number of veterans receiving service[A]: Skilled home health
care: 8; Number of veterans receiving service[A]: Adult day health
care: 38; Number of veterans receiving service[A]: Geriatric
evaluation: [Empty]; Number of veterans receiving service[A]: Respite
care: [Empty].
VA medical facility or health care system (HCS): New Orleans; Number of
veterans receiving service[A]: Home-based primary care: 82; Number of
veterans receiving service[A]: Homemaker/: home health aide: [Empty];
Number of veterans receiving service[A]: Skilled home health care: 12;
Number of veterans receiving service[A]: Adult day health care: 35;
Number of veterans receiving service[A]: Geriatric evaluation: [Empty];
Number of veterans receiving service[A]: Respite care: [Empty].
VA medical facility or health care system (HCS): Oklahoma City; Number
of veterans receiving service[A]: Home-based primary care: 32; Number
of veterans receiving service[A]: Homemaker/: home health aide: 34;
Number of veterans receiving service[A]: Skilled home health care: 160;
Number of veterans receiving service[A]: Adult day health care: 11;
Number of veterans receiving service[A]: Geriatric evaluation: --;
Number of veterans receiving service[A]: Respite care: --.
VA medical facility or health care system (HCS): Shreveport; Number of
veterans receiving service[A]: Home-based primary care: 64; Number of
veterans receiving service[A]: Homemaker/: home health aide: 33; Number
of veterans receiving service[A]: Skilled home health care: 80; Number
of veterans receiving service[A]: Adult day health care: [Empty];
Number of veterans receiving service[A]: Geriatric evaluation: [Empty];
Number of veterans receiving service[A]: Respite care: [Empty].
VA medical facility or health care system (HCS): Network 17 (Dallas):
VA medical facility or health care system (HCS): Central Texas HCS;
Number of veterans receiving service[A]: Home-based primary care:
[Empty]; Number of veterans receiving service[A]: Homemaker/: home
health aide: 97; Number of veterans receiving service[A]: Skilled home
health care: 23; Number of veterans receiving service[A]: Adult day
health care: 2; Number of veterans receiving service[A]: Geriatric
evaluation: 18; Number of veterans receiving service[A]: Respite care:
0.
VA medical facility or health care system (HCS): North Texas HCS[B];
Number of veterans receiving service[A]: Home-based primary care: 195;
Number of veterans receiving service[A]: Homemaker/: home health aide:
98; Number of veterans receiving service[A]: Skilled home health care:
39; Number of veterans receiving service[A]: Adult day health care: 18;
Number of veterans receiving service[A]: Geriatric evaluation: 62;
Number of veterans receiving service[A]: Respite care: [Empty].
VA medical facility or health care system (HCS): South Texas HCS;
Number of veterans receiving service[A]: Home-based primary care: 189;
Number of veterans receiving service[A]: Homemaker/: home health aide:
128; Number of veterans receiving service[A]: Skilled home health care:
57; Number of veterans receiving service[A]: Adult day health care: 44;
Number of veterans receiving service[A]: Geriatric evaluation: 418;
Number of veterans receiving service[A]: Respite care: [Empty].
VA medical facility or health care system (HCS): Network 18 (Phoenix):
VA medical facility or health care system (HCS): Albuquerque[B]; Number
of veterans receiving service[A]: Home-based primary care: 96; Number
of veterans receiving service[A]: Homemaker/: home health aide: 168;
Number of veterans receiving service[A]: Skilled home health care: 3;
Number of veterans receiving service[A]: Adult day health care:
[Empty]; Number of veterans receiving service[A]: Geriatric evaluation:
135; Number of veterans receiving service[A]: Respite care: [Empty].
VA medical facility or health care system (HCS): Amarillo[B]; Number of
veterans receiving service[A]: Home-based primary care: [Empty]; Number
of veterans receiving service[A]: Homemaker/: home health aide:
[Empty]; Number of veterans receiving service[A]: Skilled home health
care: 82; Number of veterans receiving service[A]: Adult day health
care: [Empty]; Number of veterans receiving service[A]: Geriatric
evaluation: [Empty]; Number of veterans receiving service[A]: Respite
care: [Empty].
VA medical facility or health care system (HCS): Big Spring; Number of
veterans receiving service[A]: Home-based primary care: [Empty]; Number
of veterans receiving service[A]: Homemaker/: home health aide:
[Empty]; Number of veterans receiving service[A]: Skilled home health
care: [Empty]; Number of veterans receiving service[A]: Adult day
health care: [Empty]; Number of veterans receiving service[A]:
Geriatric evaluation: [Empty]; Number of veterans receiving service[A]:
Respite care: [Empty].
VA medical facility or health care system (HCS): El Paso[B]; Number of
veterans receiving service[A]: Home-based primary care: [Empty]; Number
of veterans receiving service[A]: Homemaker/: home health aide:
[Empty]; Number of veterans receiving service[A]: Skilled home health
care: 3; Number of veterans receiving service[A]: Adult day health
care: [Empty]; Number of veterans receiving service[A]: Geriatric
evaluation: 1; Number of veterans receiving service[A]: Respite care:
[Empty].
VA medical facility or health care system (HCS): Phoenix; Number of
veterans receiving service[A]: Home-based primary care: 75; Number of
veterans receiving service[A]: Homemaker/: home health aide: 57; Number
of veterans receiving service[A]: Skilled home health care: 250; Number
of veterans receiving service[A]: Adult day health care: --; Number of
veterans receiving service[A]: Geriatric evaluation: [Empty]; Number of
veterans receiving service[A]: Respite care: [Empty].
VA medical facility or health care system (HCS): Prescott; Number of
veterans receiving service[A]: Home-based primary care: [Empty]; Number
of veterans receiving service[A]: Homemaker/: home health aide: 6;
Number of veterans receiving service[A]: Skilled home health care: 72;
Number of veterans receiving service[A]: Adult day health care: 38;
Number of veterans receiving service[A]: Geriatric evaluation: --;
Number of veterans receiving service[A]: Respite care: [Empty].
VA medical facility or health care system (HCS): Tucson; Number of
veterans receiving service[A]: Home-based primary care: 163; Number of
veterans receiving service[A]: Homemaker/: home health aide: 128;
Number of veterans receiving service[A]: Skilled home health care: 156;
Number of veterans receiving service[A]: Adult day health care: 39;
Number of veterans receiving service[A]: Geriatric evaluation: 25;
Number of veterans receiving service[A]: Respite care: 8.
VA medical facility or health care system (HCS): Network 19 (Denver):
VA medical facility or health care system (HCS): Cheyenne; Number of
veterans receiving service[A]: Home-based primary care: [Empty]; Number
of veterans receiving service[A]: Homemaker/: home health aide: 107;
Number of veterans receiving service[A]: Skilled home health care: 1;
Number of veterans receiving service[A]: Adult day health care:
[Empty]; Number of veterans receiving service[A]: Geriatric evaluation:
[Empty]; Number of veterans receiving service[A]: Respite care:
[Empty].
VA medical facility or health care system (HCS): Denver; Number of
veterans receiving service[A]: Home-based primary care: 76; Number of
veterans receiving service[A]: Homemaker/: home health aide: 134;
Number of veterans receiving service[A]: Skilled home health care: 66;
Number of veterans receiving service[A]: Adult day health care: 61;
Number of veterans receiving service[A]: Geriatric evaluation: 122;
Number of veterans receiving service[A]: Respite care: 14.
VA medical facility or health care system (HCS): Fort Lyon; Number of
veterans receiving service[A]: Home-based primary care: [Empty]; Number
of veterans receiving service[A]: Homemaker/: home health aide: 85;
Number of veterans receiving service[A]: Skilled home health care: 165;
Number of veterans receiving service[A]: Adult day health care:
[Empty]; Number of veterans receiving service[A]: Geriatric evaluation:
[Empty]; Number of veterans receiving service[A]: Respite care: 0.
VA medical facility or health care system (HCS): Grand Junction[B];
Number of veterans receiving service[A]: Home-based primary care:
[Empty]; Number of veterans receiving service[A]: Homemaker/: home
health aide: [Empty]; Number of veterans receiving service[A]: Skilled
home health care: 6; Number of veterans receiving service[A]: Adult day
health care: [Empty]; Number of veterans receiving service[A]:
Geriatric evaluation: [Empty]; Number of veterans receiving service[A]:
Respite care: [Empty].
VA medical facility or health care system (HCS): Montana HCS; Number of
veterans receiving service[A]: Home-based primary care: [Empty]; Number
of veterans receiving service[A]: Homemaker/: home health aide:
[Empty]; Number of veterans receiving service[A]: Skilled home health
care: [Empty]; Number of veterans receiving service[A]: Adult day
health care: [Empty]; Number of veterans receiving service[A]:
Geriatric evaluation: [Empty]; Number of veterans receiving service[A]:
Respite care: [Empty].
VA medical facility or health care system (HCS): Salt Lake City[B];
Number of veterans receiving service[A]: Home-based primary care: 127;
Number of veterans receiving service[A]: Homemaker/: home health aide:
115; Number of veterans receiving service[A]: Skilled home health care:
98; Number of veterans receiving service[A]: Adult day health care:
[Empty]; Number of veterans receiving service[A]: Geriatric evaluation:
83; Number of veterans receiving service[A]: Respite care: [Empty].
VA medical facility or health care system (HCS): Sheridan; Number of
veterans receiving service[A]: Home-based primary care: [Empty]; Number
of veterans receiving service[A]: Homemaker/: home health aide: 25;
Number of veterans receiving service[A]: Skilled home health care: 5;
Number of veterans receiving service[A]: Adult day health care: 2;
Number of veterans receiving service[A]: Geriatric evaluation: [Empty];
Number of veterans receiving service[A]: Respite care: [Empty].
VA medical facility or health care system (HCS): Network 20 (Portland):
VA medical facility or health care system (HCS): Alaska HCS; Number of
veterans receiving service[A]: Home-based primary care: [Empty]; Number
of veterans receiving service[A]: Homemaker/: home health aide: 15;
Number of veterans receiving service[A]: Skilled home health care: 87;
Number of veterans receiving service[A]: Adult day health care:
[Empty]; Number of veterans receiving service[A]: Geriatric evaluation:
[Empty]; Number of veterans receiving service[A]: Respite care:
[Empty].
VA medical facility or health care system (HCS): Boise; Number of
veterans receiving service[A]: Home-based primary care: [Empty]; Number
of veterans receiving service[A]: Homemaker/: home health aide: 45;
Number of veterans receiving service[A]: Skilled home health care: 43;
Number of veterans receiving service[A]: Adult day health care:
[Empty]; Number of veterans receiving service[A]: Geriatric evaluation:
5; Number of veterans receiving service[A]: Respite care: [Empty].
VA medical facility or health care system (HCS): Portland; Number of
veterans receiving service[A]: Home-based primary care: 119; Number of
veterans receiving service[A]: Homemaker/: home health aide: 26; Number
of veterans receiving service[A]: Skilled home health care: 68; Number
of veterans receiving service[A]: Adult day health care: [Empty];
Number of veterans receiving service[A]: Geriatric evaluation: 94;
Number of veterans receiving service[A]: Respite care: [Empty].
VA medical facility or health care system (HCS): Puget Sound HCS;
Number of veterans receiving service[A]: Home-based primary care: 149;
Number of veterans receiving service[A]: Homemaker/: home health aide:
125; Number of veterans receiving service[A]: Skilled home health care:
19; Number of veterans receiving service[A]: Adult day health care: 35;
Number of veterans receiving service[A]: Geriatric evaluation: 144;
Number of veterans receiving service[A]: Respite care: 0.
VA medical facility or health care system (HCS): Roseburg; Number of
veterans receiving service[A]: Home-based primary care: [Empty]; Number
of veterans receiving service[A]: Homemaker/: home health aide: 25;
Number of veterans receiving service[A]: Skilled home health care: 17;
Number of veterans receiving service[A]: Adult day health care:
[Empty]; Number of veterans receiving service[A]: Geriatric evaluation:
[Empty]; Number of veterans receiving service[A]: Respite care:
[Empty].
VA medical facility or health care system (HCS): Spokane; Number of
veterans receiving service[A]: Home-based primary care: [Empty]; Number
of veterans receiving service[A]: Homemaker/: home health aide: 28;
Number of veterans receiving service[A]: Skilled home health care: 11;
Number of veterans receiving service[A]: Adult day health care: 12;
Number of veterans receiving service[A]: Geriatric evaluation: [Empty];
Number of veterans receiving service[A]: Respite care: 10.
VA medical facility or health care system (HCS): Walla Walla[B]; Number
of veterans receiving service[A]: Home-based primary care: [Empty];
Number of veterans receiving service[A]: Homemaker/: home health aide:
14; Number of veterans receiving service[A]: Skilled home health care:
--; Number of veterans receiving service[A]: Adult day health care:
[Empty]; Number of veterans receiving service[A]: Geriatric evaluation:
[Empty]; Number of veterans receiving service[A]: Respite care:
[Empty].
VA medical facility or health care system (HCS): White City
Domiciliary; Number of veterans receiving service[A]: Home-based
primary care: [Empty]; Number of veterans receiving service[A]:
Homemaker/: home health aide: 29; Number of veterans receiving
service[A]: Skilled home health care: --; Number of veterans receiving
service[A]: Adult day health care: 76; Number of veterans receiving
service[A]: Geriatric evaluation: 60; Number of veterans receiving
service[A]: Respite care: 3.
VA medical facility or health care system (HCS): Network 21 (San
Francisco):
VA medical facility or health care system (HCS): Central California
HCS[B]; Number of veterans receiving service[A]: Home-based primary
care: 52; Number of veterans receiving service[A]: Homemaker/: home
health aide: 18; Number of veterans receiving service[A]: Skilled home
health care: 19; Number of veterans receiving service[A]: Adult day
health care: [Empty]; Number of veterans receiving service[A]:
Geriatric evaluation: 38; Number of veterans receiving service[A]:
Respite care: [Empty].
VA medical facility or health care system (HCS): Honolulu[B]; Number of
veterans receiving service[A]: Home-based primary care: 65; Number of
veterans receiving service[A]: Homemaker/: home health aide: 11; Number
of veterans receiving service[A]: Skilled home health care: 4; Number
of veterans receiving service[A]: Adult day health care: 2; Number of
veterans receiving service[A]: Geriatric evaluation: 75; Number of
veterans receiving service[A]: Respite care: [Empty].
VA medical facility or health care system (HCS): Northern California
HCS; Number of veterans receiving service[A]: Home-based primary care:
185; Number of veterans receiving service[A]: Homemaker/: home health
aide: 78; Number of veterans receiving service[A]: Skilled home health
care: 69; Number of veterans receiving service[A]: Adult day health
care: 6; Number of veterans receiving service[A]: Geriatric evaluation:
[Empty]; Number of veterans receiving service[A]: Respite care:
[Empty].
VA medical facility or health care system (HCS): Palo Alto; Number of
veterans receiving service[A]: Home-based primary care: 115; Number of
veterans receiving service[A]: Homemaker/: home health aide: 29; Number
of veterans receiving service[A]: Skilled home health care: 48; Number
of veterans receiving service[A]: Adult day health care: 15; Number of
veterans receiving service[A]: Geriatric evaluation: 90; Number of
veterans receiving service[A]: Respite care: 10.
VA medical facility or health care system (HCS): Reno; Number of
veterans receiving service[A]: Home-based primary care: 83; Number of
veterans receiving service[A]: Homemaker/: home health aide: 83; Number
of veterans receiving service[A]: Skilled home health care: 83; Number
of veterans receiving service[A]: Adult day health care: 9; Number of
veterans receiving service[A]: Geriatric evaluation: 35; Number of
veterans receiving service[A]: Respite care: 0.
VA medical facility or health care system (HCS): San Francisco; Number
of veterans receiving service[A]: Home-based primary care: 99; Number
of veterans receiving service[A]: Homemaker/: home health aide: 69;
Number of veterans receiving service[A]: Skilled home health care: 40;
Number of veterans receiving service[A]: Adult day health care: 8;
Number of veterans receiving service[A]: Geriatric evaluation: 80;
Number of veterans receiving service[A]: Respite care: [Empty].
VA medical facility or health care system (HCS): Network 22 (Long
Beach):
VA medical facility or health care system (HCS): Greater Los Angeles
HCS; Number of veterans receiving service[A]: Home-based primary care:
245; Number of veterans receiving service[A]: Homemaker/: home health
aide: 95; Number of veterans receiving service[A]: Skilled home health
care: 12; Number of veterans receiving service[A]: Adult day health
care: 57; Number of veterans receiving service[A]: Geriatric
evaluation: 123; Number of veterans receiving service[A]: Respite care:
[Empty].
VA medical facility or health care system (HCS): Loma Linda; Number of
veterans receiving service[A]: Home-based primary care: [Empty]; Number
of veterans receiving service[A]: Homemaker/: home health aide: 90;
Number of veterans receiving service[A]: Skilled home health care: 210;
Number of veterans receiving service[A]: Adult day health care: 25;
Number of veterans receiving service[A]: Geriatric evaluation: [Empty];
Number of veterans receiving service[A]: Respite care: [Empty].
VA medical facility or health care system (HCS): Long Beach; Number of
veterans receiving service[A]: Home-based primary care: 115; Number of
veterans receiving service[A]: Homemaker/: home health aide: [Empty];
Number of veterans receiving service[A]: Skilled home health care:
[Empty]; Number of veterans receiving service[A]: Adult day health
care: [Empty]; Number of veterans receiving service[A]: Geriatric
evaluation: 119; Number of veterans receiving service[A]: Respite care:
[Empty].
VA medical facility or health care system (HCS): Southern Nevada HCS;
Number of veterans receiving service[A]: Home-based primary care:
[Empty]; Number of veterans receiving service[A]: Homemaker/: home
health aide: [Empty]; Number of veterans receiving service[A]: Skilled
home health care: 33; Number of veterans receiving service[A]: Adult
day health care: [Empty]; Number of veterans receiving service[A]:
Geriatric evaluation: 34; Number of veterans receiving service[A]:
Respite care: 0.
VA medical facility or health care system (HCS): San Diego; Number of
veterans receiving service[A]: Home-based primary care: 77; Number of
veterans receiving service[A]: Homemaker/: home health aide: 40; Number
of veterans receiving service[A]: Skilled home health care: 15; Number
of veterans receiving service[A]: Adult day health care: 50; Number of
veterans receiving service[A]: Geriatric evaluation: 80; Number of
veterans receiving service[A]: Respite care: [Empty].
VA medical facility or health care system (HCS): Network 23
(Minneapolis)[C]:
VA medical facility or health care system (HCS): Black Hills HCS;
Number of veterans receiving service[A]: Home-based primary care:
[Empty]; Number of veterans receiving service[A]: Homemaker/: home
health aide: 105; Number of veterans receiving service[A]: Skilled home
health care: 101; Number of veterans receiving service[A]: Adult day
health care: [Empty]; Number of veterans receiving service[A]:
Geriatric evaluation: [Empty]; Number of veterans receiving service[A]:
Respite care: 1.
VA medical facility or health care system (HCS): Central Iowa HCS;
Number of veterans receiving service[A]: Home-based primary care: 49;
Number of veterans receiving service[A]: Homemaker/: home health aide:
17; Number of veterans receiving service[A]: Skilled home health care:
66; Number of veterans receiving service[A]: Adult day health care:
[Empty]; Number of veterans receiving service[A]: Geriatric evaluation:
[Empty]; Number of veterans receiving service[A]: Respite care:
[Empty].
VA medical facility or health care system (HCS): Fargo; Number of
veterans receiving service[A]: Home-based primary care: [Empty]; Number
of veterans receiving service[A]: Homemaker/: home health aide: 69;
Number of veterans receiving service[A]: Skilled home health care: 240;
Number of veterans receiving service[A]: Adult day health care: 2;
Number of veterans receiving service[A]: Geriatric evaluation: [Empty];
Number of veterans receiving service[A]: Respite care: [Empty].
VA medical facility or health care system (HCS): Iowa City; Number of
veterans receiving service[A]: Home-based primary care: [Empty]; Number
of veterans receiving service[A]: Homemaker/: home health aide: 182;
Number of veterans receiving service[A]: Skilled home health care: 302;
Number of veterans receiving service[A]: Adult day health care: 85;
Number of veterans receiving service[A]: Geriatric evaluation: 352;
Number of veterans receiving service[A]: Respite care: 4.
VA medical facility or health care system (HCS): Minneapolis; Number of
veterans receiving service[A]: Home-based primary care: 116; Number of
veterans receiving service[A]: Homemaker/: home health aide: 200;
Number of veterans receiving service[A]: Skilled home health care: 130;
Number of veterans receiving service[A]: Adult day health care: 200;
Number of veterans receiving service[A]: Geriatric evaluation: 44;
Number of veterans receiving service[A]: Respite care: 0.
VA medical facility or health care system (HCS): Nebraska/Western Iowa
HCS; Number of veterans receiving service[A]: Home-based primary care:
[Empty]; Number of veterans receiving service[A]: Homemaker/: home
health aide: 94; Number of veterans receiving service[A]: Skilled home
health care: 82; Number of veterans receiving service[A]: Adult day
health care: 7; Number of veterans receiving service[A]: Geriatric
evaluation: 36; Number of veterans receiving service[A]: Respite care:
1.
VA medical facility or health care system (HCS): Sioux Falls; Number of
veterans receiving service[A]: Home-based primary care: [Empty]; Number
of veterans receiving service[A]: Homemaker/: home health aide: 51;
Number of veterans receiving service[A]: Skilled home health care: 50;
Number of veterans receiving service[A]: Adult day health care: 2;
Number of veterans receiving service[A]: Geriatric evaluation: 16;
Number of veterans receiving service[A]: Respite care: [Empty].
VA medical facility or health care system (HCS): St. Cloud; Number of
veterans receiving service[A]: Home-based primary care: [Empty]; Number
of veterans receiving service[A]: Homemaker/: home health aide: 76;
Number of veterans receiving service[A]: Skilled home health care: 105;
Number of veterans receiving service[A]: Adult day health care: 87;
Number of veterans receiving service[A]: Geriatric evaluation: 12;
Number of veterans receiving service[A]: Respite care: 1.
Source: GAO.
Notes: Responses to our surveys were submitted September through
November 2002.
Facility cells that are empty indicate that a facility did not report
offering the service at the time of our survey. A dash indicates that a
facility reported offering the service but did not report the service's
July 2002 utilization.
[A] Services include those provided directly by VA staff or through
contracts.
[B] Facility reported using only a volunteer service to provide
noninstitutional respite care to veterans. We did not include volunteer
respite care services in our number of facilities offering
noninstitutional respite care.
[C] Network 23 was created when Networks 13 and 14 were merged into a
single network in January 2002. VA currently has 21 networks.
[End of table]
[End of section]
Appendix IV: Comments From the Department of Veterans Affairs:
THE SECRETARY OF VETERANS AFFAIRS WASHINGTON:
April 7, 2003:
Ms. Cynthia A. Bascetta Director, Health Care-Veterans' Health and
Benefits Issues Health Care Team:
U. S. General Accounting Office 441 G Street, NW Washington, DC 20548:
Dear Ms. Bascetta:
The Department of Veterans Affairs (VA) has reviewed your draft report,
VA LONG-TERM CARE: Service Gaps and Facility Restrictions Limit
Veterans' Access to Noninstitutional Care (GAO-03-487) and agrees with
your findings and conclusions. VA concurs with your recommendations and
offers these preliminary comments. The Veterans Health Administration
will add eligibility sections in each new directive and handbook
concerning Home and Community Based Care Programs. It will also develop
performance measures to underscore the importance the Department places
on its noninstitutional long-term care programs.
VA will provide its detailed action plan to implement GAO's
recommendations when responding to your final report.
Thank you for the opportunity to comment on your draft report.
Sincerely yours,
Anthony J. Principi:
Signed by Anthony J. Principi:
[End of section]
Appendix V: GAO Contact and Staff Acknowledgments:
GAO Contact:
James C. Musselwhite, (202) 512-7259:
Acknowledgments:
In addition to the contact named above Pamela Dooley, Steve Gaty,
Marcia Mann, and Kristin Wilson made key contributions to this report.
[End of section]
Related GAO Products:
Long-Term Care: Availability of Medicaid Home and Community Services
for Elderly Individuals Varies Considerably. GAO-02-1121. Washington,
D.C.: September 26, 2002.
VA Long-Term Care: The Availability of Noninstitutional Services Is
Uneven. GAO-02-652T. Washington, D.C.: April 25, 2002.
VA Long-Term Care: Implementation of Certain Millennium Act Provisions
Is Incomplete, and Availability of Noninstitutional Services Is Uneven.
GAO-02-510R. Washington, D.C.: March 29, 2002.
Veterans' Affairs: Observations on Selected Features of the Proposed
Veterans' Millennium Health Care Act. GAO/T-HEHS-99-125. Washington,
D.C.: May 19, 1999.
FOOTNOTES
[1] Pub. L. No. 106-117, 113 Stat. 1545 (1999).
[2] The act requires that VA provide noninstitutional extended care
services to enrolled veterans until December 31, 2003.
[3] U.S. General Accounting Office, VA Long-Term Care: The Availability
of Noninstitutional Services Is Uneven, GAO-02-652T (Washington, D.C.:
Apr. 25, 2002).
[4] U.S. General Accounting Office, VA Long-Term Care: Implementation
of Certain Millennium Act Provisions Is Incomplete, and Availability of
Noninstitutional Services Is Uneven, GAO-02-510R (Washington, D.C.:
Mar. 29, 2002).
[5] Although VA has 172 medical centers, in some instances 2 or more
medical centers have consolidated into health care systems. Counting
health care systems and individual medical centers that are not part of
a health care system as single facilities, VA has 139 facilities.
[6] VA originally created 22 networks, but in January 2002 VA merged 2
networks into a single network, leaving the agency with 21 networks.
[7] Pub. L. No. 104-262 §§ 101, 104, 110 Stat. 3178-79, 3182-83 (1996).
[8] A service-connected disability is an injury or disease that was
incurred or aggravated while on active military duty. VA classifies
veterans with service-connected disabilities according to the extent of
their disability. These classifications are expressed in terms of
percentages--for example, the most severely disabled such veteran would
be classified as having a service-connected disability of 100 percent.
Percentages are assigned in increments of 10 percent.
[9] Priority 8 veterans are primarily veterans with no service-
connected disabilities who have incomes above established limits for
geographic regions set by the U.S. Department of Housing and Urban
Development to reflect regional costs of living. Priority 8 veterans
enrolled prior to January 17, 2003, remain enrolled to receive VA
health care benefits.
[10] Medicaid, the joint federal-state health-financing program for
low-income individuals, is the nation's largest funding source for
long-term care. In fiscal year 2001, Medicaid expenditures on long-term
care totaled $75.3 billion.
[11] For more information on VA's resource allocation system see U.S.
General Accounting Office, VA Health Care: Allocation Changes Would
Better Align Resources with Workload, GAO-02-338 (Washington, D.C.:
Feb. 28, 2002).
[12] Case management includes assessment of the veteran's care needs,
care planning and implementation, referral coordination, monitoring,
and periodic reassessment of the veteran's care needs.
[13] Although VA issued a regulation on September 17, 2002, granting
priority for appointments to veterans with service-connected
disabilities of at least 50 percent and veterans needing care for a
service-connected disability, the regulation does not change other
veterans' eligibility to receive services.
[14] The Millennium Act requires that VA provide nursing home care to
any veteran who needs such care and who has a service-connected
disability of 70 percent or greater, or to any veteran needing such
care specifically for a service-connected disability, even if the
disability is less than 70 percent.
[15] According to VA, when it plans for noninstitutional services it
assumes that the vast majority of veterans will choose to use their
Medicare benefits for home health care.
[16] The medical benefits package is the set of services to be
available to all enrolled veterans.
[17] At two facilities we visited where home-based primary care is
offered, officials told us that veterans would likely be provided home
health care through a contract service if they lived outside of each
facility's home-based primary care service area.
[18] The utilization data provided by VA facilities does not represent
an unduplicated count of veterans in these settings because some
veterans may receive more than one noninstitutional service.
[19] GAO-02-652T.
[20] Although VA has 172 medical centers, in some instances 2 or more
medical centers have consolidated into health care systems. Counting
health care systems and individual medical centers that are not part of
a health care system as single facilities, VA has 139 facilities.
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