VA Long-Term Care
Trends and Planning Challenges in Providing Nursing Home Care to Veterans Gao ID: GAO-06-333T January 9, 2006The Department of Veterans Affairs (VA) operates a nursing home program that provides or pays for veterans' care in three nursing home settings: VA-operated nursing homes, community nursing homes, and state veterans' nursing homes. In addition, veterans needing nursing home care may also receive it from non-VA providers that are not funded by VA. VA is faced with a large elderly veteran population, many of whom may be in need of nursing home care. In 2004, 38 percent of the nation's veteran population was over the age of 65, compared with 12 percent of the general population. The Veterans Millennium Health Care and Benefits Act (Millennium Act) of 1999 and VA policy require that VA provide nursing home care to certain veterans. This statement focuses on VA's nursing home program and trends in nursing home expenditures, trends in the number of patients served, or "patient workload," and key challenges VA faces in planning for nursing home care for veterans. To examine these trends, GAO updated information from prior work with spending and patient workload data for fiscal year 2005 that VA provided. In a November 2004 report, GAO presented spending and patient workload data through fiscal year 2003. GAO discussed the updated information with VA and incorporated comments as appropriate.
VA's reported overall nursing home care expenditures in its three settings increased from $2.3 billion to almost $3.2 billion from fiscal year 2003 through fiscal year 2005. VA officials attributed the expenditure increase from fiscal year 2003 to fiscal year 2005, in part, to a change in the cost accounting system used to develop expenditure totals for each nursing home setting. Based on VA's reported expenditures, VA-operated nursing homes continued to account for about three-quarters of VA's overall nursing home care expenditures in fiscal year 2005, as they did in fiscal year 2003. In fiscal year 2005, 77 percent of nursing home care expenditures were accounted for by VA-operated nursing homes, compared to 73 percent in 2003. VA spent the remainder on state veterans' nursing homes and community nursing homes. From fiscal year 2003 through fiscal year 2005, the percentage of overall expenditures for state veterans' nursing homes declined from 15 to 12 percent and the percentage of overall expenditures for community nursing homes declined from 12 to 11 percent. VA's overall patient workload in nursing homes increased to an average of 34,375 patients per day by fiscal year 2005, 3.5 percent above the fiscal year 2003 workload. State veterans' nursing homes accounted for over half of VA's patient workload in fiscal year 2005. The workload percent is higher than the 12 percent expenditure in state veterans' nursing homes partly because VA pays on average about one-third of the costs for care veterans receive in state veterans' nursing homes, compared to the full cost in other settings. From fiscal year 2003 through fiscal year 2005, the percentage of workload provided in state veterans' nursing homes increased from 50 to 52 percent. In contrast, the percentage of patient workload provided in VA-operated nursing homes declined from 37 to 35 percent. The percentage of workload in community nursing homes stayed the same at 13 percent. VA faces two key challenges in planning for the provision of nursing home care. The first challenge is estimating who will seek care from VA and what their nursing home care needs will be. This includes estimating the number of veterans that will be eligible for nursing home care, based on law and VA policy, and the extent to which these veterans will be seeking care for short-stay postacute needs or long-stay chronic needs. A second key challenge VA faces is determining whether it will maintain or increase the proportion of nursing home care demand it meets in each of the three nursing home settings or whether veterans will need to rely more on other non-VA nursing home care providers that are funded by other programs, such as Medicaid and Medicare.
GAO-06-333T, VA Long-Term Care: Trends and Planning Challenges in Providing Nursing Home Care to Veterans
This is the accessible text file for GAO report number GAO-06-333
entitled 'VA Long-Term Care: Trends and Planning Challenges in
Providing Nursing Home Care to Veterans' which was released on January
10, 2006.
This text file was formatted by the U.S. Government Accountability
Office (GAO) to be accessible to users with visual impairments, as part
of a longer term project to improve GAO products' accessibility. Every
attempt has been made to maintain the structural and data integrity of
the original printed product. Accessibility features, such as text
descriptions of tables, consecutively numbered footnotes placed at the
end of the file, and the text of agency comment letters, are provided
but may not exactly duplicate the presentation or format of the printed
version. The portable document format (PDF) file is an exact electronic
replica of the printed version. We welcome your feedback. Please E-mail
your comments regarding the contents or accessibility features of this
document to Webmaster@gao.gov.
This is a work of the U.S. government and is not subject to copyright
protection in the United States. It may be reproduced and distributed
in its entirety without further permission from GAO. Because this work
may contain copyrighted images or other material, permission from the
copyright holder may be necessary if you wish to reproduce this
material separately.
Testimony:
Before the Committee on Veterans' Affairs, U.S. Senate:
United States Government Accountability Office:
GAO:
For Release on Delivery Expected at 10:00 a.m. HST:
Lihue, Hawaii:
Monday, January 9, 2006:
VA Long-Term Care:
Trends and Planning Challenges in Providing Nursing Home Care to
Veterans:
Statement of Laurie E. Ekstrand:
Director, Health Care:
GAO-06-333T:
GAO Highlights:
Highlights of GAO-06-333T, a testimony before the Committee on
Veterans‘ Affairs, U.S. Senate:
Why GAO Did This Study:
The Department of Veterans Affairs (VA) operates a nursing home program
that provides or pays for veterans‘ care in three nursing home
settings: VA-operated nursing homes, community nursing homes, and state
veterans‘ nursing homes. In addition, veterans needing nursing home
care may also receive it from non-VA providers that are not funded by
VA. VA is faced with a large elderly veteran population, many of whom
may be in need of nursing home care. In 2004, 38 percent of the
nation‘s veteran population was over the age of 65, compared with 12
percent of the general population. The Veterans Millennium Health Care
and Benefits Act (Millennium Act) of 1999 and VA policy require that VA
provide nursing home care to certain veterans.
This statement focuses on VA‘s nursing home program and trends in
nursing home expenditures, trends in the number of patients served, or
’patient workload,“ and key challenges VA faces in planning for nursing
home care for veterans.
To examine these trends, GAO updated information from prior work with
spending and patient workload data for fiscal year 2005 that VA
provided. In a November 2004 report, GAO presented spending and patient
workload data through fiscal year 2003. GAO discussed the updated
information with VA and incorporated comments as appropriate.
What GAO Found:
VA‘s reported overall nursing home care expenditures in its three
settings increased from $2.3 billion to almost $3.2 billion from fiscal
year 2003 through fiscal year 2005. VA officials attributed the
expenditure increase from fiscal year 2003 to fiscal year 2005, in
part, to a change in the cost accounting system used to develop
expenditure totals for each nursing home setting. Based on VA‘s
reported expenditures, VA-operated nursing homes continued to account
for about three-quarters of VA‘s overall nursing home care expenditures
in fiscal year 2005, as they did in fiscal year 2003. In fiscal year
2005, 77 percent of nursing home care expenditures were accounted for
by VA-operated nursing homes, compared to 73 percent in 2003. VA spent
the remainder on state veterans‘ nursing homes and community nursing
homes. From fiscal year 2003 through fiscal year 2005, the percentage
of overall expenditures for state veterans‘ nursing homes declined from
15 to 12 percent and the percentage of overall expenditures for
community nursing homes declined from 12 to 11 percent.
VA‘s overall patient workload in nursing homes increased to an average
of 34,375 patients per day by fiscal year 2005, 3.5 percent above the
fiscal year 2003 workload. State veterans‘ nursing homes accounted for
over half of VA‘s patient workload in fiscal year 2005. The workload
percent is higher than the 12 percent expenditure in state veterans‘
nursing homes partly because VA pays on average about one-third of the
costs for care veterans receive in state veterans‘ nursing homes,
compared to the full cost in other settings. From fiscal year 2003
through fiscal year 2005, the percentage of workload provided in state
veterans‘ nursing homes increased from 50 to 52 percent. In contrast,
the percentage of patient workload provided in VA-operated nursing
homes declined from 37 to 35 percent. The percentage of workload in
community nursing homes stayed the same at 13 percent.
VA faces two key challenges in planning for the provision of nursing
home care. The first challenge is estimating who will seek care from VA
and what their nursing home care needs will be. This includes
estimating the number of veterans that will be eligible for nursing
home care, based on law and VA policy, and the extent to which these
veterans will be seeking care for short-stay postacute needs or long-
stay chronic needs. A second key challenge VA faces is determining
whether it will maintain or increase the proportion of nursing home
care demand it meets in each of the three nursing home settings or
whether veterans will need to rely more on other non-VA nursing home
care providers that are funded by other programs, such as Medicaid and
Medicare.
www.gao.gov/cgi-bin/getrpt?GAO-06-333T.
To view the full product, including the scope and methodology, click on
the link above. For more information, contact Laurie E. Ekstrand at
(202) 512-7101 or ekstrandl@gao.gov.
[End of section]
Mr. Chairman and Members of the Committee:
We are pleased to be here today as you discuss issues regarding the
Department of Veterans Affairs (VA) health care program for veterans.
One important part of that program is nursing home care, which accounts
for about 9 percent of VA's health care expenditures. The VA nursing
home program provides care in three settings. It operates its own
nursing homes in 134 locations, including a nursing home in Honolulu;
it pays for care under contract in non-VA nursing homes, referred to as
community nursing homes, including two community nursing homes on the
island of Oahu; and it pays about one-third of the costs per day for
veterans in state veterans' nursing homes, one of which will be built
in Hilo.[Footnote 1] In addition, veterans needing nursing home care
may also receive it from non-VA providers that are not funded by VA. In
its three settings, a range of nursing home services is provided to
veterans, including short-stay postacute care for patients recovering
from a condition such as a stroke to long-stay care for patients who
cannot be cared for at home because of severe, chronic physical or
mental limitations. VA nursing home care is part of a continuum of long-
term care services that VA provides, including services to veterans in
the community and in veterans' own homes.[Footnote 2]
As you know, meeting veterans' nursing home care needs is a key issue
for VA nationally, and here in Hawaii, because of the large elderly
veteran population, many of whom are in need of such care. Nationwide,
the issue of meeting nursing home needs is even more urgent for the
veteran population than for the general population because the veteran
population is older. In 2004, 38 percent of the nation's veteran
population was over the age of 65, compared with 12 percent of the
general population. Similarly, in Hawaii, 38 percent of the veteran
population was over the age of 65, compared with almost 14 percent of
the general population.
In my remarks today I will discuss trends in VA's overall nursing home
care expenditures,[Footnote 3] trends in the number of patients served,
or "patient workload," and key challenges VA faces in planning for
nursing home care for veterans. Examination of data on trends in the
provision of nursing home care and of challenges VA faces in planning
for nursing home care is important for oversight and strategic
planning. Examination of these data is also useful in assessing whether
the nursing home program is meeting current goals. My comments today
are based primarily on work we have previously completed.[Footnote 4]
We updated information from our prior work with spending and patient
workload data for fiscal year 2005 that VA provided. Thus we present
the most current information available at the time of our November 2004
report[Footnote 5] alongside the most current information available now
to assess trends between these two points in time. For fiscal year
2005, VA used a different cost accounting system to develop expenditure
totals for each nursing home setting. VA told us that the accounting
system used in fiscal year 2005 would result in higher expenditures
than the accounting system VA used in fiscal year 2003. VA could not
provide the 2005 expenditure totals using the 2003 cost accounting
system, which could be used to determine the extent to which the change
in expenditures resulted from real changes in the level of nursing home
care expenditures or from the change in cost accounting systems. As in
our previous work, we measured patient workload by using the average
daily census, which reflects the average number of veterans receiving
nursing home care on any given day during the course of the year. In
doing our work, we discussed the updated information with VA,
determined the information was adequate for our purposes, and
incorporated comments from VA as appropriate. We conducted our review
from December 2005 through January 2006 in accordance with generally
accepted government auditing standards.
In summary, VA's reported overall nursing home care expenditures in its
three settings increased from $2.3 billion to almost $3.2 billion from
fiscal year 2003 through fiscal year 2005. VA officials attributed the
expenditure increase from fiscal year 2003 to fiscal year 2005, in
part, to a change in the cost accounting system used to develop
expenditure totals for each nursing home setting. Based on VA's
reported expenditures, VA-operated nursing homes continued to account
for about three-quarters of VA's overall nursing home care expenditures
in fiscal year 2005, as they did in fiscal year 2003. In fiscal year
2005, 77 percent of nursing home care expenditures were accounted for
by VA-operated nursing homes, compared to 73 percent in 2003. VA spent
the remainder on state veterans' nursing homes and community nursing
homes. From fiscal year 2003 through fiscal year 2005, the percentage
of overall expenditures for state veterans' nursing homes declined from
15 to 12 percent and the percentage of overall expenditures for
community nursing homes declined from 12 to 11 percent.
VA's overall patient workload in nursing homes increased to an average
of 34,375 patients per day by fiscal year 2005, 3.5 percent above the
fiscal year 2003 workload. State veterans' nursing homes accounted for
over half of VA's patient workload in fiscal year 2005. The workload
percent is higher than the 12 percent expenditure in state veterans'
nursing homes partly because VA pays on average about one-third of the
costs for care veterans receive in state veterans' nursing homes,
compared to the full cost in other settings. From fiscal year 2003
through fiscal year 2005, the percentage of workload provided in state
veterans' nursing homes increased from 50 to 52 percent. In contrast,
the percentage of patient workload provided in VA-operated nursing
homes declined from 37 to 35 percent. The percentage of workload in
community nursing homes stayed the same at 13 percent.
VA faces two key challenges in planning for the provision of nursing
home care. The first challenge is estimating who will seek care from VA
and what their nursing home care needs will be. This includes
estimating the number of veterans that will be eligible for nursing
home care, based on law and VA policy, and the extent to which these
veterans will be seeking care for short-stay postacute needs or long-
stay chronic needs. A second key challenge VA faces is determining
whether it will maintain or increase the proportion of nursing home
care demand it meets in each of the three nursing home settings or
whether veterans will need to rely more on other non-VA nursing home
care providers that are funded by other programs, such as Medicaid and
Medicare.
Background:
VA has provided nursing home care to veterans for over 40 years. The
Veterans Millennium Health Care and Benefits Act (Millennium
Act)[Footnote 6] made important changes in VA's nursing home program.
This act required that through December 31, 2003, VA provide nursing
home care to veterans with a service-connected disability rating of 70
percent or greater,[Footnote 7] veterans requiring nursing home care
because of a condition related to their service, and veterans who were
receiving care in a VA nursing home on November 30, 1999. Subsequent
law extended these provisions through December 31, 2008.[Footnote 8] VA
also has established a policy to provide nursing home care to veterans
with a 60 percent service-connected disability rating who also were
classified as unemployable or permanently and totally disabled. For all
other veterans, VA provides care in VA-operated nursing homes and
contract community nursing homes on a discretionary basis, depending on
available resources, with certain patients having higher priority,
including veterans who require postacute care after a hospital stay. VA
pays a portion of the cost to treat veterans who seek care in state
veterans' nursing homes.
The state veterans' nursing homes receive VA funds as part of their
participation in VA's program. As of fiscal year 2005, 116 state
veterans' nursing homes in 44 states and Puerto Rico received payment
from VA to provide care. In fiscal year 2005, VA paid $59.36 per day
per veteran to these state veterans' nursing homes and awarded grants
to states for renovations to existing facilities or construction of new
state veterans' homes. States are responsible for obtaining financing
sources to pay for their portion of veterans' daily cost of care and
for their portion related to renovations to existing facilities or
construction of new state veterans' homes.
Most veterans, however, do not receive their nursing home care from the
VA program but instead receive it from other providers. Care from
others includes both long-stay nursing home care to assist with daily
activities, such as eating and bathing, and short-stay care requiring
skilled nursing home care following hospitalization. For veterans who
do not receive their nursing home care from the VA program, care is
financed by programs such as Medicaid, Medicare, private health or long-
term care insurance, or "self-financing" by the patients.[Footnote 9]
States administer Medicaid programs that include coverage for long-
stay nursing home care. State Medicaid programs are the primary funders
of nursing homes, and self-financing is the next most common source.
Medicare primarily covers acute care health costs and therefore limits
its nursing home coverage to short stays. Private health insurance pays
for a smaller portion of nursing home expenditures than the other three
main sources.[Footnote 10]
Reported Overall Nursing Home Expenditures Increased, with VA-Operated
Nursing Homes Continuing to Account for Almost Three-Quarters of
Expenditures:
VA's reported overall nursing home care expenditures increased from
$2.3 billion to almost $3.2 billion from fiscal year 2003 through
fiscal year 2005. (See table 1.) Expenditures increased in each nursing
home setting. From fiscal year 2003 through fiscal year 2005,
expenditures increased by $743 million in VA-operated nursing homes,
$80 million in community nursing homes, and $30 million in state
veterans' nursing homes. VA officials attributed the expenditure
increase from fiscal year 2003 to fiscal year 2005, in part, to a
change in the cost accounting system used to develop expenditure totals
for each nursing home setting.[Footnote 11]
Table 1: Change in Reported Nursing Home Care Expenditures, Fiscal
Years 2003 and 2005:
Dollars in millions.
Nursing home setting: VA-operated nursing homes;
FY 2003: $1,697;
FY 2005: $2,441;
Change from FY 2003 to FY 2005: $743.
Nursing home setting: Community nursing homes;
FY 2003: $272;
FY 2005: $352;
Change from FY 2003 to FY 2005: $80.
Nursing home setting: State veterans' nursing homes;
FY 2003: $352;
FY 2005: $382;
Change from FY 2003 to FY 2005: $30.
Total;
FY 2003: $2,321;
FY 2005: $3,174;
Change from FY 2003 to FY 2005: $853.
Source: VA.
Note: Dollar amounts may not add due to rounding. VA officials
attributed the increase in expenditures during this period, in part, to
a change in the cost accounting system used to estimate expenditures
for each nursing home setting.
[End of table]
Based on VA's reported nursing home care expenditures, VA-operated
nursing homes continued to account for about three-quarters of VA's
overall nursing home care expenditures in fiscal year 2005, as they did
in fiscal year 2003. (See fig. 1.) In fiscal year 2005, 77 percent of
nursing home care expenditures were accounted for by VA-operated
nursing homes, compared to 73 percent in 2003. From fiscal year 2003 to
fiscal year 2005, the percentage of overall expenditures for state
veterans' nursing homes and community nursing homes declined. The
percentage of overall expenditures for state veterans' nursing homes
declined during this period because expenditures in VA-operated nursing
homes increased more rapidly than expenditures for state veterans'
nursing homes. Growth in the percentage of overall nursing home
expenditures accounted for by VA-operated nursing homes, as well as the
decline in community nursing homes during this 3-year period, was
similar to the pattern we observed from fiscal year 1998 through fiscal
year 2003.[Footnote 12] In contrast, the percentage of overall nursing
home expenditures accounted for by state veterans' nursing homes
increased in the prior period, but decreased from fiscal year 2003
through fiscal year 2005.
Figure 1: Percentage of Reported Overall Nursing Home Care Expenditures
by Setting, Fiscal Years 2003 and 2005:
[See PDF for image]
Note: We calculated these percentages based on VA's reported nursing
home care expenditures, which were based on expenditure totals from
different cost accounting systems VA used in each fiscal year.
[End of figure]
Overall Patient Workload Increased Slightly, with State Veterans'
Nursing Homes Continuing to Account for about Half of VA's Overall
Patient Workload:
VA's overall patient workload in all three nursing home settings, as
measured by average daily census, increased to an average of 34,375
patients per day by fiscal year 2005, 3.5 percent above the fiscal year
2003 workload. (See table 2.) However, the small increase in overall
workload masked different workload trends in VA's three settings.
Strong growth in state veterans' patient workload offset a small
increase in community patient workload and a decline in VA-operated
patient workload. From fiscal year 2003 through fiscal year 2005,
average daily patient workload in the nursing homes VA operated
declined by 215, whereas workload in community nursing homes increased
by 221 and workload in state veterans' nursing homes increased by
1,155. The continued strong growth in workload in state veterans'
nursing homes largely contributed to growth in overall patient workload
during this 3-year period and was consistent with the trends that we
observed from fiscal year 1998 through fiscal year 2003.
Table 2: Change in Patient Workload, Fiscal Years 2003 and 2005:
Nursing home setting: VA-operated nursing homes;
FY 2003: 12,373;
FY 2005: 12,158;
Change from FY 2003 to FY 2005: (215).
Nursing home setting: Community nursing homes;
FY 2003: 4,202;
FY 2005: 4,423;
Change from FY 2003 to FY 2005: 221.
Nursing home setting: State veterans' nursing homes;
FY 2003: 16,639;
FY 2005: 17,794;
Change from FY 2003 to FY 2005: 1,155.
Nursing home setting: Total;
FY 2003: 33,214;
FY 2005: 34,375;
Change from FY 2003 to FY 2005: 1,161.
Source: VA.
Note: The workload measure is average daily census, which represents
the total number of days of nursing home care provided in a year
divided by the number of days in the year.
[End of table]
The percentage of workload provided in state veterans' nursing homes
continued to account for about half of VA's overall patient workload,
increasing from 50 percent in fiscal year 2003 to 52 percent in fiscal
year 2005. In contrast, the percentage of patient workload provided in
VA-operated nursing homes declined. The percentage provided in
community nursing homes stayed the same. (See fig. 2.) In fiscal year
2005, state veterans' nursing homes accounted for over half of VA's
overall workload, and they accounted for 12 percent of overall
expenditures for patient care. The relatively low proportion of
expenditures can be explained in large part by VA's per-diem rate for
care in state veterans' nursing homes, which on average accounts for
about one-third of the cost for care in this setting. Continued growth
in the percentage of overall patient workload accounted for by state
veterans' nursing homes during this 3-year period was similar to the
pattern we observed from fiscal year 1998 through fiscal year 2003.
Figure 2: Percentage of Overall Patient Workload by Setting, Fiscal
Years 2003 and 2005:
[See PDF for image]
Note: The workload measure is average daily census, which represents
the total number of days of nursing home care provided in a year
divided by the number of days in the year.
[End of figure]
VA Faces Two Key Challenges in Planning for Nursing Home Care:
VA faces two key challenges in planning for the provision of nursing
home care. The first challenge is estimating who will seek care from VA
and what their nursing home care needs will be. To do this, VA will
need to estimate the number of veterans that will be eligible for
nursing home care based on the Millennium Act and VA policy or that
will be able to receive such care on a discretionary basis, based on
available resources. Moreover, VA will need to estimate the extent to
which these veterans will be seeking care for short-stay postacute
needs or long-stay chronic needs. To meet this challenge, VA needs to
establish a baseline for current nursing home needs being met by
obtaining more complete information on the eligibility of veterans
currently receiving services and on whether they are using short-stay
or long-stay nursing home care. Although VA collects data on
eligibility and length of stay for its VA-operated nursing homes, it
lacks comparable data on eligibility and length of stay for state
veterans' nursing homes and on length of stay for community nursing
homes. We recommended in November 2004 that VA work to close this
gap.[Footnote 13] VA agreed to do so, but has not fully implemented our
recommendations. VA has begun to collect and report eligibility data on
veterans receiving care in VA community nursing homes. Data on
eligibility and length of stay for state veterans' nursing homes and
community nursing homes are especially critical because these two
settings account for almost two-thirds of VA's overall nursing home
workload. Without these data, VA does not know how the three settings
in combination are being used to serve veterans of different
eligibility, and what proportion of short-stay and long-stay needs are
being met in all three settings. As a result, VA does not have a
baseline from which to estimate future demand for nursing home care in
each setting as the overall veteran population and its needs change
over time.
A second key challenge VA faces is determining whether it will maintain
or increase the proportion of nursing home care demand it meets in each
of the three nursing home settings or whether veterans will need to
rely more on other non-VA nursing home care providers that are funded
by other programs, such as Medicaid and Medicare. To meet this
challenge, VA needs to make policy determinations concerning which
veterans it will provide nursing home care to in the future and the mix
of short-stay and long-stay services it will offer. For example, to
what extent will VA continue to provide nursing home care to veterans
in addition to those that it is required to serve under the Millennium
Act? To what extent will VA provide short-stay nursing home care, and
to what extent will it provide long-stay nursing home care? VA told us
that such policy decisions have not been made. These policy decisions
are needed to establish criteria to be used to identify which veterans
VA will serve and what nursing home services it will offer as a matter
of policy, in addition to those required by law. Then VA can begin to
generate the information it needs for planning. This may include, for
example, how many nursing homes are needed in each setting and where
they should be located.
VA is working on these challenges and has developed a draft long-term
care strategic plan. Completing the long-term care strategic plan could
help VA determine how to maximize the use of resources for meeting
nursing home needs of veterans across the country in each of the three
nursing home settings. VA has not given a timeline for completion of
the long-term care strategic plan. In May 2004, the Secretary of
Veterans Affairs acknowledged that a strategic plan would be necessary
to help achieve VA's goals, including ensuring that veterans have
access to an appropriate range of services.[Footnote 14]
Mr. Chairman, this concludes my prepared remarks. I will be pleased to
answer any questions you or other Members of the Committee may have.
Contact and Acknowledgments:
For further information, please contact Laurie E. Ekstrand at (202) 512-
7101 or ekstrandl@gao.gov. Individuals making key contributions to this
testimony include James C. Musselwhite, assistant director, Roseanne
Price, and Thomas A. Walke.
[End of section]
Related GAO Products:
VA Health Care: Key Challenges to Aligning Capital Assets and Enhancing
Veterans' Care. GAO-05-429. Washington D.C.: August 5, 2005.
VA Long-Term Care: Oversight of Nursing Home Program Impeded by Data
Gaps. GAO-05-65. Washington, D.C.: November 10, 2004.
VA Long-Term Care: More Accurate Measure of Home-Based Primary Care
Workload Is Needed. GAO-04-913. Washington, D.C.: September 8, 2004.
VA Long-Term Care: Changes in Service Delivery Raise Important
Questions. GAO-04-425T. Washington, D.C.: January 28, 2004.
VA Long-Term Care: Veterans' Access to Noninstitutional Care Is Limited
by Service Gaps and Facility Restrictions. GAO-03-815T. Washington,
D.C.: May 22, 2003.
VA Long-Term Care: Service Gaps and Facility Restrictions Limit
Veterans' Access to Noninstitutional Care. GAO-03-487. Washington,
D.C.: May 9, 2003.
Department of Veterans Affairs: Key Management Challenges in Health and
Disability Programs. GAO-03-756T. Washington, D.C.: May 8, 2003.
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.
VA Long-Term Care: Oversight of Community Nursing Homes Needs
Strengthening. GAO-01-768. Washington, D.C.: July 27, 2001.
FOOTNOTES
[1] In addition to operating expenses, VA also pays about two-thirds of
the costs of construction for state veterans' nursing homes.
[2] VA noninstitutional services include home-based primary care,
homemaker/home-health aid, adult day health care, skilled home health
care, and home-respite care.
[3] These expenditures do not include construction costs.
[4] See Related GAO Products at the end of this statement.
[5] See GAO, VA Long-Term Care: Oversight of Nursing Home Program
Impeded by Data Gaps, GAO-05-65 (Washington D.C.: Nov. 10, 2004).
[6] Pub. L. No. 106-117, §101(a)(1), 113 Stat. 1545, 1547-51 (1999).
[7] A service-connected disability is an injury or disease that was
incurred or aggravated while on active 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 veteran would be
classified as having a service-connected disability of 100 percent.
Percentages are assigned in increments of 10 percent.
[8] The Veterans Health Care, Capital Asset, and Business Improvement
Act of 2003, Pub. L. No. 108-170, § 106 (b), 117 Stat. 2042, 2045-46.
[9] VA is not authorized, in most cases, to bill and collect payments
from Medicaid and Medicare, nor can VA bill other insurers for health
care services that are related to a service-connected disability.
However, a veteran's eligibility to participate in VA's nursing home
program does not prohibit him or her from using these financing sources
for nursing home care outside of VA's health care system, if eligible.
[10] See GAO, Long-Term Care: Aging Baby Boom Generation Will Increase
Demand and Burden on Federal and State Budgets, GAO-02-544T
(Washington, D.C.: Mar. 21, 2002).
[11] The change in cost accounting systems may explain why the annual
growth in nursing home expenditures from fiscal year 2003 to fiscal
year 2005 of over 18 percent was more than double the growth rate of
almost 8 percent from fiscal year 1998 through fiscal year 2003.
[12] See GAO-05-65.
[13] GAO-05-65.
[14] Department of Veterans Affairs, Secretary of Veterans Affairs:
CARES Decision (Washington, D.C.: May 7, 2004). The Capital Asset
Realignment for Enhanced Services (CARES) was designed to assess VA's
buildings and land ownership in light of expected demand for VA
inpatient and outpatient health care services through fiscal year 2022.
Through this process, VA sought to determine what health care services
veterans would need in what locations.
