 Long-term care LTC can be defined as the range of institutional and home and community-based services that support individuals needing chronic care. The defining values of LTC in the VA include caring for patients in the least restrictive environment consistent with meeting a patients needs. VA faces an increasing demand for these services with the growing number of veterans 85 years and older, those most in need of LTC. Yet in fiscal year 2007, 87 of the 3.5 billion total VA dollars spent on LTC went to institutional care rather than the less restrictive Home and Community Based Services HCBS. VA Central Office has formally committed to tripling the proportion of LTC that is HCBS between 1999 and 2011. 