The care provided to veterans at a  VA nursing home could include a range of services, including short-term  postacute care needed to recover from a condition such as a stroke to  longer-term care required by veterans who cannot be cared for at home  because of severe, chronic physical or mental limitations. Overall, VA spent approximately   $2.3 billion to provide or pay for nursing home care in VA nursing homes,  community nursing homes, and state veterans’ nursing homes in fiscal  year 2003. 1.) 2.) State Veterans’ Nursing Homes Provided Half of VA’s Overall Nursing Home Workload, but Networks’ Use of Nursing Home Care Setting Varied

State veterans’ nursing homes accounted for half of VA’s overall nursing  home workload—measured by average daily census—in fiscal year 2003,  even though they accounted for only 15 percent of expenditures. In large  part this is because VA pays a per-diem rate for care in state veterans’  nursing homes that, on average, accounts for about one-third of the cost to  provide veterans nursing home care in this setting. 3.) About One-Third of VA Nursing Home Care Is Long Stay, but VA Lacks Comparable Information for Other Nursing Home Settings

About one-third of the care VA provided in VA nursing homes was long  stay in fiscal year 2003. The remainder, or two-thirds of VA nursing home care,  was short-stay care (less than 90 days) in this setting. About One-Fourth of Veterans Who Received Care in VA Nursing Homes Are Required to Be Served by the Millennium Act or VA Policy, but VA Lacks Comparable Information for Other Settings

In fiscal year 2003, about 26 percent of veterans who received care in VA  nursing homes are required to be served by the Millennium Act or VA’s  policy on nursing home eligibility. 7.) VA lacks comparable information for community nursing homes or state  veterans’ nursing homes on the percentage of veterans that are required to  be served based on the Millennium Act or VA’s policy on nursing home  eligibility even though these settings combined accounted for 63 percent  of VA’s overall nursing home workload. However, VA does not have data on length of stay and the  eligibility status of veterans receiving care in these settings as it has for VA  nursing homes. Another contact and key contributors are listed in  appendix V.

Appendix I: Objectives, Scope, and Methodology

We reviewed the Department of Veterans Affairs’ (VA) nursing home  program for fiscal year 2003 for VA nursing homes, community nursing  homes, and state veterans’ nursing homes to determine (1) VA spending to  provide or pay for nursing home care, (2) VA workload provided or paid  for, (3) the percentage of nursing home care that is long and short stay,  and (4) the percentage of veterans receiving care that are required to be  served by the Millennium Act or VA policy.
Why GAO Did This Study

The Department of Veterans Affairs (VA) operates a $2.3 billion nursing home program that provides or pays for veterans' care in three settings: VA nursing homes, community nursing homes, and state veterans' nursing homes. The Veterans Millennium Health Care and Benefits Act (Millennium Act) of 1999 and VA policy require that VA provide nursing home care to veterans with a certain eligibility. Congress has expressed a need for additional data to conduct oversight of VA's nursing home program. Specifically, for all VA nursing home settings in fiscal year 2003, GAO was asked to report on (1) VA spending to provide or pay for nursing home care, (2) VA workload provided or paid for, (3) the percentage of nursing home care that is long and short stay, and (4) the percentage of veterans receiving care required by the Millennium Act or VA policy.

What GAO Found

In fiscal year 2003, VA spent 73 percent of its nursing home resources on VA nursing homes--almost $1.7 billion of about $2.3 billion--and the remaining 27 percent on community and state veterans' nursing homes. Half of VA's average daily nursing home workload of 33,214 in fiscal year 2003 was for state veterans' nursing homes, even though this setting accounted for 15 percent of VA's overall nursing home expenditures. In large part, this is because VA pays about one-third of the cost of care in state veterans' nursing homes. Community nursing homes and VA nursing homes accounted for 13 and 37 percent of the workload, respectively. About one-third of nursing home care in VA nursing homes in fiscal year 2003 was long-stay care (90 days or more). Long-stay services include those needed by veterans who cannot be cared for at home because of severe, chronic physical or mental impairments such as the inability to independently eat or the need for supervision because of dementia. The other two-thirds was short-stay care (less than 90 days), which includes services such as postacute care needed for recuperation from a stroke. VA lacks similar data for community and state veterans' nursing homes. About one-fourth of veterans who received care in VA nursing homes in fiscal year 2003 were served because the Millennium Act or VA policy requires that VA provide or pay for nursing home care of veterans with a certain eligibility. All other veterans received care at VA's discretion. VA lacks data on comparable eligibility status for community and state veterans' nursing homes even though these settings combined accounted for 63 percent of VA's overall workload. Gaps in data on length of stay and eligibility in these two settings impede program oversight.