Expansion in Veterans Affairs nursing home use rose 3% from 2012 to 2017, but that will be just a fraction of growth leaps in the future

The VA projects nursing home needs will increase 16% between fiscal years 2017 and 2022, fueled largely by Vietnam War veterans. The average daily census at VA nursing homes from 2012 to 2017 rose from 37,687 to 38,880 veterans.

Future VA nursing home residents could receive care under stricter oversight, if recommendations from the Government Accountability Office come to fruition. 

VA officials indicated, however, that they have not been able to keep up with their own planned observation and oversight goals, so it is unclear what enhanced regulation could take place. The Centers for Medicare & Medicaid Services surveys many of the VA-sanctioned facilities, but CMS and VA standards and findings do not always match.

“By not requiring the contractor to cite all failures to meet quality standards as deficiencies on its inspections, VA does not have complete information on deficiencies identified at [state veterans’ homes] and therefore cannot track this information to help identify trends in quality across these homes,” notes a new GAO report publicly released on Friday, “VA Has Opportunities to Enhance Its Oversight and Provide More Comprehensive Information on Its Website.” 

Veterans and their families are on their own to determine placement for an individual, but the VA publicly provides information on care quality for only two of the three possible settings covered. Not included are the 148 state veterans’ homes (SVHs) that provide skilled nursing care, the GAO pointed out.

Further, there is no requirement to provide information on quality at the 148 on the VA’s Access to Care website because SVHs are owned and operated by the states. Access to Care is the VA’s equivalent to CMS’s Nursing Home Compare.

The GAO made four recommendations, all of which the VA at least provisionally concurred with. Included were calls to regularly monitor inspection processes, making sure results are being adequately documented and corrective actions taken; to cite all quality failures as deficiencies on SVH inspections; to develop guidance for staff conducting optional onsite reviews at some facilities; and to provide quality info on SVHs on the Access to Care website comparable to information provided about other nursing home settings.