VA Long-Term Care: Changes In Service Delivery Raise Important Questions Page: 4 of 19
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workload as defined by average daily census, which reflects the average
number of veterans receiving nursing home care on any given day during
the course of the year. We also measured noninstitutional workload using
average daily census; however, the number of veterans receiving these
services may be less than workload because a veteran may receive more
than one service in a day. We analyzed data on nursing home workload
that VA provided to determine how workload had changed from fiscal
years 1998 through 2003. We also verified VA's nursing home workload
numbers based on contacts with officials from VA's 21 health care
networks and VA headquarters. To determine how noninstitutional long-
term care workload has changed during this period, we analyzed data on
visits for six noninstitutional services which VA either provides directly or
pays for others to provide: home-based primary care, adult day health
care, homemaker/home health aide, skilled home health care, home
respite care, and home hospice care. We also interviewed VA officials at
headquarters and obtained information from the networks to better
understand the reasons for changes in nursing home workload during this
period. In doing our work, we tested the reliability of the data and
determined they were adequate for our purposes. We did our work in
accordance with generally accepted government auditing standards from
January 2003 through January 2004.
In summary, recent trends in VA nursing home and noninstitutional
service delivery raise important questions, particularly whether access to
services is sufficient to meet the needs of a rapidly growing elderly veteran
population. VA's overall nursing home workload--average daily census--
was 33,214 in fiscal year 2003, 1 percent below its fiscal year 1998
workload. The workload was below the fiscal year 1998 level each year,
decreasing by as much as 8 percent below the fiscal year 1998 level in
fiscal year 2000. Fourteen of 21 networks experienced declines in nursing
home workload during this period. Moreover, VA's use of the three nursing
home settings changed over this 6-year period. First, the percentage of
workload met in state veterans' nursing homes increased from 43 to 50
percent as the number of state veterans' nursing homes receiving VA
payment increased. The percentage of workload met in state veterans'
nursing homes increased in 19 of VA's 21 health care networks. Second,
the percentage of workload in VA's own nursing homes declined from 40
to 37 percent. Thirteen networks provided a smaller percentage of
workload in VA-operated homes during this period. The percentage of
workload provided in VA-operated homes declined, in part, because VA
decreased the number of long-stay patients and increased the number of
short-stay patients it treats in its own nursing homes. This is consistent
with VA's policy to give priority to post-acute patients and certain otherGAO-04-425T
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United States. General Accounting Office. VA Long-Term Care: Changes In Service Delivery Raise Important Questions, text, January 28, 2004; Washington D.C.. (https://digital.library.unt.edu/ark:/67531/metadc294756/m1/4/: accessed April 18, 2024), University of North Texas Libraries, UNT Digital Library, https://digital.library.unt.edu; crediting UNT Libraries Government Documents Department.