May 05, 2020

Warren, Tester, Markey, Casey Seek Government Accountability Office Audit of VA Oversight of Care Quality at State Veterans Homes

Request Comes as State Veterans Homes Nationwide Struggle to Contain COVID-19 Outbreaks

Senators Also Seek Update on VA's Progress to Improve Monitoring of these State-Run Facilities and Transparency of SVH Inspections Oversight 

Text of Letter (PDF)

Washington, D.C. - United States Senator Elizabeth Warren (D-Mass.), Senate Veterans' Affairs Committee Ranking Member Jon Tester (D-Mont.), and Senators Edward J. Markey (D-Mass.) and Bob Casey (D-Penn.) wrote to the Government Accountability Office (GAO) requesting a review of the oversight by the U.S. Department of Veterans Affairs (VA) of quality of care at State Veterans Homes (SVHs). The senators' request comes amid a recent spike in veteran deaths and other reported care deficiencies at SVHs across the nation during the coronavirus disease 2019 (COVID-19) pandemic.

The senators also asked that the review include an update on the progress VA has made in implementing GAO's recommendations issued in July 2019 for VA to improve its oversight of State Veterans Homes and the transparency regarding its assessments of these facilities.

"The recent deaths of veteran residents and other care challenges at State Veterans Homes during the COVID-19 public health emergency remind us that VA's implementation of these recommendations would contribute toward improved care quality at these facilities nationwide and better inform veterans and their families about the best care options," the senators wrote in their letter.

State Veterans Homes are state-operated and managed facilities that provide nursing home, home, or adult day care to veterans, and they represent the majority of the veterans who receive nursing home care. While the Centers for Medicare & Medicaid Services (CMS) conducts oversight for about two-thirds of SVHs (i.e., those that receive Medicare or Medicaid payments), VA is the only entity that conducts annual inspections of all SVHs in order to assess their compliance with VA quality standards. A VA-recognized State Veterans Home may receive payments from VA to help fund all or some of the costs associated with caring for veterans.

In July 2019, a GAO review found that VA has not adequately monitored its contractor's performance of SVH inspections to ensure that contractor staff effectively determine whether SVHs are meeting required VA standards. This failure increases the possibility that problems in SVHs could be overlooked, placing veterans at risk. GAO also found that VA is not transparent about its assessments of care quality at SVHs because it does not publish information on the quality of SVHs on its website, even though there is no limit to VA's authority to do so.

Based on these findings, GAO made three recommendations to VA regarding its oversight role in SVHs: 1) devise a strategy to regularly monitor the performance of its contractors that inspect SVHs, and make sure their performance is documented and corrective actions at SVHs are taken; 2) require that VA's contractors classify as "deficiencies" in its SVH inspections all failures to meet VA's quality standards; and 3) publish information on the quality of care at all SVHs on VA's website. VA has not fully implemented these recommendations.

"Given the importance of State Veterans Homes in VA's overall portfolio for providing institutional care to veterans and our ongoing concerns about VA's role monitoring states' operation of these facilities, we would like GAO to conduct a more detailed examination of VA's oversight of State Veterans Homes' quality of care and report on any progress in implementing recommendations from GAO's July 2019 report," the senators continued.

Last month, Senators Warren and Markey led Massachusetts lawmakers in writing to the VA New England Health Care System asking what steps it is taking to assist State Veterans Homes in coronavirus mitigation.