The VA saw a 14 percent increase in the number of veterans needing long-term care between 2014 and 2018, according to a recent report from the Government Accountability Office, while funding for those services jumped 33 percent, from $6.8 million to $9.1 million. With the number of veterans needing care expected to continue rising, and with that care becoming more complex, the GAO expect the VA’s budget with double in less than 20 years.
In its report, the GAO identified three challenges in meeting the demand for long-term care:
- Geographic alignment: Many VA services, as well as those healthcare providers used by the VA and veterans, are clustered in cities and other densely-populated areas, yet a growing percentage of veterans are living in rural areas, where access to care is limited. The VA needs to find a way to better meet the needs of rural veterans needing care.
- Workforce shortages: The ranks of healthcare providers are in decline, and once again clustered in urban areas.
- Specialty care: As the veteran population ages, long-term care needs become more complex, requiring the attention of specialists. Yet those specialists are limited, and once again more commonly found in urban areas.
Long-term care is broadly defined, ranging from occasional help around the house to daily care to more complicated chronic care management.
Most of that care is managed by the VA though 14 programs, in both institutional (long-term care facilities and nursing homes) and non-institutional (home) settings. And that care is overseen by the VA’s Geriatrics and Extended Care (GEC) office.
“However, GEC has not established measurable goals for these efforts, such as specific staffing targets for programs with waitlists or specific targets for providing telehealth to veterans in rural areas,” the GAO report states. “Without measurable goals, VA is limited in its ability to address the challenges it faces meeting veterans’ long-term care needs.”
In its report, the GAO recommends that the VA, through the GEC, “develop measurable goals” to address all three challenges. The VA has reportedly agreed with those recommendations and plans to act on them.
All three of the challenges identified by the GAO involve access to care, and connected health advocates have long said telehealth and mHealth can address those points.
The VA’s health system is the largest in the country to use telehealth and mHealth, and it has been held up as an example of how a health system successfully uses connected health technology. Roughly 1 million veterans have used telehealth or mHealth to access care, accounting for close to 3 million virtual care episodes.
The plan going forward, according to the GAO, will be to prioritize some of that care for veterans with long-term care needs, perhaps by creating specific programs.