United States Government Accountability Office

GAO Testimony 

Before the Committee on Veterans’ 

Affairs, U.S. Senate

VA LONG-TERM CARE

Trends and Planning 

Challenges in Providing 

Nursing Home Care to 

Veterans 

Statement of Laurie E. Ekstrand 

Director, Health Care 

For Release on Delivery

Expected at 10:00 a.m. HST 

Lihue, Hawaii

Monday, January 9, 2006

 

GAO-06-333T 
What GAO Found

United States Government Accountability Office

Why GAO Did This Study

Highlights

Accountability Integrity Reliability

January 9, 2006

VA LONG-TERM CARE

Trends and Planning Challenges in 

Highlights of GAO-06-333T, a testimony Providing Nursing Home Care to Veterans 

before the Committee on Veterans’ Affairs, 

U.S. Senate 

The Department of Veterans Affairs 

(VA) operates a nursing home 

program that provides or pays for 

veterans’ care in three nursing 

home settings: VA-operated nursing

homes, community nursing homes, 

and state veterans’ nursing homes. 

In addition, veterans needing 

nursing home care may also

receive it from non-VA providers 

that are not funded by VA. VA is

faced with a large elderly veteran 

population, many of whom may be

in need of nursing home care. In

2004, 38 percent of the nation’s 

veteran population was over the 

age of 65, compared with 12

percent of the general population. 

The Veterans Millennium Health 

Care and Benefits Act (Millennium 

Act) of 1999 and VA policy require 

that VA provide nursing home care 

to certain veterans. 

This statement focuses on VA’s 

nursing home program and trends 

in nursing home expenditures,

trends in the number of patients 

served, or “patient workload,” and 

key challenges VA faces in planning

for nursing home care for veterans. 

To examine these trends, GAO

updated information from prior 

work with spending and patient 

workload data for fiscal year 2005

that VA provided. In a November 

2004 report, GAO presented 

spending and patient workload

data through fiscal year 2003. GAO

discussed the updated information 

with VA and incorporated 

comments as appropriate. 

VA’s reported overall nursing home care expenditures in its three settings 

increased from $2.3 billion to almost $3.2 billion from fiscal year 2003 

through fiscal year 2005. VA officials attributed the expenditure increase 

from fiscal year 2003 to fiscal year 2005, in part, to a change in the cost 

accounting system used to develop expenditure totals for each nursing home 

setting. Based on VA’s reported expenditures, VA-operated nursing homes 

continued to account for about three-quarters of VA’s overall nursing home 

care expenditures in fiscal year 2005, as they did in fiscal year 2003. In fiscal 

year 2005, 77 percent of nursing home care expenditures were accounted for 

by VA-operated nursing homes, compared to 73 percent in 2003. VA spent 

the remainder on state veterans’ nursing homes and community nursing 

homes. From fiscal year 2003 through fiscal year 2005, the percentage of 

overall expenditures for state veterans’ nursing homes declined from 15 to 

12 percent and the percentage of overall expenditures for community 

nursing homes declined from 12 to 11 percent. 

VA’s overall patient workload in nursing homes increased to an average of 

34,375 patients per day by fiscal year 2005, 3.5 percent above the fiscal year 

2003 workload. State veterans’ nursing homes accounted for over half of 

VA’s patient workload in fiscal year 2005. The workload percent is higher 

than the 12 percent expenditure in state veterans’ nursing homes partly 

because VA pays on average about one-third of the costs for care veterans 

receive in state veterans’ nursing homes, compared to the full cost in other 

settings. From fiscal year 2003 through fiscal year 2005, the percentage of 

workload provided in state veterans’ nursing homes increased from 50 to 

52 percent. In contrast, the percentage of patient workload provided in VAoperated nursing homes declined from 37 to 35 percent. The percentage of 

workload in community nursing homes stayed the same at 13 percent. 

VA faces two key challenges in planning for the provision of nursing home 

care. The first challenge is estimating who will seek care from VA and what 

their nursing home care needs will be. This includes estimating the number 

of veterans that will be eligible for nursing home care, based on law and VA 

policy, and the extent to which these veterans will be seeking care for shortstay postacute needs or long-stay chronic needs. A second key challenge VA 

faces is determining whether it will maintain or increase the proportion of 

nursing home care demand it meets in each of the three nursing home 

settings or whether veterans will need to rely more on other non-VA nursing 

home care providers that are funded by other programs, such as Medicaid 

and Medicare. 

www.gao.gov/cgi-bin/getrpt?GAO-06-333T.

To view the full product, including the scope 

and methodology, click on the link above. 

For more information, contact Laurie E. 

Ekstrand at (202) 512-7101 or 

ekstrandl@gao.gov. 
Mr. Chairman and Members of the Committee: 

We are pleased to be here today as you discuss issues regarding the 

Department of Veterans Affairs (VA) health care program for veterans. 

One important part of that program is nursing home care, which accounts 

for about 9 percent of VA’s health care expenditures. The VA nursing home 

program provides care in three settings. It operates its own nursing homes 

in 134 locations, including a nursing home in Honolulu; it pays for care 

under contract in non-VA nursing homes, referred to as community 

nursing homes, including two community nursing homes on the island of 

Oahu; and it pays about one-third of the costs per day for veterans in state 

veterans’ nursing homes, one of which will be built in Hilo.1

 In addition, 

veterans needing nursing home care may also receive it from non-VA 

providers that are not funded by VA. In its three settings, a range of 

nursing home services is provided to veterans, including short-stay 

postacute care for patients recovering from a condition such as a stroke to 

long-stay care for patients who cannot be cared for at home because of 

severe, chronic physical or mental limitations. VA nursing home care is 

part of a continuum of long-term care services that VA provides, including 

services to veterans in the community and in veterans’ own homes.2

As you know, meeting veterans’ nursing home care needs is a key issue for 

VA nationally, and here in Hawaii, because of the large elderly veteran 

population, many of whom are in need of such care. Nationwide, the issue 

of meeting nursing home needs is even more urgent for the veteran 

population than for the general population because the veteran population

is older. In 2004, 38 percent of the nation’s veteran population was over 

the age of 65, compared with 12 percent of the general population. 

Similarly, in Hawaii, 38 percent of the veteran population was over the age

of 65, compared with almost 14 percent of the general population. 

In my remarks today I will discuss trends in VA’s overall nursing home 

care expenditures,3

 trends in the number of patients served, or “patient 

workload,” and key challenges VA faces in planning for nursing home care 

for veterans. Examination of data on trends in the provision of nursing 

 1

In addition to operating expenses, VA also pays about two-thirds of the costs of 

construction for state veterans’ nursing homes. 

2

VA noninstitutional services include home-based primary care, homemaker/home-health 

aid, adult day health care, skilled home health care, and home-respite care. 

3

These expenditures do not include construction costs.

Page 1 GAO-06-333T
home care and of challenges VA faces in planning for nursing home care is

important for oversight and strategic planning. Examination of these data 

is also useful in assessing whether the nursing home program is meeting 

current goals. My comments today are based primarily on work we have

previously completed.4

 We updated information from our prior work with 

spending and patient workload data for fiscal year 2005 that VA provided. 

Thus we present the most current information available at the time of our 

November 2004 report5 alongside the most current information available 

now to assess trends between these two points in time. For fiscal year 

2005, VA used a different cost accounting system to develop expenditure 

totals for each nursing home setting. VA told us that the accounting system

used in fiscal year 2005 would result in higher expenditures than the 

accounting system VA used in fiscal year 2003. VA could not provide the 

2005 expenditure totals using the 2003 cost accounting system, which 

could be used to determine the extent to which the change in expenditures 

resulted from real changes in the level of nursing home care expenditures 

or from the change in cost accounting systems. As in our previous work, 

we measured patient workload by using the average daily census, which 

reflects the average number of veterans receiving nursing home care on

any given day during the course of the year. In doing our work, we 

discussed the updated information with VA, determined the information 

was adequate for our purposes, and incorporated comments from VA as 

appropriate. We conducted our review from December 2005 through 

January 2006 in accordance with generally accepted government auditing

standards. 

In summary, VA’s reported overall nursing home care expenditures in its 

three settings increased from $2.3 billion to almost $3.2 billion from fiscal 

year 2003 through fiscal year 2005. VA officials attributed the expenditure 

increase from fiscal year 2003 to fiscal year 2005, in part, to a change in the 

cost accounting system used to develop expenditure totals for each 

nursing home setting. Based on VA’s reported expenditures, VA-operated

nursing homes continued to account for about three-quarters of VA’s 

overall nursing home care expenditures in fiscal year 2005, as they did in 

fiscal year 2003. In fiscal year 2005, 77 percent of nursing home care 

expenditures were accounted for by VA-operated nursing homes, 

compared to 73 percent in 2003. VA spent the remainder on state veterans’

 4

See Related GAO Products at the end of this statement. 

5

See GAO, VA Long-Term Care: Oversight of Nursing Home Program Impeded by Data

Gaps, GAO-05-65 (Washington D.C.: Nov. 10, 2004). 

Page 2 GAO-06-333T
nursing homes and community nursing homes. From fiscal year 2003 

through fiscal year 2005, the percentage of overall expenditures for state 

veterans’ nursing homes declined from 15 to 12 percent and the 

percentage of overall expenditures for community nursing homes declined 

from 12 to 11 percent. 

VA’s overall patient workload in nursing homes increased to an average of

34,375 patients per day by fiscal year 2005, 3.5 percent above the fiscal

year 2003 workload. State veterans’ nursing homes accounted for over half 

of VA’s patient workload in fiscal year 2005. The workload percent is 

higher than the 12 percent expenditure in state veterans’ nursing homes 

partly because VA pays on average about one-third of the costs for care 

veterans receive in state veterans’ nursing homes, compared to the full 

cost in other settings. From fiscal year 2003 through fiscal year 2005, the 

percentage of workload provided in state veterans’ nursing homes 

increased from 50 to 52 percent. In contrast, the percentage of patient 

workload provided in VA-operated nursing homes declined from 37 to 

35 percent. The percentage of workload in community nursing homes 

stayed the same at 13 percent. 

VA faces two key challenges in planning for the provision of nursing home 

care. The first challenge is estimating who will seek care from VA and 

what their nursing home care needs will be. This includes estimating the 

number of veterans that will be eligible for nursing home care, based on 

law and VA policy, and the extent to which these veterans will be seeking 

care for short-stay postacute needs or long-stay chronic needs. A second 

key challenge VA faces is determining whether it will maintain or increase 

the proportion of nursing home care demand it meets in each of the three 

nursing home settings or whether veterans will need to rely more on other

non-VA nursing home care providers that are funded by other programs, 

such as Medicaid and Medicare. 

VA has provided nursing home care to veterans for over 40 years. The 

Veterans Millennium Health Care and Benefits Act (Millennium Act)6

 made 

important changes in VA’s nursing home program. This act required that

through December 31, 2003, VA provide nursing home care to veterans 

Background 

 6

Pub. L. No. 106-117, §101(a)(1), 113 Stat. 1545, 1547-51 (1999). 

Page 3 GAO-06-333T
with a service-connected disability rating of 70 percent or greater,7

veterans requiring nursing home care because of a condition related to 

their service, and veterans who were receiving care in a VA nursing home 

on November 30, 1999. Subsequent law extended these provisions through 

December 31, 2008.8

 VA also has established a policy to provide nursing 

home care to veterans with a 60 percent service-connected disability rating 

who also were classified as unemployable or permanently and totally 

disabled. For all other veterans, VA provides care in VA-operated nursing 

homes and contract community nursing homes on a discretionary basis, 

depending on available resources, with certain patients having higher 

priority, including veterans who require postacute care after a hospital 

stay. VA pays a portion of the cost to treat veterans who seek care in state

veterans’ nursing homes. 

The state veterans’ nursing homes receive VA funds as part of their 

participation in VA’s program. As of fiscal year 2005, 116 state veterans’ 

nursing homes in 44 states and Puerto Rico received payment from VA to 

provide care. In fiscal year 2005, VA paid $59.36 per day per veteran to 

these state veterans’ nursing homes and awarded grants to states for 

renovations to existing facilities or construction of new state veterans’ 

homes. States are responsible for obtaining financing sources to pay for 

their portion of veterans’ daily cost of care and for their portion related to 

renovations to existing facilities or construction of new state veterans’ 

homes. 

Most veterans, however, do not receive their nursing home care from the 

VA program but instead receive it from other providers. Care from others 

includes both long-stay nursing home care to assist with daily activities, 

such as eating and bathing, and short-stay care requiring skilled nursing 

home care following hospitalization. For veterans who do not receive their 

nursing home care from the VA program, care is financed by programs 

such as Medicaid, Medicare, private health or long-term care insurance, or

 7

A service-connected disability is an injury or disease that was incurred or aggravated while 

on active duty. VA classifies veterans with service-connected disabilities according to the 

extent of their disability. These classifications are expressed in terms of percentages—for 

example, the most severely disabled veteran would be classified as having a serviceconnected disability of 100 percent. Percentages are assigned in increments of 10 percent.

8

The Veterans Health Care, Capital Asset, and Business Improvement Act of 2003, Pub. L. 

No. 108-170, § 106 (b), 117 Stat. 2042, 2045-46. 

Page 4 GAO-06-333T
“self-financing” by the patients.9

 States administer Medicaid programs that 

include coverage for long-stay nursing home care. State Medicaid 

programs are the primary funders of nursing homes, and self-financing is 

the next most common source. Medicare primarily covers acute care 

health costs and therefore limits its nursing home coverage to short stays. 

Private health insurance pays for a smaller portion of nursing home 

expenditures than the other three main sources.10

VA’s reported overall nursing home care expenditures increased from $2.3

billion to almost $3.2 billion from fiscal year 2003 through fiscal year 2005. 

(See table 1.) Expenditures increased in each nursing home setting. From 

fiscal year 2003 through fiscal year 2005, expenditures increased by $743 

million in VA-operated nursing homes, $80 million in community nursing 

homes, and $30 million in state veterans’ nursing homes. VA officials 

attributed the expenditure increase from fiscal year 2003 to fiscal year 

2005, in part, to a change in the cost accounting system used to develop

expenditure totals for each nursing home setting.11

Reported Overall 

Nursing Home

Expenditures 

Increased, with VAOperated Nursing 

Homes Continuing to 

Account for Almost 

Three-Quarters of 

Expenditures 

 9

VA is not authorized, in most cases, to bill and collect payments from Medicaid and 

Medicare, nor can VA bill other insurers for health care services that are related to a 

service-connected disability. However, a veteran’s eligibility to participate in VA’s nursing

home program does not prohibit him or her from using these financing sources for nursing 

home care outside of VA’s health care system, if eligible. 

10See GAO, Long-Term Care: Aging Baby Boom Generation Will Increase Demand and

Burden on Federal and State Budgets, GAO-02-544T (Washington, D.C.: Mar. 21, 2002). 

11The change in cost accounting systems may explain why the annual growth in nursing 

home expenditures from fiscal year 2003 to fiscal year 2005 of over 18 percent was more

than double the growth rate of almost 8 percent from fiscal year 1998 through fiscal year 

2003. 

Page 5 GAO-06-333T
Table 1: Change in Reported Nursing Home Care Expenditures, Fiscal Years 2003

and 2005 

Dollars in millions

Nursing home setting FY 2003 FY 2005

Change from 

FY 2003 

to FY 2005

VA-operated nursing homes $1,697 $2,441 $743

Community nursing homes $272 $352 $80

State veterans’ nursing homes $352 $382 $30

Total $2,321 $3,174 $853

Source: VA. 

Note: Dollar amounts may not add due to rounding. VA officials attributed the increase in 

expenditures during this period, in part, to a change in the cost accounting system used to estimate 

expenditures for each nursing home setting. 

Based on VA’s reported nursing home care expenditures, VA-operated 

nursing homes continued to account for about three-quarters of VA’s 

overall nursing home care expenditures in fiscal year 2005, as they did in 

fiscal year 2003. (See fig. 1.) In fiscal year 2005, 77 percent of nursing home 

care expenditures were accounted for by VA-operated nursing homes, 

compared to 73 percent in 2003. From fiscal year 2003 to fiscal year 2005,

the percentage of overall expenditures for state veterans’ nursing homes 

and community nursing homes declined. The percentage of overall 

expenditures for state veterans’ nursing homes declined during this period

because expenditures in VA-operated nursing homes increased more 

rapidly than expenditures for state veterans’ nursing homes. Growth in the 

percentage of overall nursing home expenditures accounted for by VAoperated nursing homes, as well as the decline in community nursing 

homes during this 3-year period, was similar to the pattern we observed 

from fiscal year 1998 through fiscal year 2003.12 In contrast, the percentage 

of overall nursing home expenditures accounted for by state veterans’ 

nursing homes increased in the prior period, but decreased from fiscal 

year 2003 through fiscal year 2005. 

 12See GAO-05-65. 

Page 6 GAO-06-333T
Figure 1: Percentage of Reported Overall Nursing Home Care Expenditures by Setting, Fiscal Years 2003 and 2005 

2003 Nursing home care expenditures: total $2.3 billion

Source: GAO analysis of VA data.

73%

15% 12%

VA-operated

nursing homes

Community

nursing homes

State veterans’

nursing homes

2005 Nursing home care expenditures: total $3.2 billion

77%

11% 12%

VA-operated

nursing homes

Community

nursing homes

State veterans’

nursing homes

Note: We calculated these percentages based on VA’s reported nursing home care expenditures, 

which were based on expenditure totals from different cost accounting systems VA used in each 

fiscal year. 

VA’s overall patient workload in all three nursing home settings, as 

measured by average daily census, increased to an average of 34,375 

patients per day by fiscal year 2005, 3.5 percent above the fiscal year 2003 

workload. (See table 2.) However, the small increase in overall workload 

masked different workload trends in VA’s three settings. Strong growth in 

state veterans’ patient workload offset a small increase in community 

patient workload and a decline in VA-operated patient workload. From 

fiscal year 2003 through fiscal year 2005, average daily patient workload in 

the nursing homes VA operated declined by 215, whereas workload in 

community nursing homes increased by 221 and workload in state 

veterans’ nursing homes increased by 1,155. The continued strong growth 

in workload in state veterans’ nursing homes largely contributed to growth 

in overall patient workload during this 3-year period and was consistent 

with the trends that we observed from fiscal year 1998 through fiscal year 

2003. 

Overall Patient 

Workload Increased 

Slightly, with State 

Veterans’ Nursing

Homes Continuing to 

Account for about 

Half of VA’s Overall 

Patient Workload 

Page 7 GAO-06-333T
Table 2: Change in Patient Workload, Fiscal Years 2003 and 2005 

Average Daily Census

Nursing home setting FY 2003 FY 2005

Change from 

FY 2003 

to FY 2005

VA-operated nursing homes 12,373 12,158 (215)

Community nursing homes 4,202 4,423 221

State veterans’ nursing homes 16,639 17,794 1,155

Total 33,214 34,375 1,161

Source: VA. 

Note: The workload measure is average daily census, which represents the total number of days of 

nursing home care provided in a year divided by the number of days in the year. 

The percentage of workload provided in state veterans’ nursing homes 

continued to account for about half of VA’s overall patient workload, 

increasing from 50 percent in fiscal year 2003 to 52 percent in fiscal year 

2005. In contrast, the percentage of patient workload provided in VAoperated nursing homes declined. The percentage provided in community 

nursing homes stayed the same. (See fig. 2.) In fiscal year 2005, state 

veterans’ nursing homes accounted for over half of VA’s overall workload, 

and they accounted for 12 percent of overall expenditures for patient care.

The relatively low proportion of expenditures can be explained in large 

part by VA’s per-diem rate for care in state veterans’ nursing homes, which 

on average accounts for about one-third of the cost for care in this setting. 

Continued growth in the percentage of overall patient workload accounted 

for by state veterans’ nursing homes during this 3-year period was similar 

to the pattern we observed from fiscal year 1998 through fiscal year 2003.

Page 8 GAO-06-333T
Figure 2: Percentage of Overall Patient Workload by Setting, Fiscal Years 2003 and 2005 

2003 Nursing home care workload: total 33,214

Source: GAO analysis of VA data.

50%

13%

37%

State veterans’

nursing homes

VA-operated

nursing homes

Community

nursing homes

2005 Nursing home care workload: total 34,375

52%

35%

13%

State veterans’

nursing homes

VA-operated

nursing homes

Community

nursing homes

Note: The workload measure is average daily census, which represents the total number of days of 

nursing home care provided in a year divided by the number of days in the year. 

VA faces two key challenges in planning for the provision of nursing home 

care. The first challenge is estimating who will seek care from VA and 

what their nursing home care needs will be. To do this, VA will need to 

estimate the number of veterans that will be eligible for nursing home care 

based on the Millennium Act and VA policy or that will be able to receive 

such care on a discretionary basis, based on available resources. 

Moreover, VA will need to estimate the extent to which these veterans will 

be seeking care for short-stay postacute needs or long-stay chronic needs.

To meet this challenge, VA needs to establish a baseline for current 

nursing home needs being met by obtaining more complete information on 

the eligibility of veterans currently receiving services and on whether they

are using short-stay or long-stay nursing home care. Although VA collects 

data on eligibility and length of stay for its VA-operated nursing homes, it 

lacks comparable data on eligibility and length of stay for state veterans’ 

nursing homes and on length of stay for community nursing homes. We 

recommended in November 2004 that VA work to close this gap.13 VA 

agreed to do so, but has not fully implemented our recommendations. VA 

VA Faces Two Key 

Challenges in 

Planning for Nursing 

Home Care 

 13GAO-05-65. 

Page 9 GAO-06-333T
has begun to collect and report eligibility data on veterans receiving care 

in VA community nursing homes. Data on eligibility and length of stay for 

state veterans’ nursing homes and community nursing homes are 

especially critical because these two settings account for almost twothirds of VA’s overall nursing home workload. Without these data, VA does

not know how the three settings in combination are being used to serve 

veterans of different eligibility, and what proportion of short-stay and longstay needs are being met in all three settings. As a result, VA does not have

a baseline from which to estimate future demand for nursing home care in

each setting as the overall veteran population and its needs change over 

time. 

A second key challenge VA faces is determining whether it will maintain or 

increase the proportion of nursing home care demand it meets in each of 

the three nursing home settings or whether veterans will need to rely more 

on other non-VA nursing home care providers that are funded by other 

programs, such as Medicaid and Medicare. To meet this challenge, VA 

needs to make policy determinations concerning which veterans it will 

provide nursing home care to in the future and the mix of short-stay and 

long-stay services it will offer. For example, to what extent will VA 

continue to provide nursing home care to veterans in addition to those 

that it is required to serve under the Millennium Act? To what extent will 

VA provide short-stay nursing home care, and to what extent will it 

provide long-stay nursing home care? VA told us that such policy decisions 

have not been made. These policy decisions are needed to establish 

criteria to be used to identify which veterans VA will serve and what 

nursing home services it will offer as a matter of policy, in addition to 

those required by law. Then VA can begin to generate the information it 

needs for planning. This may include, for example, how many nursing 

homes are needed in each setting and where they should be located. 

VA is working on these challenges and has developed a draft long-term 

care strategic plan. Completing the long-term care strategic plan could 

help VA determine how to maximize the use of resources for meeting 

nursing home needs of veterans across the country in each of the three 

nursing home settings. VA has not given a timeline for completion of the 

long-term care strategic plan. In May 2004, the Secretary of Veterans 

Affairs acknowledged that a strategic plan would be necessary to help 

Page 10 GAO-06-333T
achieve VA’s goals, including ensuring that veterans have access to an 

appropriate range of services.14

Mr. Chairman, this concludes my prepared remarks. I will be pleased to 

answer any questions you or other Members of the Committee may have. 

For further information, please contact Laurie E. Ekstrand at (202) 512-

7101 or ekstrandl@gao.gov. Individuals making key contributions to this 

testimony include James C. Musselwhite, assistant director, Roseanne 

Price, and Thomas A. Walke. 

Contact and 

Acknowledgments 

 14Department of Veterans Affairs, Secretary of Veterans Affairs: CARES Decision 

(Washington, D.C.: May 7, 2004). The Capital Asset Realignment for Enhanced Services

(CARES) was designed to assess VA’s buildings and land ownership in light of expected 

demand for VA inpatient and outpatient health care services through fiscal year 2022.

Through this process, VA sought to determine what health care services veterans would

need in what locations. 

Page 11 GAO-06-333T
Page 12 GAO-06-333T

Related GAO Products 

VA Health Care: Key Challenges to Aligning Capital Assets and 

Enhancing Veterans’ Care. GAO-05-429. Washington D.C.: August 5, 2005. 

VA Long-Term Care: Oversight of Nursing Home Program Impeded by 

Data Gaps. GAO-05-65. Washington, D.C.: November 10, 2004. 

VA Long-Term Care: More Accurate Measure of Home-Based Primary 

Care Workload Is Needed. GAO-04-913. Washington, D.C.: September 8, 

2004. 

VA Long-Term Care: Changes in Service Delivery Raise Important 

Questions. GAO-04-425T. Washington, D.C.: January 28, 2004. 

VA Long-Term Care: Veterans’ Access to Noninstitutional Care Is 

Limited by Service Gaps and Facility Restrictions. GAO-03-815T. 

Washington, D.C.: May 22, 2003. 

VA Long-Term Care: Service Gaps and Facility Restrictions Limit 

Veterans’ Access to Noninstitutional Care. GAO-03-487. Washington, D.C.: 

May 9, 2003.

Department of Veterans Affairs: Key Management Challenges in Health 

and Disability Programs. GAO-03-756T. Washington, D.C.: May 8, 2003.

VA Long-Term Care: The Availability of Noninstitutional Services Is 

Uneven. GAO-02-652T. Washington, D.C.: April 25, 2002. 

VA Long-Term Care: Implementation of Certain Millennium Act 

Provisions Is Incomplete, and Availability of Noninstitutional Services 

Is Uneven. GAO-02-510R. Washington, D.C.: March 29, 2002.

VA Long-Term Care: Oversight of Community Nursing Homes Needs 

Strengthening. GAO-01-768. Washington, D.C.: July 27, 2001.

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