Veterans Affairs: Opportunities Exist to Improve Potential Recipients' Awareness of the Temporary Residence Adaptation Grant
Released: 2010-07-15T00:00:00

Letter

Background

Since 1948 VA has provided adaptive housing assistance grants to eligible individuals who have certain service-connected disabilities to construct an adapted home or modify an existing home to accommodate their disabilities. Today, VA provides adaptive housing assistance primarily through two programs—Specially Adapted Housing (SAH) and Special Housing Adaptation (SHA).

The SAH grant program provides financial assistance to service members and veterans who are entitled to compensation for permanent and total service-connected disability due to the loss or loss of use of multiple limbs, blindness and limb loss, or a severe burn injury. In general, eligible individuals may receive up to three SAH grants totaling no more than 50 percent of the cost of constructing or acquiring a specially adapted house or remodeling an existing house with adaptations. As shown in table 1, the maximum aggregate grant amount was $63,780 for fiscal year 2010 and is adjusted annually based on a cost-of-construction index. Grants may be used to construct a house or remodel an existing house, or they may be applied against the unpaid principal mortgage balance of a specially adapted house. The SHA grant program is similar to SAH but is for individuals with slightly less severe disabilities and may be used for slightly different purposes; for fiscal year 2010, the maximum amount was $12,756, which also is adjusted annually based on a cost-of-construction index. SAH and SHA are administered by VA’s Veterans Benefits Administration.

In 2006 Congress created the TRA benefit, which allows veterans to apply for a grant to adapt a home owned by a family member with whom they are temporarily residing. The benefit was further extended to active-duty service members with the passage of the Housing and Economic Recovery Act of 2008. The TRA grant program enables service members and veterans eligible under the SAH and SHA programs to use up to $14,000 and $2,000, respectively, to modify a family member’s home. As shown in table 1, a TRA grant can only be used once and counts as one of the three grants allowed under either SAH or SHA. TRA grants also count toward the maximum allowable amount, $63,780 under SAH and $12,756 under SHA. The TRA grant program will expire on December 31, 2011, unless Congress extends it before then.

Use of TRA Has Been Low and TRA Grantees Include Both Younger and Older Veterans

Only 18 TRA grants have been used since the inception of the program. The age of these grantees and the cause of their disabilities varied, and the majority of the grantees have used the maximum allowable TRA grant amount of $14,000, although some adaptations have cost more than this amount.

The TRA Grant Program Has Not Been Widely Used

Use of the TRA grant program has been low—since the TRA program’s creation on June 15, 2006, through April 4, 2010, VA has processed a total of 18 TRA grants. Of these, four grants were processed in 2007, five grants in 2008, eight grants in 2009, and one grant in 2010, as of April 4. While comprehensive data are not available on the total number of service members and veterans who have a disability rating qualifying them for adaptive housing assistance, our analysis of VA data indicates that this number is well in excess of 10,000. As a result, only a very small proportion of those potentially eligible for adaptive housing assistance have used TRA. Because VA does not track the specific living arrangements of individuals eligible for adaptive housing benefits, it is not known how many of these individuals would have also met the criteria that would be required specifically to receive a TRA grant.

TRA Grantees Include Both Younger and Older Veterans and the Causes of Their Disabilities Vary

As shown in table 2, the age of the 18 TRA grant recipients when they were approved for a grant ranged from 23 to 92. Half of these grantees were under the age of 40 and half were over the age of 40. The average age of those under 40 was 26 years. Among those over 40, seven were over the age of 60. In addition, of the 16 grantees for whom a discharge date was available, 7 had been discharged prior to 1974.

All 18 TRA grantees qualified under the SAH (rather than SHA) grant program, which, as noted earlier, is for individuals with more severe service-connected disabilities. According to the 11 grant recipients or their caregivers with whom we spoke, all of the grantees had lost the use of both legs and required the use of a wheelchair or walker. Some of these grantees suffered from a spinal cord injury, and one was paralyzed from the neck down. In addition, three grantees suffered from brain trauma and one from a hearing impairment. The cause of the disabilities varied among the 11 grantees. Three of the grantees were injured abroad while serving in Operation Iraqi Freedom, four grantees were injured domestically in a vehicle or sporting accident, and four grantees suffered an illness, such as multiple sclerosis.

Five of the 11 TRA grantees we spoke with used the grant to adapt the home of a parent, 2 to adapt the home of a son or daughter, and 4 to adapt the home of another relative, such as an uncle or sibling. Nine of the 11 grantees still lived in their relative’s adapted home at the time we contacted them, and in some cases, the grantee or caregiver indicated the grantee would likely continue to live there for an extended period of time. Five caregivers told us the grantee was unable to care for himself or herself and would likely require long-term live-in assistance. Four other grantees told us that they lived independently or planned to do so in the future. For example, one grantee lived with his parents for about 2 months while he recovered from injuries and subsequently purchased his own home. Another grantee continued to live in the home owned by her brother but was able to live independently.

The Majority of the TRA Grantees Used the Full Grant Amount

As shown in table 3, the dollar amount of the 18 TRA grants that had been processed as of April 4, 2010, ranged from $3,575 to $14,000. Eleven of these grants were for the maximum allowable amount of $14,000, and three others were near that maximum. Our review of VA’s case files found that in 8 of 18 cases, the cost to adapt the relative’s home, as recorded in the file, exceeded $14,000. For example, in one case, the cost to adapt a bedroom and bathroom was $62,115. According to the file, the TRA grant was supplemented by a grant of $23,865 from a nonprofit organization, and the grantee paid the remaining uncovered cost of $24,250. In another case, the cost of adapting a bathroom, replacing a sliding door, building a platform in the sun porch, and adding a ramp to the exterior door was $24,500. According to the file of this grantee, $10,500 not covered by TRA was funded by the grantee’s uncle and by donations from contractors.

Some TRA grantees made adaptations to a home prior to using the TRA grant. The cost of those adaptations would not necessarily be included in VA’s case file and thus would not be reflected in table 3. For example, a caregiver of a grantee told us that prior to using the TRA grant, the family spent more than $50,000 installing hardwood flooring throughout the house to make it wheelchair accessible.

We were not able to identify comprehensive and up-to-date data on the typical costs for adapting a home to accommodate severe disabilities like those experienced by individuals eligible for adaptive housing grants. However, VA’s 2004 Report to Congress: Assessment of the Adequacy of VA Authorities to Provide Specially Adaptive Housing provided some information on typical costs for making certain home adaptations. The report cited the typical cost for adapting a bathroom to make it handicapped accessible as $22,000, which included installing a bidet that washes and dries, a toilet or urinal with an automatic flush sensor, and a shower or bathtub with automatic soap and shampoo dispensers. The typical cost to adapt a kitchen was cited as $8,000, which included installing an automatic shut-off stove, raising a dishwasher, lowering countertops, and installing a side-by-side refrigerator. The report also noted that the cost of widening four doorways, which a typical home might require, was $2,400. The VA report did not address the TRA program in particular, but it did note that the SHA grant amount of $12,000 would typically not cover the full cost of adaptations needed to accommodate a grantee’s disabilities.

The median number of days from the submission of a grant application to VA’s approval of the 12 grants approved after June 15, 2006, was 299, with a range from 34 to 641 days. After a veteran or service member submits an application for adaptive housing assistance and decides to take advantage of the benefit, he or she must make a number of decisions related to the project—including arranging for mortgage and construction financing, hiring architects, working with VA to review and approve adaptation plans, and soliciting bids from and selecting contractors— before VA approves the grant. VA staff told us that the length of time from application to approval is often driven by the amount of time needed by the recipient for project design.

After VA approves a veteran’s or service member’s grant, construction begins on the project. Among the 16 TRA grants for which construction was completed as of April 4, 2010, the construction phase of the grant process—that is, the period between the grant approval date and VA’s final payment for services—ranged from 20 days to 233 days, with a median of 45 days. Most of the TRA grantees or their caregivers with whom we spoke generally said that once the grant was approved, they did not experience any problems in the construction phase of the grant process.

Most Individuals We Spoke with Were Unaware of TRA, and Some Could Have Benefited from the Program

To explore the underlying reasons for low use of TRA, we interviewed 50 service members and veterans under the age of 35 who were eligible for adaptive housing but had not used TRA. Half these individuals had applied for some form of adaptive housing assistance and half had not.

Awareness of TRA May Be Low

Our interviews suggest that awareness of the TRA grant program may be low among service members and veterans eligible for adaptive housing benefits. Of the 50 service members and veterans we spoke with, most were familiar with adaptive housing benefits in general, but 38 of the 50 were not familiar with the TRA program in particular, and they did not know that adaptive housing grants can be used to modify a home owned by a family member. Ten individuals—nine of whom had applied for adaptive housing—were familiar with TRA, and two said they were unsure as to the extent to which they were familiar with the program.

There are a variety of mechanisms through which individuals can learn about adaptive housing benefits. VA benefits counselors, SAH agents, and military services coordinators—who work directly with offices on military installations that provide education, medical, family and personal counseling—may speak individually with injured service members and provide information on adaptive housing. VA military services coordinators also typically assist in conducting Transition Assistance Program and Disabled Transition Assistance Program briefings, which may cover housing benefits, among other things, to service members in the process of being discharged. Participation by service members in these briefings is voluntary and consists of 3-day seminars conducted by VA, DOD and the Department of Labor at military installations for personnel within 1 year of separation from the military or 2 years of retirement. Additionally, DOD Recovery Care Coordinators and Federal Recovery Care Coordinators, both of whom oversee recovery plans for injured service members, also provide information about relevant benefits, which could include adaptive housing. Further, DOD’s Wounded Warrior programs offer recovering service members and their family assistance with medical and nonmedical support, the latter of which can include information about adaptive housing benefits. In addition to these federal agencies, veterans service organizations—such as Paralyzed Veterans of America and Disabled American Veterans—offer a wide range of assistance to veterans and their dependents, which can include informing veterans about benefits available to them and assisting with the application process.

The Veterans Benefits Administration’s mission is to provide benefits to veterans and their families in a timely and responsive fashion and one of the agency’s stated core values is to communicate to veterans in a timely, thorough, and accurate manner. With regard to adaptive housing, VA sends annual letters to eligible individuals reminding them of the availability of adaptive housing benefits and offering the opportunity to speak with a VA representative. When an eligible individual applies for adaptive housing benefits, a VA representative typically visits that individual to conduct an interview and provide additional information. In addition, VA’s Web site includes fact sheets on the SAH and SHA programs that provide information on topics such as eligibility requirements, use of the grants, and how to apply for the benefits.

However, while eligible service members and veterans have various means through which they can learn about adaptive housing in general, the extent to which they are informed about TRA in particular is unclear. Of the 50 individuals we spoke with who were eligible for adaptive housing but had not used TRA, 43 said they could not recall ever receiving information about the program from VA or other sources. Even among those who had applied for adaptive housing—and thus presumably had been briefed on the options available—the majority were not familiar with TRA. As noted earlier, we also spoke with 11 service members and veterans who had used TRA grants. In those interviews, we found that 8 of the 11 grantees learned about the TRA grant through VA—for example, through a case manager or representative providing documentation describing the grant—and the other 3 grantees learned about the program while conducting their own research on adaptive housing assistance.

The extent to which TRA is addressed in VA’s information sources about adaptive housing benefits is limited. VA’s Web site includes fact sheets for SAH and SHA, but there is no separate fact sheet for TRA. Fact sheets for those two programs do list TRA as an option for how the grants can be used, but the specific information provided is not comprehensive. For example, the fact sheets include the maximum TRA grant amount available but do not mention that the grant may only be used once. Additionally, the grant is referred to as a “temporary grant,” but the fact sheets never provide the formal name of the benefit, Temporary Residence Adaptation, which could limit potential applicants’ ability to find the program using an electronic word search. As noted earlier, VA sends annual outreach letters to individuals eligible for adaptive housing assistance reminding them of the availability of their benefits, but a recent sample outreach letter we reviewed did not contain information on TRA. VA officials told us that when TRA was created in 2006, a one-time letter was sent out to individuals eligible for adaptive housing notifying them of the availability of the benefit.

VA officials told us that when VA representatives conduct an interview with an individual who has applied for adaptive housing assistance, they typically provide information about the TRA option. However, the extent to which this information is consistently or comprehensively provided is unclear. For example, until recently VA did not include TRA in the checklist of items that representatives were to cover when conducting the interview.

Additionally, VA conducts comprehensive annual surveys of SAH grantees to measure their satisfaction with various areas of the program. VA also conducts annual surveys of individuals who are eligible for an SAH grant but have not applied, focusing on the reasons these individuals have not applied for a grant and the barriers they may face in learning about the program. In 2009 survey results provided to us by VA, 88 percent of respondents said they had been aware of SAH prior to receiving the survey. To date, these surveys have not specifically included questions about TRA because, according to VA officials, the agency must obtain approval from the U. S. Office of Management and Budget prior to changing its survey tool. VA officials told us that they anticipate including questions about TRA in the 2010 surveys.

Our Interviews Found Veterans Who Could Have Benefited from TRA

In our 50 interviews with service members and veterans who had not used TRA, 7 individuals or their caregivers described personal circumstances well suited for use of TRA. In five of the seven cases, the individuals were not aware of TRA until we described the benefit to them. In the other two cases, the individual or caregiver became familiar with TRA only after adaptations to a relative’s home had already been made. In all seven cases, including the following examples, the individual or caregiver told us that they think they would have used the TRA program had they previously been aware of it.

A veteran of Operation Iraqi Freedom who was injured in an ambush attack said that he lived in a home owned by his mother and father from November 2006 through March 2009. He said that his parents paid to adapt part of the bathroom and add a ramp to the home, and that had he known about TRA he would have used it to help pay for the adaptations.

A service member lived with his mother for a little over a year after sustaining injuries in a motor vehicle accident and becoming paralyzed in July 2008. He told us that his mother made $15,000 in adaptations to her home and that, had he been aware of TRA, he could have used the grant to help pay for the adaptations.

The mother of a veteran who was also injured in a motor vehicle accident told us that her son lived with her for about 6 months and that she paid approximately $2,000 to $3,000 to add a ramp and widen doorways in the mobile home she owned. She said that she would have had her son apply for TRA to pay for the adaptations.

A veteran of Operations Iraqi Freedom and Enduring Freedom who was paralyzed in a training exercise said that he lived with his parents for about a year while recovering from his injuries, and that his parents spent between $40,000 and $50,000 to widen doorways and add a ramp, chair-lift, and roll-in shower. The veteran said that had he known about it, the TRA grant probably would have been useful to offset the cost of the adaptations.

In addition to those cases, another seven individuals, including the following examples, told us that had they been aware of TRA, they would have at least considered using the grant.

A quadriplegic veteran we spoke with was in the process of jointly purchasing a house with his parents so he could use an SAH grant, which requires the veteran to be at least partial owner of the home. However, he said that had he been aware of TRA, he would have considered using it to make adaptations to his parents’ current home, where he presently resides.

Another quadriplegic veteran said that had he been aware of TRA, he would have considered using it to modify his father’s home, which wasn’t wheelchair accessible, instead of living with his grandmother for 8 months.

A service member who was injured in Operation Iraqi Freedom and is in the process of retiring from the military stated that he would have considered using a TRA grant to live with his mother for a period of time.

An additional three veterans or their caregivers, including the following examples, told us they could envision using TRA at some point in the future, and two of these three had not been previously aware of TRA until we described the program to them.

The mother and caregiver for a veteran who was paralyzed in a car accident told us that her son needs constant care and will continue to live with her for an extended period of time. She said she could envision using the TRA benefit now that she was familiar with it.

The grandmother and caregiver for a veteran who suffers from an immune system disorder told us that her grandson’s condition will likely worsen. She said he will continue to need to live with relatives and might use TRA at some future time.

Of the 50 individuals we interviewed, many told us that TRA was not applicable to their personal circumstances. For instance, a little less than half of the interviewees said they did not use TRA—or would not have used it had they been aware of it—because they owned their own home, did not live or want to live with family, or did not need or want to make adaptations to a family member’s home. Additionally, three veterans we spoke with said that they did not use TRA in part because it would have counted against the overall maximum amount allowable to them for adaptive housing. They said they would rather use their adaptive housing benefits on a home they owned than on a temporary residence. Finally, one veteran and one caregiver each said they had not applied for adaptive housing benefits in general because they believed VA’s process could be difficult or very time-consuming.

Conclusions

Use of the Temporary Residence Adaptation grant program among individuals eligible for adaptive housing remains low. Our interviews with 50 individuals who had not used TRA, while not statistically generalizable, suggest that many eligible individuals may not be familiar with the program. The Veterans Benefits Administration’s mission is to provide benefits to veterans and their families in a timely and responsive fashion and one of the agency’s stated core values is to communicate to veterans in a timely, thorough, and accurate manner. While VA has a variety of mechanisms to provide service members and veterans with information about adaptive housing benefits in general, it is unclear to what extent the agency provides information specifically on TRA. As a result, the program may not be reaching all of the individuals who could benefit from it. Moreover, several of the individuals we interviewed appeared to be in a position to use and benefit from the program. More information is needed on why eligible service members and veterans may not be familiar with the TRA program. Specifically, a better understanding is needed of potential information gaps that may be occurring when severely disabled service members transition to civilian life and when veterans are informed about adaptive housing benefits. Additional efforts to make eligible individuals better aware of the TRA grant program could help ensure that the program more fully serves its intended beneficiaries.

Recommendations

To help ensure that the TRA program serves its intended beneficiaries to the greatest extent possible, we recommend that the Secretary of Veterans Affairs direct the Under Secretary for Benefits to evaluate the current methods of communicating information about the TRA grant to eligible individuals, and take appropriate measures to improve awareness of the program among such individuals.

Agency Comments

We provided a draft of this report to VA and DOD for their review and comment. In its comment letter, which is reprinted in appendix II, VA said that it concurred with our conclusions and recommendations. The agency stated that in the fourth quarter of fiscal year 2010, it will conduct an evaluation of its internal and external communications with service members and veterans about the TRA grant, as well as the media and technology used to communicate with potential grant recipients. VA also said that beginning in the first quarter of fiscal year 2011, it will identify ways to improve service members’ and veterans’ awareness of TRA grants, which will include an investigation of the applicability of marketing and communication tools employed by other agencies and companies to disseminate information. VA also provided technical comments that we incorporated as appropriate. DOD had no comments on the draft report.

We are sending copies of this report to the Secretaries of Veterans Affairs and Defense and interested congressional committees. In addition, the report will be available at no charge on GAO’s Web site at http://www.gao.gov.

If you or your staffs have any questions about this report, please contact me at (202) 512-8678 or sciremj@gao.gov. Contact points for our Offices of Congressional Relations and Public Affairs may be found on the last page of this report. GAO staff who made major contributions to this report are listed in appendix III.

Appendix I: Scope and Methodology

To describe the characteristics of Temporary Residence Adaptation (TRA) grants and grantees and how the grants have been used, we analyzed Department of Veterans Affairs (VA) data on selected characteristics of TRA grants and grantees for the period between June 15, 2006 (the date TRA was created) and April 4, 2010. In responding to our data request, VA headquarters staff gathered information on approved TRA grants from the VA Regional Loan Centers and compared it to the information in its SAHSHA system to ensure the grants were in fact approved and processed.

To estimate the number of service members and veterans who may be eligible for adaptive housing assistance, we analyzed data from VA’s SAHSHA system on the number and selected characteristics of individuals who applied for such assistance between October 1, 2000, and October 31, 2009. We also analyzed data from VA’s Veterans Service Network on the number and selected characteristics of service members and veterans who had not used the benefit but who received a rating that qualified them for adaptive housing assistance between October 1, 2003, and October 31, 2009. VA could not provide the number of individuals who received a rating that made them eligible for adaptive housing assistance from fiscal years 2001 through 2003 because VA did not consistently track such information until fiscal year 2004. In addition, because VA does not track the living arrangements of individuals eligible for adaptive housing benefits, we could not estimate the number of individuals who may have met the criteria specifically required to receive a TRA grant—that is, individuals who lived or planned to live with a relative who owns a home. We assessed the reliability of the data we received from VA by reviewing relevant documentation, interviewing knowledgeable officials, and performing electronic testing of the data. We determined that the data were reliable for the purposes of this report.

We also reviewed VA’s case file, which included construction contracts and invoices describing work performed, for each of the 18 individuals who had received a TRA grant as of April 4, 2010. In addition, we interviewed 11 of the 18 TRA grantees, or their caregivers, to obtain information on their use of the grant, the nature of their disabilities, their living circumstances, and any barriers they may have faced in using the grant. Five of the interviews were with the grantee and six were with the grantee’s caregiver. In addition to the grantees we interviewed, three grantees were deceased and four others declined to speak with us. We obtained information on those seven grantees, as available, from their VA case files and VA data.

To determine what accounts for service members’ and veterans’ low utilization of the TRA grant program and what, if anything, could be done to ensure that the program serves its intended recipients, we conducted telephone interviews with 50 service members and veterans who had qualified for adaptive housing benefits but had not applied for TRA. These interviews were comprised of (1) a nonprobability sample of 25 individuals who had applied for adaptive housing between July 1, 2006 (after the creation of TRA) and October 31, 2009, and (2) a nonprobability sample of 25 individuals who became eligible for adaptive housing between July 1, 2006, and October 31, 2009, but had not applied for the benefit. We limited our selection to individuals who were under the age of 35 because we believed that younger veterans would be more likely to potentially live temporarily with a family member, as required to receive a TRA grant.

Applying these criteria resulted in 516 individuals who had applied for adaptive housing benefits and 97 who had not. From each of these two categories, we randomly selected 50 individuals and began contacting these individuals (up to 3 attempts per individual to reach them and conduct an interview) until we completed our target of 25 interviews from each list, resulting in a total of 50 interviews. Forty-three of our interviewees were veterans, 5 were service members, and 2 were service members on the Temporary Disability Retired List.

In addition to our interviews, we reviewed documentation from VA, including the agency’s policies and procedures on use of adaptive housing benefits, examples of outreach and informational documents, and its annual surveys of the Specially Adapted Housing Grant Program. In addition, we reviewed documentation on the Department of Defense’s Recovery Care Coordinator and Wounded Warrior programs, as well as the Federal Recovery Coordination Program. Finally, we conducted interviews with staff from VA, a veterans service organization, and the Federal Recovery Coordination Program.

We conducted this performance audit between August 2009 and July 2010 in accordance with generally accepted government auditing standards. Those standards require that we plan and perform the audit to obtain sufficient, appropriate evidence to provide a reasonable basis for our findings and conclusions based on our audit objectives. We believe that the evidence obtained provides a reasonable basis for our findings and conclusions based on our audit objectives.

Appendix II: Comments from the Department of Veterans Affairs

Appendix III: GAO Contact and Staff Acknowledgments

GAO Contact

Staff Acknowledgments

In addition to the contact named above, Jason Bromberg (Assistant Director), Rudy Chatlos, Tarek Mahmassani, Cory Marzullo, John McGrail, Josephine Perez, and Jennifer Schwartz made key contributions to this report.