VA Long-Term Care: Implementation of Certain Millennium Act	 
Provisions Is Incomplete, and Availability of Noninstitutional	 
Services Is Uneven (29-MAR-02, GAO-02-510R).			 
                                                                 
The Department of Veterans Affairs (VA) spent about $3.1 billion 
on long-term care in fiscal year 2001, This amount is likely to  
increase as the veteran population ages. VA provides or pays for 
long-term care in institutional settings, such as nursing homes, 
or in veteran's own homes and other community locations. The	 
Veterans Millennium Health Care and Benefits Act of 1999 required
VA to offer long-term care services to eligible veterans,	 
including in noninstitutional settings. More than two years after
the act's passage, VA has not completely met the act's		 
requirement that all eligible veterans be offered adult day	 
health care, respite care, and geriatric evaluation. Although VA 
published draft regulations that would make these three services 
available, the regulations were not finalized as of March 2002.  
To respond to the act's requirements before its draft regulations
were finalized, VA issued a policy directive making these three  
services available in noninstitutional settings. At the time of  
GAO's review, however, access to these services was far from	 
universal. Moreover, the availability of all VA noninstitutional 
long-term care services, including the newly required services,  
is uneven across the VA system. 				 
-------------------------Indexing Terms------------------------- 
REPORTNUM:   GAO-02-510R					        
    ACCNO:   A02952						        
  TITLE:     VA Long-Term Care: Implementation of Certain Millennium  
Act Provisions Is Incomplete, and Availability of		 
Noninstitutional Services Is Uneven				 
     DATE:   03/29/2002 
  SUBJECT:   Health care costs					 
	     Health care facilities				 
	     Health care services				 
	     Home health care services				 
	     Veterans benefits					 
	     Long-term care					 

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GAO-02-510R
     
GAO- 02- 510R VA Long- Term Care Services United States General Accounting
Office

Washington, DC 20548

March 29, 2002 The Honorable John D. Rockefeller IV Chairman Committee on
Veterans? Affairs United States Senate

The Honorable Lane Evans Ranking Democratic Member Committee on Veterans?
Affairs House of Representatives Subject: VA Long- Term Care: Implementation
of Certain Millennium Act Provisions Is Incomplete, and Availability of
Noninstitutional Services Is Uneven The Department of Veterans Affairs (VA)
spent about $3.1 billion on long- term care in

fiscal year 2001, an amount that is likely to increase in the coming years
as the veteran population ages. VA provides or pays for long- term care in
institutional settings such as nursing homes and through noninstitutional
care in veterans? own homes and other locations in the community. VA
generally provided or contracted for long- term care on a discretionary
basis until passage of the Veterans Millennium Health Care and Benefits Act
in November 1999. 1 The Millennium Act required VA to offer certain long-
term care services to eligible veterans, including care in noninstitutional
settings. As part of our ongoing work addressing the availability of
noninstitutional long- term care in VA, you asked us to provide the
information we have obtained to date on (1) VA?s efforts to expand
noninstitutional long- term care in response to the act?s requirements and
(2) the noninstitutional long- term care services that VA?s medical
facilities offer. As agreed with your offices, we are also providing data on
the number of institutional services offered by VA?s facilities, and

their utilization, to place the noninstitutional services in perspective. In
summary, more than 2 years after the act?s passage VA has not completely
implemented its response to the act?s requirement that all eligible veterans
be offered adult day health care, respite care, and geriatric evaluation.
Although VA published draft regulations that would make these three services
available in noninstitutional settings to eligible veterans, the regulations
had not been made final as of March 19, 2002. To be responsive to the act?s
requirements before its draft regulations were finalized, VA issued a policy
directive requiring that these three services be available in
noninstitutional settings. At the time of our review, however, access to
these

1 Pub. L. No. 106- 117, 113 Stat. 1545 (1999).

2 GAO- 02- 510R VA Long- Term Care Services

services was far from universal in VA. More generally, the availability of
all VA noninstitutional long- term care services, including the newly
required services, is uneven across the VA system. In commenting on a draft
of this letter, VA officials

generally agreed with our assessment. To determine the status of VA?s
efforts to expand noninstitutional long- term care in response to the
Millennium Act?s requirements, we interviewed officials in VA?s Geriatrics
and Extended Care Strategic Healthcare Group and evaluated directives,
regulations, and other guidance that had been prepared in response to the
act. To determine which long- term care services are offered by each of VA?s
139 facilities, 2 we compiled a list of the services as identified by VA
officials and in VA documents.

We subsequently used a survey instrument to collect data on the types of
services offered at each of VA?s 139 facilities and the utilization of these
services. In constructing this survey, we consulted with VA headquarters
officials and pretested it with VA field staff to ensure that it would be
clear to the respondents. We received responses for all 139 VA facilities.
However, we did not conduct site visits or otherwise attempt to verify any
of the data provided to us in the surveys. Our work was conducted from
September 2001 through March 2002 in accordance with generally accepted
government auditing standards.

Background VA served about one- third of its fiscal year 2001 long- term
care workload, or average daily census, in noninstitutional settings (see
table 1). Noninstitutional care accounted for about 8 percent of VA?s long-
term care costs during the same year. Table 1: VA Long- Term Care Workload
and Costs, by Care Setting, Fiscal Year 2001 Long- term care setting Average
daily census a Total cost

Institutional b 45,033 $2,888,659,000 Noninstitutional 23,205 239,939,000

Total 68,238 $3,128,598,000

Source: VA. a The average daily census represents the total number of days
of inpatient care for institutional care and the total number of outpatient
encounters for noninstitutional care, each divided by the number of days in
the year. Although these figures represent VA?s average daily census during
the year, they are not an unduplicated count of veterans in these settings
because some veterans receive more than one service.

b Institutional long- term care includes care that VA provides or pays for
in nursing homes and other residential settings. VA is not alone among
federal agencies in spending a relatively small percentage of

its long- term care dollars in noninstitutional settings. Noninstitutional
care also accounts for a relatively small percentage of long- term care
expenditures under Medicaid, the nation?s largest purchaser of long- term
care. In 2000, for example, about 27 percent of Medicaid?s long- term care
spending was devoted to noninstitutional care.

2 Although VA has 172 medical centers, in some instances two or more medical
centers have consolidated into health care systems. Counting health care
systems and individual medical centers that are not part of a health care
system as single facilities, VA has 139 facilities.

3 GAO- 02- 510R VA Long- Term Care Services VA?s Response to the Millennium
Act Is Not Fully Implemented

The Millennium Act requires VA to provide adult day health care- health
maintenance and rehabilitative services provided to frail elderly veterans
in an outpatient day setting. The act also requires that VA provide two
additional services- geriatric evaluation (evaluation of veterans with
particular geriatric needs, generally provided by VA through one of two
services, geriatric evaluation and management or geriatric primary care) and
respite care (brief periods of care provided to veterans in order to give
veterans? regular caregivers a period of respite)- but does not specify
whether these services must be provided in institutional or noninstitutional
settings. 3 (Descriptions of these and other VA longterm care services are
provided in enclosure I.) The Millennium Act?s long- term care provisions
were written partly in response to the 1998 report of the Federal Advisory
Committee on the Future of VA Long- Term Care. 4 The committee?s report
stated that VA long- term care was ?marginalized and unevenly funded? and
recommended that noninstitutional long- term care become the preferred
option, when clinically appropriate, for veterans needing long- term care.

More than 2 years after the act?s passage, however, VA has not completely
implemented its response to the act?s requirement that all eligible veterans
be offered adult day health care, respite care, and geriatric evaluation. In
October 2001, VA published draft regulations to add the three required
services in noninstitutional settings to its medical benefits package, the
standard health plan available to all veterans enrolled in VA?s health care
system. As of March 19, 2002, final regulations had not been published,
although VA officials told us that VA sent the regulations to the Office of
Management and Budget for approval on March 14, 2002.

To be responsive to the act?s requirements before its draft regulations were
finalized, however, VA issued a policy directive in October 2001 requiring
medical facilities to ensure that veterans have access to adult day health
care, respite care, and geriatric evaluations in noninstitutional settings.
VA?s directive- as well as its draft regulations- specifies that respite
care and geriatric evaluation be provided in noninstitutional settings even
though the act does not state whether these two services must be provided in
institutional or noninstitutional settings. (Adult day health care is by
definition a noninstitutional service.) VA officials told us that VA made
this decision because respite care and geriatric evaluation were already
widely offered in institutional settings. A VA headquarters official told us
that VA headquarters will soon begin monitoring field facilities to ensure
that they provide access to these three services in noninstitutional
settings.

When VA issued its policy directive in October 2001, it was far from its
goal of universal access to these three noninstitutional services, as shown
in figure 1. Among the three services, respite care was most widely
available, although at most facilities this care was still offered only in
institutional settings. According to VA officials, noninstitutional respite
care is not widely offered because until the Millennium Act

3 Although nursing home care and domiciliary care are also required by the
act, we do not address these requirements. 4 Department of Veterans Affairs,
VA Long- Term Care At The Crossroads: Report of the Federal Advisory
Committee on the Future of VA Long- Term Care (Washington, D. C.: June
1998).

4 GAO- 02- 510R VA Long- Term Care Services

VA was not authorized to provide respite care in noninstitutional settings.
Second to respite care in availability was adult day health care, followed
by geriatric evaluation.

Figure 1: Number of 139 VA Facilities Offering Certain Long- Term Care
Services Required by the Millennium Act and Available in Noninstitutional
Settings, During September and October 2001 0

20 40

60 80

100 120

140 Adult day health care Respite care Geriatric evaluation a VA long- term
care service VA facilities offering service

Offer care in both settings Offer care in noninstitutional setting only
Offer care in institutional setting only

Source: GAO survey of VA facilities; VA headquarters data. a Includes
facilities reporting geriatric evaluation and management services in our
survey and additional facilities reported by VA headquarters as offering
geriatric primary care.

Availability of Other Noninstitutional Services Is Uneven

Uneven availability of noninstitutional services is not limited to the three
services that VA requires its facilities to offer in response to the
Millennium Act. Although at least nine different noninstitutional long- term
care services are provided or paid for by VA (including the three services
that VA requires as a result of the act), considerable unevenness exists in
the number of these services offered by individual facilities and their
utilization. For example, 123 VA facilities reported offering skilled home
health care, 5 while about half as many facilities- 63- reported offering
community residential care. These results are similar to the distribution of
services noted by the 1998 Advisory Committee on the Future of VA Long- Term
Care, which

5 Skilled home health care consists of professional home health care
services, mostly nursing services, purchased by VA and delivered by non- VA
health care providers.

5 GAO- 02- 510R VA Long- Term Care Services

stated that VA long- term care- institutional as well as noninstitutional-
was not available universally and that access to long- term care was often
restricted. Similarly, a VA headquarters official we spoke with noted that
VA?s noninstitutional long- term care services are not equally accessible
across the country. The services offered by each VA facility during the
September and October 2001 period, along with the number of veterans served
in each, are shown in enclosure II.

Agency Comments

We provided a draft of this letter to VA officials for comment and received
oral comments on March 19, 2002. In providing comments, VA?s acting chief
consultant, Geriatrics and Extended Care Strategic Healthcare Group, stated
that VA agrees that its efforts to provide certain noninstitutional long-
term care services in response to the Millennium Act?s requirements are not
complete, and that the availability of

noninstitutional services is uneven. The acting chief consultant also noted
that VA?s home health care programs are widely available as shown in our
survey results. This official also provided technical comments that we have
incorporated as appropriate.

As arranged with your offices, unless you publicly announce this letter?s
contents earlier we will make no further distribution until 30 days after
its date. At that time, we will send copies to the secretary of veterans
affairs and interested congressional committees. The letter will also be
available on GAO?s home page at

http:// www. gao. gov. If you have questions, please contact me at (202)
512- 7101 or James Musselwhite at (202) 512- 7259. Joe Buschy, Steve Gaty,
and Stefanie Weldon also made key contributions to this letter.

Cynthia A. Bascetta Director, Health Care- Veterans? Health and Benefits
Issues Enclosures - 2

Enclosure I Enclosure I 6 GAO- 02- 510R VA Long- Term Care Services VA LONG-
TERM CARE SERVICES Noninstitutional Services Adult day health care: health
maintenance and rehabilitative services provided

to frail elderly veterans in an outpatient day setting.

Alzheimer?s/ dementia care: specialized outpatient services such as
behavioral and medical management provided to veterans with Alzheimer?s
disease or related dementias. Community residential care: a service in which
veterans who do not require

hospital or nursing home care- but who (because of medical or psychosocial
health conditions) are unable to live independently- live in VA- approved
community residential care facilities; VA pays administrative costs only.

Geriatric evaluation: evaluation of veterans with particular geriatric
needs, generally provided by VA through one of two services: (1) geriatric
evaluation and management (GEM), in which interdisciplinary health care
teams of geriatric specialists evaluate and manage frail elderly veterans,
and (2) geriatric primary care, in which outpatient primary care, including
medical and nursing services, preventive health care services, health
education, and specialty referral, is provided to geriatric veterans. 6
Home- based primary care: primary medical care provided in the home by VA

physicians, nurses, and other VA healthcare professionals to severely
disabled, chronically ill veterans whose conditions make them unsuitable for
management in outpatient clinics.

Homemaker/ home health aide: home health aide and homemaker services, such
as grooming, housekeeping, and meal preparation services.

Home respite care: home- based services provided to veterans on a short-
term basis to give veterans? caregivers a period of relief or respite.

Hospice care: home- based palliative and supportive services for veterans in
the last phases of incurable disease so that they may live as fully and as
comfortably as possible.

Skilled home health care: medical services provided to veterans at home by
non- VA health care providers. 6 Geriatric primary care was not among the
services included in our survey of VA facilities.

Enclosure I Enclosure I 7 GAO- 02- 510R VA Long- Term Care Services
Institutional Services

Alzheimer?s/ dementia care: specialized inpatient services such as
behavioral and medical management provided to veterans with Alzheimer?s
disease or related dementias. Community nursing home care: nursing home care
provided to veterans in

community nursing facilities. Domiciliary care: residential rehabilitation
and health maintenance services provided to veterans who do not require
hospital or nursing home care but are unable to live independently because
of medical or psychiatric disabilities; may be provided in VA domiciliaries
or in state- owned and operated veterans? domiciliaries. 7 Geriatric
evaluation and management (GEM): evaluation and management of

frail elderly veterans by interdisciplinary health care teams of geriatric
specialists; may be provided in a distinct GEM unit or in existing nursing
home or hospital beds.

Hospice care: palliative and supportive inpatient services for veterans in
the last phases of incurable disease so that they may live as fully and as
comfortably as possible; may be provided in a distinct hospice unit or in

existing nursing home or hospital beds.

Respite care: hospital or nursing home care provided to veterans on a
shortterm basis to give veterans? caregivers a period of relief or respite;
may be provided in a distinct respite unit or in existing nursing home or
hospital beds and may be provided in VA hospitals, VA nursing homes, or
community nursing homes. State veterans? nursing home care: nursing home
care provided to veterans in

state- owned and operated veterans? nursing homes, for which VA pays a
portion of daily costs. VA nursing home care: nonacute nursing care
services, variously referred to as subacute, skilled, intermediate, or
custodial nursing care, provided to

veterans in a VA facility?s nursing home care unit. 7 Because VA does not
actively place veterans in state veterans? domiciliaries or state veterans?
nursing homes (rather, veterans must apply to the facilities for admission,
and admission requirements vary by state), state veterans? domiciliary and
state veterans? nursing home services were not included in our survey of VA
facilities.

Enclosure II Enclosure II 8 GAO- 02- 510R VA Long- Term Care Services VA
LONG- TERM CARE SERVICES BY VA FACILITY This enclosure provides information
on the types and utilization of long- term care

services, both institutional and noninstitutional, that VA?s 139 facilities
reported as of the September and October 2001 time frame. Each table
contains service utilization data for all VA facilities in one of the 22 VA
health care networks existing at the time of our survey. 8 Following are the
key methods we used to collect and present the data. Because of differences
in the way utilization is calculated, the numbers in this enclosure should
not be compared to those presented in table 1.

We obtained data on the number of veterans receiving or authorized to
receive services from each VA facility on the day the survey was completed.
9 For example, if a veteran was receiving homemaker/ home health aide
services 3 days per week at the time of our survey, that veteran would have
been counted in the utilization total even if the veteran was not receiving
services on the particular day the survey was filled out. As a result, the
utilization we report may exceed the average daily census for individual
services, particularly in noninstitutional services, because on a given day
the number of veterans authorized to receive services may be greater than
the number who actually receive services.

Several facilities indicated they had ?other? services- that is, services
other than those we specifically asked about in our survey. In instances in
which facilities reported ?other? services with utilization of greater than
1,000 veterans, we note the types of ?other? services these facilities
reported.

8 In 1995, VA created 22 Veterans Integrated Service Networks, a new
management structure to coordinate the activities of and allocate funds to
VA hospitals, outpatient clinics, nursing homes, and other facilities in
each region. In January 2002, VA announced the merger of networks 13 and 14
into a single organization known as network 23. In this enclosure, we report
on these two networks separately because at the time of our survey they were
operating as individual networks. 9 Although the surveys were sent out
simultaneously, surveys for each facility were not completed on

the same day.

Enclosure II Enclosure II 9 GAO- 02- 510R VA Long- Term Care Services Table
2: Long- Term Care Services Offered by VA Facilities in Network 1, Boston,
Mass. (Fall 2001) Number of veterans in each service, by facility or health
care system (HCS) VA service Bedford Boston

HCS Connecticut HCS Manchester Northampton Providence Togus

White River Junction Total a Noninstitutional long- term care services Adult
day

health care 68 80 49 13 19 4 48 281 Alzheimer?s/ dementia care 200 125 325

Community residential care 202 85 75 362 Geriatric evaluation and

management 25 0 28 94 147 Home- based primary care 15 132 -- 63 210

Homemaker/ home health aide 45 235 52 28 115 12 42 13 542 Home respite care
Hospice care -- --

Skilled home health care 1 68 29 -- 40 30 90 37 295 Other noninstitutional
368 0 368

Institutional long- term care services

Alzheimer?s/ dementia care 110 50 160 Community nursing home care 32 95 62
15 34 53 23 11 325 Domiciliary care 42 42 Geriatric evaluation and

management 24 13 0 4 41 Hospice care 2 5 3 10 1 1 6 2 30 Respite care 122 9
3 40 0 3 2 46 225 VA nursing home care 152 146 9 70 59 38 474 Other
institutional Source: GAO survey of VA facilities.

Notes: Responses to our survey were submitted in September and October 2001.
Empty cells indicate that a facility did not report offering the service at
the time of our survey. Dashes indicate that a facility reported the service
but did not report the service?s utilization. a We did not calculate the
total number of veterans receiving services at each facility because
veterans may be authorized to receive more than one service. Some veterans
may thus appear in several services at one facility.

Enclosure II Enclosure II 10 GAO- 02- 510R VA Long- Term Care Services Table
3: Long- Term Care Services Offered by VA Facilities in Network 2, Albany,
N. Y. (Fall 2001) Number of veterans in each service, by facility or health
care system (HCS) VA service Albany Bath Canandaigua Syracuse Western New
York HCS Total a Noninstitutional long- term care services

Adult day health care 123 10 29 107 80 349 Alzheimer?s/ dementia care 100 49
318 222 689 Community residential care 0 68 -- -- 68 Geriatric evaluation
and management -- 62 62 Home- based primary care 140 160 109 762 259 1,430
Homemaker/ home health aide 60 104 211 129 261 765 Home respite care Hospice
care 1 1 2

Skilled home health care 21 0 5 168 194 Other noninstitutional 2 13 15

Institutional long- term care services

Alzheimer?s/ dementia care 24 24 Community nursing home care 50 5 8 32 25
120 Domiciliary care 203 203 Geriatric evaluation and management Hospice
care 2 7 0 3 3 15

Respite care 1 4 1 4 6 16 VA nursing home care 28 147 80 30 111 396 Other
institutional Source: GAO survey of VA facilities.

Notes: Responses to our survey were submitted in September and October 2001.
Empty cells indicate that a facility did not report offering the service at
the time of our survey. Dashes indicate that a facility reported the service
but did not report the service?s utilization. a We did not calculate the
total number of veterans receiving services at each facility because
veterans may be authorized to receive more than one service. Some veterans
may thus appear in several services at one facility.

Enclosure II Enclosure II 11 GAO- 02- 510R VA Long- Term Care Services Table
4: Long- Term Care Services Offered by VA Facilities in Network 3, Bronx, N.
Y. (Fall 2001) Number of veterans in each service, by facility or health
care system (HCS) VA service Bronx Hudson Valley HCS New Jersey

HCS Northport New York Harbor

HCS Total a Noninstitutional long- term care services

Adult day health care 3 4 34 67 108 Alzheimer?s/ dementia care 321 29 350
Community residential care 272 230 215 717 Geriatric evaluation and
management Home- based primary care 107 65 143 45 137 497

Homemaker/ home health aide 35 196 159 127 517 Home respite care Hospice
care Skilled home health care 22 6 38 35 19 120

Other noninstitutional 241 241

Institutional long- term care services

Alzheimer?s/ dementia care 14 14 Community nursing home care 19 36 47 4 106

Domiciliary care 133 165 50 348 Geriatric evaluation and management 2 2 3 7
Hospice care 7 2 4 7 5 25 Respite care 2 3 2 1 6 14 VA nursing home care 69
180 260 101 153 763 Other institutional 11 11

Source: GAO survey of VA facilities. Notes: Responses to our survey were
submitted in September and October 2001. Empty cells indicate that a
facility did not report offering the service at the time of our survey.
Dashes indicate that a facility reported the service but did not report the
service?s utilization. a We did not calculate the total number of veterans
receiving services at each facility because veterans may be authorized to
receive more than one service. Some veterans may thus appear in several
services at one facility.

Enclosure II Enclosure II 12 GAO- 02- 510R VA Long- Term Care Services Table
5: Long- Term Care Services Offered by VA Facilities in Network 4,
Pittsburgh, Pa. (Fall 2001) Number of veterans in each service, by facility
or health care system (HCS) VA service Altoona Butler Clarksburg Coatesville
Erie Lebanon Philadelphia Pittsburgh HCS WilkesBarre Wilmington Total a
Noninstitutional long- term care services

Adult day health care 26 6 46 1 44 2 0 125 Alzheimer?s/ dementia care 200
200 Community residential care 0 32 115 181 -- 91 4 423

Geriatric evaluation and management 24 5 925 954 Home- based primary care 31
0 56 123 210 Homemaker/ home health aide 78 139 94 82 7 30 113 39 13 595

Home respite care -- 0 0 Hospice care 0 1 -- 1 Skilled home health care 7 15
37 3 15 5 76 28 16 22 224

Other noninstitutional 50 2 0 26 1 79

Institutional long- term care services

Alzheimer?s/ dementia care 36 17 50 103 Community nursing home care 10 6 29
1 3 13 12 97 6 6 183

Domiciliary care 47 229 74 350 Geriatric evaluation and management 6 6
Hospice care 0 1 6 20 6 7 4 44 Respite care 1 4 0 3 1 40 4 8 60 2 123 VA
nursing home care 40 70 217 32 74 208 336 0 56 1,033 Other institutional 38
12 0 50

Source: GAO survey of VA facilities. Notes: Responses to our survey were
submitted in September and October 2001. Empty cells indicate that a
facility did not report offering the service at the time of our survey.
Dashes indicate that a facility reported the service but did not report the
service?s utilization. a We did not calculate the total number of veterans
receiving services at each facility because veterans may be authorized to
receive more than one service. Some veterans may thus appear in several
services at one facility.

Enclosure II Enclosure II 13 GAO- 02- 510R VA Long- Term Care Services Table
6: Long- Term Care Services Offered by VA Facilities in Network 5,
Baltimore, Md. (Fall 2001) Number of veterans in each service, by facility
or health care system (HCS) VA service Martinsburg Maryland HCS Washington,
D. C. Total a Noninstitutional long- term care services

Adult day health care 7 198 81 286 Alzheimer?s/ dementia care 148 148
Community residential care 0 50 50 Geriatric evaluation and management 0
1,150 1,150 Home- based primary care 180 109 289 Homemaker/ home health aide
18 252 117 387 Home respite care 0 0 Hospice care 10 10 Skilled home health
care 180 5 185 Other noninstitutional 42 3 45

Institutional long- term care services

Alzheimer?s/ dementia care 0 0 Community nursing home care 22 26 65 113
Domiciliary care 281 50 331 Geriatric evaluation and management 24 24
Hospice care 23 16 39 Respite care 2 10 4 16 VA nursing home care 166 200 90
456 Other institutional 101 101

Source: GAO survey of VA facilities. Notes: Responses to our survey were
submitted in September and October 2001. Empty cells indicate that a
facility did not report offering the service at the time of our survey.
Dashes indicate that a facility reported the service but did not report the
service?s utilization. a We did not calculate the total number of veterans
receiving services at each facility because veterans may be authorized to
receive more than one service. Some veterans may thus appear in several
services at one facility.

Enclosure II Enclosure II 14 GAO- 02- 510R VA Long- Term Care Services Table
7: Long- Term Care Services Offered by VA Facilities in Network 6, Durham,
N. C. (Fall 2001) Number of veterans in each service, by facility or health
care system (HCS) VA service Asheville Beckley Durham Fayetteville (N. C.)
Hampton Richmond Salem Salisbury Total a Noninstitutional long- term care
services

Adult day health care 61 16 18 70 14 179 Alzheimer?s/ dementia care 150 38
125 313 Community residential care 21 30 200 251

Geriatric evaluation and management 374 374 Home- based primary care 33 36
69

Homemaker/ home health aide 76 33 0 60 40 43 252 Home respite care Hospice
care 4 1 2 -- 5 12 Skilled home health care 94 8 70 21 65 -- 258 Other
noninstitutional -- --

Institutional long- term care services

Alzheimer?s/ dementia care Community nursing

home care 7 11 22 33 26 9 5 41 154 Domiciliary care 151 151 Geriatric
evaluation and management 3 -- -- 13 10 26 Hospice care 5 3 10 5 4 10 2 8 47
Respite care 2 2 4 4 0 5 4 21 VA nursing home care 98 36 98 37 72 71 80 204
696

Other institutional 18 18 Source: GAO survey of VA facilities. Notes:
Responses to our survey were submitted in September and October 2001. Empty
cells indicate that a facility did not report offering the service at the
time of our survey. Dashes indicate that a facility reported the service but
did not report the service?s utilization. a We did not calculate the total
number of veterans receiving services at each facility because veterans may
be authorized to receive more than one service. Some veterans may thus
appear in several services at one facility.

Enclosure II Enclosure II 15 GAO- 02- 510R VA Long- Term Care Services Table
8: Long- Term Care Services Offered by VA Facilities in Network 7, Atlanta,
Ga. (Fall 2001) Number of veterans in each service, by facility or health
care system (HCS) VA service Atlanta Augusta Birmingham Central Alabama HCS
Charleston Columbia (S. C.) Dublin Tuscaloosa Total a Noninstitutional long-
term care services

Adult day health care 19 0 8 10 29 66 Alzheimer?s/ dementia care 5 5
Community residential care 31 174 124 30 359

Geriatric evaluation and management 250 0 250 Home- based primary care 87 47
90 130 95 63 512

Homemaker/ home health aide 67 149 24 46 50 62 78 104 580 Home respite care
0 0 0 Hospice care 6 0 8 5 19 Skilled home health care 62 83 21 75 60 35 336

Other noninstitutional 10 144 1,139 b 18 13 1,324

Institutional long- term care services

Alzheimer?s/ dementia care 72 40 53 165 Community nursing home care 71 53 23
4 12 51 27 5 246 Domiciliary care 60 60 Geriatric evaluation

and management 2 10 0 12 Hospice care 7 11 8 -- 4 30 Respite care 0 0 4 5 --
1 10 VA nursing home care 100 53 80 28 81 115 116 573 Other institutional 0
-- 20 20

Source: GAO survey of VA facilities. Notes: Responses to our survey were
submitted in September and October 2001. Empty cells indicate that a
facility did not report offering the service at the time of our survey.
Dashes indicate that a facility reported the service but did not report the
service?s utilization. a We did not calculate the total number of veterans
receiving services at each facility because veterans may be authorized to
receive more than one service. Some veterans may thus appear in several
services at one facility.

b Geriatric primary care.

Enclosure II Enclosure II 16 GAO- 02- 510R VA Long- Term Care Services Table
9: Long- Term Care Services Offered by VA Facilities in Network 8, Bay
Pines, Fla. (Fall 2001) Number of veterans in each service, by facility or
health care system (HCS) VA service Bay Pines Miami North Florida/ South
Georgia

HCS San Juan Tampa West Palm Beach Total a Noninstitutional long- term care
services

Adult day health care 43 29 13 85 Alzheimer?s/ dementia care Community

residential care 90 165 255 Geriatric evaluation and management 30 300 330
Home- based primary care 100 150 195 82 143 670

Homemaker/ home health aide 100 75 280 19 45 50 569 Home respite care 4 4
Hospice care 0 0 Skilled home health care 154 18 35 5 180 4 396

Other noninstitutional 1,528 b 2,239 c 373 4,140

Institutional long- term care services

Alzheimer?s/ dementia care 29 61 90 Community nursing home care 92 24 195 3
51 12 377 Domiciliary care 104 17 121 Geriatric evaluation and management 8
5 20 0 33 Hospice care 10 15 9 5 20 10 69 Respite care 8 4 7 5 11 3 38 VA
nursing home care 102 127 116 116 161 98 720 Other institutional 24 27 17 68

Source: GAO survey of VA facilities. Notes: Responses to our survey were
submitted in September and October 2001. Empty cells indicate that a
facility did not report offering the service at the time of our survey.
Dashes indicate that a facility reported the service but did not report the
service?s utilization. a We did not calculate the total number of veterans
receiving services at each facility because veterans may be authorized to
receive more than one service. Some veterans may thus appear in several
services at one facility.

b Geriatric primary care and geriatric psychiatry care. c Geriatric primary
care.

Enclosure II Enclosure II 17 GAO- 02- 510R VA Long- Term Care Services Table
10: Long- Term Care Services Offered by VA Facilities in Network 9,
Nashville, Tenn. (Fall 2001) Number of veterans in each service, by facility
or health care system (HCS) VA service Huntington Lexington Louisville
Memphis Mountain Home Tennessee

Valley HCS Total a Noninstitutional long- term care services

Adult day health care 18 12 30 Alzheimer?s/ dementia care 259 100 359

Community residential care 42 96 90 213 441 Geriatric evaluation and

management 338 84 422 Home- based primary care 95 95

Homemaker/ home health aide 36 31 27 59 162 194 509 Home respite care
Hospice care 4 1 5

Skilled home health care 28 65 325 214 178 810 Other noninstitutional 3 180
100 283

Institutional long- term care services

Alzheimer?s/ dementia care 34 34 Community nursing home care 53 33 36 40 49
43 254 Domiciliary care 330 330 Geriatric evaluation and

management 20 4 24 Hospice care -- 2 2 16 10 30 Respite care 4 4 2 0 5 3 18
VA nursing home care 18 63 110 191 Other institutional 43 43

Source: GAO survey of VA facilities. Notes: Responses to our survey were
submitted in September and October 2001. Empty cells indicate that a
facility did not report offering the service at the time of our survey.
Dashes indicate that a facility reported the service but did not report the
service?s utilization. a We did not calculate the total number of veterans
receiving services at each facility because veterans may be authorized to
receive more than one service. Some veterans may thus appear in several
services at one facility.

Enclosure II Enclosure II 18 GAO- 02- 510R VA Long- Term Care Services Table
11: Long- Term Care Services Offered by VA Facilities in Network 10,
Cincinnati, Ohio (Fall 2001) Number of veterans in each service, by facility
or health care system (HCS) VA service Chillicothe Cincinnati Cleveland
Columbus Dayton Total a Noninstitutional long- term care services

Adult day health care 2 85 13 26 29 155 Alzheimer?s/ dementia care Community
residential

care 267 22 278 19 63 649 Geriatric evaluation and management 80 201 691 197
1,169 Home- based primary care 190 45 235 Homemaker/ home health aide 230 37
380 44 171 862 Home respite care Hospice care 1 -- 3 4

Skilled home health care 235 167 175 697 180 1,454 Other noninstitutional
Institutional long- term care services

Alzheimer?s/ dementia care 24 24 Community nursing home care 30 13 41 16 39
139

Domiciliary care 42 66 92 100 300 Geriatric evaluation and management 126 30
156 Hospice care 7 -- 14 22 43 Respite care 5 2 2 3 12 VA nursing home care
91 51 137 146 425 Other institutional Source: GAO survey of VA facilities.

Notes: Responses to our survey were submitted in September and October 2001.
Empty cells indicate that a facility did not report offering the service at
the time of our survey. Dashes indicate that a facility reported the service
but did not report the service?s utilization. a We did not calculate the
total number of veterans receiving services at each facility because
veterans may be authorized to receive more than one service. Some veterans
may thus appear in several services at one facility.

Enclosure II Enclosure II 19 GAO- 02- 510R VA Long- Term Care Services Table
12: Long- Term Care Services Offered by VA Facilities in Network 11, Ann
Arbor, Mich. (Fall 2001) Number of veterans in each service, by facility or
health care system (HCS) VA service Ann Arbor Battle

Creek Danville Detroit Indianapolis Northern

Indiana HCS Saginaw Total a Noninstitutional long- term care services

Adult day health care 0 16 57 5 26 4 0 108 Alzheimer?s/ dementia care
Community

residential care 0 0 137 0 45 96 0 278 Geriatric evaluation and

management 28 28 Home- based primary care 12 21 1 19 2 55

Homemaker/ home health aide 43 79 66 48 7 243 Home respite care 0 0 0 0 0 0
0 0 Hospice care 3 4 7 Skilled home health care 1 2 6 6 17 22 1 55 Other
noninstitutional Institutional long- term care services

Alzheimer?s/ dementia care 23 23 Community nursing home care 19 17 34 15 54
35 5 179 Domiciliary care Geriatric evaluation and

management 16 16 Hospice care 11 42 2 1 56 Respite care 2 3 1 2 -- 1 2 11 VA
nursing home care 15 86 125 62 125 70 483 Other institutional Source: GAO
survey of VA facilities.

Notes: Responses to our survey were submitted in September and October 2001.
Empty cells indicate that a facility did not report offering the service at
the time of our survey. Dashes indicate that a facility reported the service
but did not report the service?s utilization. a We did not calculate the
total number of veterans receiving services at each facility because
veterans may be authorized to receive more than one service. Some veterans
may thus appear in several services at one facility.

Enclosure II Enclosure II 20 GAO- 02- 510R VA Long- Term Care Services Table
13: Long- Term Care Services Offered by VA Facilities in Network 12,
Chicago, Ill. (Fall 2001) Number of veterans in each service, by facility or
health care system (HCS) VA service Chicago HCS Hines Iron

Mountain Madison Milwaukee North Chicago Tomah Total a Noninstitutional
long- term care services

Adult day health care 29 60 1 5 73 28 125 321 Alzheimer?s/ dementia care 73
73

Community residential care 20 0 20 Geriatric evaluation and management 440
805 300 106 1,651 Home- based primary care 92 219 115 115 541

Homemaker/ home health aide 49 73 14 14 34 2 3 189 Home respite care Hospice
care 1 6 5 12 Skilled home health care 48 87 15 37 2 189 Other
noninstitutional 180 38 218

Institutional long- term care services

Alzheimer?s/ dementia care 27 27 Community nursing home care 102 78 5 12 43
92 10 342 Domiciliary care 167 159 326 Geriatric evaluation and management
120 9 4 10 -- 143 Hospice care 15 5 30 7 4 61 Respite care 12 6 2 0 4 0 2 26
VA nursing home care 75 33 93 157 200 558 Other institutional 33 -- 33

Source: GAO survey of VA facilities. Notes: Responses to our survey were
submitted in September and October 2001. Empty cells indicate that a
facility did not report offering the service at the time of our survey.
Dashes indicate that a facility reported the service but did not report the
service?s utilization. a We did not calculate the total number of veterans
receiving services at each facility because veterans may be authorized to
receive more than one service. Some veterans may thus appear in several
services at one facility.

Enclosure II Enclosure II 21 GAO- 02- 510R VA Long- Term Care Services Table
14: Long- Term Care Services Offered by VA Facilities in Network 13,
Minneapolis, Minn. (Fall 2001) Number of veterans in each service, by
facility or health care system (HCS) VA service Black Hills HCS Fargo
Minneapolis Sioux Falls St. Cloud Total a Noninstitutional long- term care
services

Adult day health care 2 95 6 58 161 Alzheimer?s/ dementia care 1 -- 14 15
Community residential care 30 30 Geriatric evaluation and management 5 10 15
Home- based primary care 25 25 Homemaker/ home health aide 35 49 195 5 51
335

Home respite care 0 -- 1 0 1 Hospice care 4 1 12 2 0 19 Skilled home health
care 49 48 229 23 94 443 Other noninstitutional Institutional long- term
care services

Alzheimer?s/ dementia care Community nursing home care 11 16 84 10 11 132
Domiciliary care 132 105 237 Geriatric evaluation and management 1 1 Hospice
care 15 2 10 4 3 34 Respite care 4 1 4 3 6 18 VA nursing home care 63 31 76
30 215 415 Other institutional 41 41

Source: GAO survey of VA facilities. Notes: In January 2002, VA announced
the merger of networks 13 and 14 into a single organization known as network
23. In this enclosure we report on these networks separately because at the
time of our survey they were operating as individual networks.

Responses to our survey were submitted in September and October 2001. Empty
cells indicate that a facility did not report offering the service at the
time of our survey. Dashes indicate that a facility reported the service but
did not report the service?s utilization. a We did not calculate the total
number of veterans receiving services at each facility because veterans may
be authorized to receive more than one service. Some veterans may thus
appear in several services at one facility.

Enclosure II Enclosure II 22 GAO- 02- 510R VA Long- Term Care Services Table
15: Long- Term Care Services Offered by VA Facilities in Network 14,
Lincoln, Neb. (Fall 2001) Number of veterans in each service, by facility or
health care system (HCS) VA service Central Iowa HCS Iowa City Nebraska/
Western Iowa HCS Total a Noninstitutional long- term care services

Adult day health care 4 53 2 59 Alzheimer?s/ dementia care Community
residential care 0 0

Geriatric evaluation and management 21 12 33 Home- based primary care 33 33
Homemaker/ home health aide 8 81 32 121 Home respite care -- 2 2 Hospice
care 0 6 3 9 Skilled home health care 25 243 17 285 Other noninstitutional
Institutional long- term care services

Alzheimer?s/ dementia care Community nursing home care 25 17 58 100
Domiciliary care 68 14 82 Geriatric evaluation and management 1 1 Hospice
care 13 3 3 19 Respite care 1 0 2 3 VA nursing home care 179 54 233 Other
institutional 14 14

Source: GAO survey of VA facilities. Notes: In January 2002, VA announced
the merger of networks 13 and 14 into a single organization known as network
23. In this enclosure we report on these networks separately because at the
time of our survey they were operating as individual networks.

Responses to our survey were submitted in September and October 2001. Empty
cells indicate that a facility did not report offering the service at the
time of our survey. Dashes indicate that a facility reported the service but
did not report the service?s utilization. a We did not calculate the total
number of veterans receiving services at each facility because veterans may
be authorized to receive more than one service. Some veterans may thus
appear in several services at one facility.

Enclosure II Enclosure II 23 GAO- 02- 510R VA Long- Term Care Services Table
16: Long- Term Care Services Offered by VA Facilities in Network 15, Kansas
City, Mo. (Fall 2001) Number of veterans in each service, by facility or
health care system (HCS) VA service Columbia (Mo.) Eastern Kansas HCS Kansas

City Marion (Ill.) Poplar Bluff St Louis Wichita Total a Noninstitutional
long- term care services

Adult day health care 1 7 7 13 6 34 Alzheimer?s/ dementia care Community
residential care 10 172 182

Geriatric evaluation and management 1,779 1,779 Home- based primary care 104
114 218

Homemaker/ home health aide 57 99 65 32 -- 101 19 373 Home respite care 0 --
0 Hospice care 0 3 2 0 -- 5 Skilled home health care 137 16 144 8 83 -- 388
Other noninstitutional 384 -- 384

Institutional long- term care services

Alzheimer?s/ dementia care Community nursing

home care -- 42 50 26 12 36 11 177 Domiciliary care 176 36 212 Geriatric
evaluation and management 12 8 20 Hospice care 4 4 1 1 0 10 Respite care 1 1
1 2 22 9 0 36 VA nursing home care 25 139 35 39 23 -- 261 Other
institutional 0 20 5 25

Source: GAO survey of VA facilities. Notes: Responses to our survey were
submitted in September and October 2001. Empty cells indicate that a
facility did not report offering the service at the time of our survey.
Dashes indicate that a facility reported the service but did not report the
service?s utilization. a We did not calculate the total number of veterans
receiving services at each facility because veterans may be authorized to
receive more than one service. Some veterans may thus appear in several
services at one facility.

Enclosure II Enclosure II 24 GAO- 02- 510R VA Long- Term Care Services Table
17: Long- Term Care Services Offered by VA Facilities in Network 16,
Jackson, Miss. (Fall 2001) Number of veterans in each service, by facility
or health care system (HCS) VA service Alexandria Central Arkansas HCS
Fayetteville

(Ark.) Gulf Coast HCS Houston Jackson Muskogee New Orleans

Oklahoma City Shreveport Total a Noninstitutional long- term care services

Adult day health care 14 75 11 18 43 43 7 211 Alzheimer?s/ dementia care 261
261 Community residential care 62 217 0 9 11 299

Geriatric evaluation and management Home- based

primary care 185 53 150 82 40 65 575 Homemaker/ home health aide 20 179 --
50 -- 27 28 304

Home respite care -- -- Hospice care -- 0 -- 0 Skilled home health care 16
76 6 111 -- 56 9 38 73 385

Other noninstitutional 0 236 236

Institutional long- term care services

Alzheimer?s/ dementia care 16 32 44 92 Community nursing home care 52 44 17
17 27 22 34 17 24 25 279

Domiciliary care -- 66 66 Geriatric evaluation and management 1 18 10 0 0 29
Hospice care -- 8 5 0 1 14 Respite care 1 8 1 2 5 57 0 0 1 1 76 VA nursing
home care 130 110 65 110 114 53 21 603 Other institutional 0 0 0

Source: GAO survey of VA facilities. Notes: Responses to our survey were
submitted in September and October 2001. Empty cells indicate that a
facility did not report offering the service at the time of our survey.
Dashes indicate that a facility reported the service but did not report the
service?s utilization. a We did not calculate the total number of veterans
receiving services at each facility because veterans may be authorized to
receive more than one service. Some veterans may thus appear in several
services at one facility.

Enclosure II Enclosure II 25 GAO- 02- 510R VA Long- Term Care Services Table
18: Long- Term Care Services Offered by VA Facilities in Network 17, Dallas,
Tex. (Fall 2001) Number of veterans in each service, by facility or health
care system (HCS) VA service Central Texas HCS North Texas HCS South Texas
HCS Total a Noninstitutional long- term care services

Adult day health care 1 11 40 52 Alzheimer?s/ dementia care 100 100
Community residential care 67 0 67 Geriatric evaluation and management 60
2,000 2,060 Home- based primary care 161 168 329 Homemaker/ home health aide
104 77 95 276 Home respite care 0 20 20 Hospice care 8 0 8 Skilled home
health care 48 65 113 Other noninstitutional 12 230 242

Institutional long- term care services

Alzheimer?s/ dementia care 4 15 58 77 Community nursing home care 102 59 90
251 Domiciliary care 0 264 264 Geriatric evaluation and management 10 8 18
Hospice care 0 17 20 37 Respite care 0 10 10 20 VA nursing home care 379 210
214 803 Other institutional 124 124

Source: GAO survey of VA facilities. Notes: Responses to our survey were
submitted in September and October 2001. Empty cells indicate that a
facility did not report offering the service at the time of our survey.
Dashes indicate that a facility reported the service but did not report the
service?s utilization. a We did not calculate the total number of veterans
receiving services at each facility because veterans may be authorized to
receive more than one service. Some veterans may thus appear in several
services at one facility.

Enclosure II Enclosure II 26 GAO- 02- 510R VA Long- Term Care Services Table
19: Long- Term Care Services Offered by VA Facilities in Network 18,
Phoenix, Ariz. (Fall 2001) Number of veterans in each service, by facility
or health care system (HCS) VA service Albuquerque Amarillo Big Spring El
Paso Phoenix Prescott Tucson Total a Noninstitutional long- term care
services

Adult day health care 5 42 37 25 109 Alzheimer?s/ dementia care 141 0 10 151

Community residential care 19 22 41 Geriatric evaluation and

management 111 40 177 114 442 Home- based primary care 124 0 84 203 411

Homemaker/ home health aide 174 -- 57 2 138 371 Home respite care 6 6

Hospice care 15 31 46 Skilled home health care 5 5 0 12 200 74 138 434 Other
noninstitutional 16 16

Institutional long- term care services

Alzheimer?s/ dementia care 16 7 23 Community nursing home care 70 4 4 64 16
56 214 Domiciliary care 120 120 Geriatric evaluation and

management -- 3 28 31 Hospice care 11 3 0 14 10 17 55 Respite care 9 0 0 4 0
6 19 VA nursing home care 3 117 40 46 57 1 264 Other institutional 4 16 20

Source: GAO survey of VA facilities. Notes: Responses to our survey were
submitted in September and October 2001. Empty cells indicate that a
facility did not report offering the service at the time of our survey.
Dashes indicate that a facility reported the service but did not report the
service?s utilization. a We did not calculate the total number of veterans
receiving services at each facility because veterans may be authorized to
receive more than one service. Some veterans may thus appear in several
services at one facility.

Enclosure II Enclosure II 27 GAO- 02- 510R VA Long- Term Care Services Table
20: Long- Term Care Services Offered by VA Facilities in Network 19, Denver,
Colo. (Fall 2001) Number of veterans in each service, by facility or health
care system (HCS) VA service Cheyenne Denver Fort Lyon Grand

Junction Montana HCS Salt Lake City Sheridan Total a Noninstitutional long-
term care services

Adult day health care 15 3 18 Alzheimer?s/ dementia care Community

residential care 132 -- 132 Geriatric evaluation and

management 150 150 Home- based primary care 72 -- 120 192

Homemaker/ home health aide 82 116 0 8 60 22 288 Home respite care 0 0 0
Hospice care -- 3 2 5 Skilled home health care 3 65 172 20 11 40 26 337
Other noninstitutional -- --

Institutional long- term care services

Alzheimer?s/ dementia care 8 8 Community nursing home care 2 57 -- 7 33 28 2
129 Domiciliary care Geriatric evaluation and

management 4 -- -- 4 Hospice care 5 10 -- -- 3 1 1 20 Respite care 0 3 0 --
3 0 1 7 VA nursing home care 37 43 27 30 -- 50 187 Other institutional 0 0 0

Source: GAO survey of VA facilities. Notes: Responses to our survey were
submitted in September and October 2001. Empty cells indicate that a
facility did not report offering the service at the time of our survey.
Dashes indicate that a facility reported the service but did not report the
service?s utilization. a We did not calculate the total number of veterans
receiving services at each facility because veterans may be authorized to
receive more than one service. Some veterans may thus appear in several
services at one facility.

Enclosure II Enclosure II 28 GAO- 02- 510R VA Long- Term Care Services Table
21: Long- Term Care Services Offered by VA Facilities in Network 20,
Portland, Oreg. (Fall 2001) Number of veterans in each service, by facility
or health care system (HCS) VA service Alaska HCS Boise Portland Puget

Sound HCS Roseburg Spokane Walla Walla White

City Total a Noninstitutional long- term care services

Adult day health care 40 15 2 57 Alzheimer?s/ dementia care 125 410 535

Community residential care Geriatric evaluation and

management 175 -- 175 Home- based primary care 116 137 253

Homemaker/ home health aide 23 52 21 95 -- 25 8 31 255 Home respite care 20
20

Hospice care 1 1 46 8 3 -- 59 Skilled home health care 77 60 188 -- 4 3 332
Other noninstitutional 99 3,127 b 3,226

Institutional long- term care services

Alzheimer?s/ dementia care 18 14 32 Community nursing home care 11 17 51 150
20 40 7 9 305 Domiciliary care 192 658 850 Geriatric evaluation and

management 4 8 0 12 Hospice care 6 7 6 3 4 -- 26 Respite care 0 49 41 16 2
100 -- 208 VA nursing home care 15 270 105 32 28 21 471 Other institutional
33 -- 33

Source: GAO survey of VA facilities. Notes: Responses to our survey were
submitted in September and October 2001. Empty cells indicate that a
facility did not report offering the service at the time of our survey.
Dashes indicate that a facility reported the service but did not report the
service?s utilization. a We did not calculate the total number of veterans
receiving services at each facility because veterans may be authorized to
receive more than one service. Some veterans may thus appear in several
services at one facility.

b Geriatric primary care, geriatric memory disorder care, and other
services.

Enclosure II Enclosure II 29 GAO- 02- 510R VA Long- Term Care Services Table
22: Long- Term Care Services Offered by VA Facilities in Network 21, San
Francisco, Calif. (Fall 2001) Number of veterans in each service, by
facility or health care system (HCS) VA service Central California HCS
Honolulu Northern

California HCS Palo Alto Reno San Francisco Total a Noninstitutional long-
term care services

Adult day health care 2 6 20 6 6 40 Alzheimer?s/ dementia care -- 100 130
230

Community residential care Geriatric evaluation and

management 300 423 100 823 Home- based primary care 39 61 117 35 7 75 334

Homemaker/ home health aide 6 11 67 20 45 70 219 Home respite care Hospice
care 2 0 5 5 12

Skilled home health care 6 20 15 3 25 69 Other noninstitutional -- 50 50

Institutional long- term care services

Alzheimer?s/ dementia care 50 50 Community nursing home care 10 3 80 50 8 32
183 Domiciliary care 100 100 Geriatric evaluation and

management 2 0 2 Hospice care 10 3 11 25 4 5 58 Respite care 300 4 5 200 3 3
515 VA nursing home care 43 41 62 343 50 75 614 Other institutional 27 0 27

Source: GAO survey of VA facilities. Notes: Responses to our survey were
submitted in September and October 2001. Empty cells indicate that a
facility did not report offering the service at the time of our survey.
Dashes indicate that a facility reported the service but did not report the
service?s utilization. a We did not calculate the total number of veterans
receiving services at each facility because veterans may be authorized to
receive more than one service. Some veterans may thus appear in several
services at one facility.

Enclosure II Enclosure II 30 GAO- 02- 510R VA Long- Term Care Services Table
23: Long- Term Care Services Offered by VA Facilities in Network 22, Long
Beach, Calif. (Fall 2001) Number of veterans in each service, by facility or
health care system (HCS) VA service Greater Los Angeles HCS Loma Linda Long

Beach Southern Nevada HCS San

Diego Total a Noninstitutional long- term care services

Adult day health care -- 38 61 99 Alzheimer?s/ dementia care 220 225 445

Community residential care 44 0 44 Geriatric evaluation and

management 350 300 53 703 Home- based primary care -- 72 70 142

Homemaker/ home health aide 56 34 90 Home respite care 20 20 Hospice care 59
0 59 Skilled home health care -- 602 0 211 813 Other noninstitutional -- --

Institutional long- term care services

Alzheimer?s/ dementia care 28 28 Community nursing home care 64 178 48 20 73
383 Domiciliary care 247 247 Geriatric evaluation and

management 7 3 10 Hospice care 10 14 6 30 Respite care 10 54 3 3 70 VA
nursing home care 240 89 76 25 430 Other institutional -- 4 4

Source: GAO survey of VA facilities. Notes: Responses to our survey were
submitted in September and October 2001. Empty cells indicate that a
facility did not report offering the service at the time of our survey.
Dashes indicate that a facility reported the service but did not report the
service?s utilization. a We did not calculate the total number of veterans
receiving services at each facility because veterans may be authorized to
receive more than one service. Some veterans may thus appear in several
services at one facility.

(290115)
*** End of document. ***