IG Report Sheds Light on VA Home Services Wait List Issues

Department of Veterans Affairs

WASHINGTON -- At least one veteran in the DC area died while on a VA wait list for home health care, and he wasn’t the only one waiting for promised home services, according to a report from the Department of Veteran’s Affairs Office of Inspector General. At the end of 2013, there were 584 patients on the wait list at the Washington DC VA Medical Center, and wait times for home services exceeded a year, the investigation found. By February 2015, with added funding, that number was reduced to zero. But it was too late for that veteran, who died in April 2014, seven months after being promised home care services that he never received. The report also found that while the Washington facility reduced that number to zero by adding funding in 2014, wait lists for home care climbed at 27 facilities around the country. In addition, it found that facility staff failed to comply with some requirements regarding quality of care, documentation and communication related to the care. The case was brought to the attention of the Inspector General when Sen. Barbara Mikulski. D-Md,. requested an investigation. Mikulski’s aides said Monday her office was still reviewing the report. According to the findings, in 2013 the unnamed veteran suffered a stroke and a series of mini strokes that led to some impairment of his mental abilities. In October 2013, a social worker found that he was unable to dress, bathe, use the toilet, shop or prepare meals by himself. But he did not meet the requirements for priority care – like suicidal or palliative patients -- so he was placed on the wait list. The veteran’s condition deteriorated. But some of his care had been at non-VA hospitals and his files at the VA were not complete, the investigation found. The investigation also found that the veteran’s family was never informed he’d been placed on a wait list or that they might want to seek other means of care. “Writer called to inform family that Home Health Aide was approved,” the social worker wrote in the patient’s electronic health record. “Writer will continue to assist as needed.” There was no documentation of offers for follow-up assistance, the investigation found. In fact, though the man died in April, his record was not updated until June, when his wife called to report that he had died two months earlier. According to the report, the DC facility had 148 patients in need of homemaker/home health aide care in 2010 and a budget of $1.3 million for those services. That figure climbed to 375 patients with a $2.8 million budget in 2012. By 2014, the budget had increased to $6.7 million to supply services to nearly 600 patients. The report found that the budget for home care services was at the discretion of district VA leaders who became aware of the growing home and community based care wait lists at several regional facilities. It wasn’t until June 2014 that regional managers allocated an additional $2 million in funds to bring down the numbers, the report said. But in other facilities around the country, the problem has gotten worse, the report found. From mid-September 2014 through March 2015, the national electronic wait list for home and community based services grew from 1,721 to 2,566 patients in more than 27 facilities. There were more than 75 patietns at 11 facilities and more than half of all those on the wait list were at five facilities: Los Angeles; Beckley, W,Va.; Richmond, Va.; Puget Sound, Wash; and White City, Ore. The report recommended that facilities develop plans to address the care needs of patients on home health services wait lists and have adequate oversight over the services, the facility director needs to ensure that staff comply with all local and national policies regarding care, communication and documentation. The Veterans Health Administration director responded, saying that addressing those needs is a “high priority," The facility responded with a promise for greater oversight and said senior social workers would ensure that mandated contacts with veterans receiving home care services are made.

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