Advocacy Issue Brief: Rebalancing Long-Term Support and Services

The Situation

  • VA long-term services and supports (L TSS) encompass a broad range of assistance to veterans regardless of age who have lost the ability to function independently thus allowing them to be active participants in their community. VA will continue to be challenged in providing appropriate L TSS due to the diversity, increasing number, and medical complexity of the veteran population who will need these services.

The Challenge

  • Projections over the next decade indicate there will be about 1 million veterans 85 and older who will most likely require L TSS. In addition, the number of veterans enrolled in the VA health care system with limitations in one or more activities of daily self-care activities who are also likely to require LTSS will remain more than 1.2 million.
  • For over a decade, VA has committed itself to provide patient centered L TSS in the least restrictive setting compatible with the veteran’s preference and reserving nursing home care for those who can no longer be safely cared for at home. However, the number of veterans served and the amount of resources expended does not yet support a balanced L TSS system within the VA’s healthcare system.
  • Changing VA’s existing L TSS system from its historic institutional model must involves thoughtful and deliberate shifting in spending from institutional to home and community-based services (HCSS). VA has made tremendous strides increasing access to HCSS; however, according to VA’s budget request for fiscal year 2013, the performance measure that helped increase access to HCSS is “being dropped after 2013,” without a suitable replacement to sustain the rebalancing VA’s L TSS system.
  • Research shows effective rebalancing of L TSS systems is achieved when services are targeted to the population most in need. While there are many validated needs assessment instruments available to target and tailor those services, there is no national standard used consistently throughout VA’s L TSS system. Thus, access to VA HCSS are driven more by locally available resources rather than clinical need, which hamper the effectiveness of planning, programs, initiatives and services.
  • Effective rebalancing also requires an easily accessible and wide array of HCSS. It has been nearly a decade since the Government Accountability Office (GAO) has reported on the availability of HCSS services in the VA healthcare system and anecdotal reports from the field today indicate wide variability of HCSS offered by VA medical centers.
  • Reports by GAO found weaknesses in VA’s budget justification for L TSS and the fiscal year 2014 budget request will use a new L TSS budget model. While these weaknesses and uncertainty remain, the information provided by VA aids Congress with appropriations decisions, performing oversight, and better control over how VA funds are spent.

The Solution

  • DAV urges VA to make a sustained commitment in requesting and spending for successful L TSS rebalancing, and to adopt an appropriate performance measure to drive forward the rebalancing VA L TSS.
  • DAV urges VA adoption of an evidence-based needs assessment instrument to determine the sufficient level of HCSS services needed for veterans and their caregiver to remain an active participant in their community.
  • DAV urges Congress to conduct rigorous oversight on VA L TSS in meeting the need of veterans evidenced by reducing service gaps in VA HCSS, offerings of newer models of care, and transformed policies and infrastructures that govern VA L TSS.
  • DAV urges Congress to request GAO to issue follow-up reports on the availability of and veterans’ access to VA HCSS and on VA’s budget justification of L TSS budget requests.