VA Inspector General Report Identifies Concerns Regarding Access to and Oversight of Home Health Services
December 8, 2015 10:11 AM
On November 16, 2015, the Department of Veterans Affairs (VA) Office of Inspector General (IG) Office of Healthcare Inspections released a report titled, “Access and Oversight Concerns for Home Health Services, Washington DC VA Medical Center, Washington DC.” The report followed an inspection conducted at the request of United States Senator Barbara Mikulski (D-MD), which resulted in the VA IG substantiating concerns that stemmed from allegations of a patient’s year-long wait after being approved for home health services in October 2013; during the wait time, the patient reportedly died in April 2014, months after being approved for home health services.
The inspection found that the facility’s wait times for home and community based services (HCBS) in fact exceeded a year, and that other facilities across the nation had similarly long wait lists. Incidentally, the inspection also found that local HCBS program managers failed to comply with certain “elements of national and local policy regarding quality of care, patient communication, and electronic health record documentation.” To address these concerns, the VA IG submitted recommendations (summarized below), all of which the VA has either completed or is in the process of implementing.
In October 2013 when the patient was approved for home health services, facility staff added his name to the HCBS electronic wait list (EWL) which “approximately a month later had 584 names and an estimated wait time of more than a year.” While the patient was notified that he had been approved for home health services, there is no evidence that the staff ever notified him that his name had been placed on the wait list or that the estimated wait time to receive care was over a year. Furthermore, during the period between when the patient was approved for home health services in October 2013 and the time of his death in April 2014, there was no documented outreach or assistance by the facility staff in order to provide information to the patient about reinitiating primary care or to facilitate continuity of care.
Veterans Health Administration policy requires that staff provide patients with information about their care and document in the electronic health record (EHR) to facilitate communication and continuity of care. “Omitting this information did not allow the patients and family members to understand fully the situation and options, or adequately communicate the same to other health care staff who accessed the EHR,” the VA IG stated in the report.
In addition the facility staff utilized “a manual spreadsheet to track HCBS patients until 2014 when they transitioned to the EWL,” despite the fact that VHA mandated the use of EWL for HCBS in 2006. “While the EWL is now in use, the delay and aforementioned concerns with quality of care, communication, and documentation reflect a lack of adequate ongoing facility-level oversight and monitoring mechanisms for the provision of HCBS,” the VA IG stated.
The Washington DC VA facility has since taken steps to reduce its wait time; however, the report also substantiated that “multiple facilities across VHA had similar challenges with HCBS EWLs,” and the total number of patients on the national EWL increased between September 2014 and March 2015. In September 2014, VHA reported that “27 facilities had HCBS waiting lists totaling 1,721 patients. Of these, seven facilities reported more than 75 patients on the HCBS EWL.” In March 2015, VHA reported “the total number of patients on the national HCBS EWL increased to 2,566. Of the VHA facilities with HCBS EWLs, 11 facilities reported more than 75 patients. Five facilities accounted for more than half of the patients on the national HCBS EWL. These five facilities included Los Angeles, CA; Pugent Sound, WA; Northport, NY; Salem, VA; and Portland, OR.”
The VA IG submitted the following recommendations, which have been completed or are in the process of being implemented by the VA:
VA IG recommended that the Under Secretary for Health require facilities to develop action plans to address the care needs of patients on home health services electronic wait lists.
VA IG recommended that the Facility Director ensure that staff comply with all elements of national and local policies regarding quality of care, communication, and documentation related to purchased home and community based services.
VA IG recommended that the Facility Director ensure that oversight and management of purchased home and community based services is adequate and in compliance with Veterans Health Administration policies.
The National Association for Home Care & Hospice (NAHC) has had multiple contacts with the VA about a number of emerging issues in VA home care. On paper, the VA has a significant set of home care benefits available to veterans. However, in practice, veterans wait far too long for care and providers of home care services are forced to navigate a complex system that adds payment delays and inconsistent payment rates to the burdens that ultimately impact veterans.
Last week NAHC stepped up its advocacy efforts in meeting with the Senate Veterans Affairs Committee staff. The primary purpose of that effort is to make sure that the home care issues with VA health care do not get lost in reforms intended to address the serious other issues facing the VA health system. Committee staff are engaged in these home care issues and indicated a strong intention to keep them in the forefront of their actions. NAHC has a further meeting planned with House Veterans Affairs Committee staff to keep them apprised of our concerns.
NAHC has also learned that a member of the VA staff has filed an internal complaint that alleges inappropriate action and inaction on the part of VA management regarding the home care program. Home care organizations with current VA home care experiences are encouraged to relay the facts of any problems to NAHC staff. Such information should be directed to Bill Dombi at firstname.lastname@example.org.