Sen. Chuck Grassley (R-Iowa) is calling on the U.S. Department of Veterans
Affairs to answer questions about its oversight of State Veterans Homes
following reports of inconsistent inspection practices and quality controls.
“Our veterans deserve the best possible care after
giving so much for our country. Unfortunately, it appears that the standard of
care and quality controls at many state veterans homes falls well short of
those required by other government supported nursing homes. Americans deserve
answers and our veterans deserve better,” Grassley
State veterans homes are federally-supported,
state-owned and managed facilities that provide nursing home, housing and adult
care services for veterans. Though these facilities have implemented some
Government Accountability Office recommendations
, recent media reports
highlight additional oversight gaps that may have fueled the death toll
among facility residents during the pandemic.
In a letter today to the VA, Grassley is seeking
details on the VA’s oversight of state veterans homes as well as any additional
authority that may be necessary to improve quality of care at those facilities.
Text of the letter
August 30, 2021
The Honorable Denis R. McDonough
U.S. Department of Veterans Affairs (VA)
810 Vermont Avenue, N.W.
Dear Secretary McDonough:
The VA regularly provides well over $1 billion
annually to State Veterans Homes, to cover all or part of the care for veterans
in need. Based on recent media reports and a report by the U.S. Government
Accountability Office (GAO) on these State- owned and operated facilities, I
strongly question the adequacy of the VA’s oversight of this federal spending.
A concerning report issued in 2019 by the GAO found
shortfalls in the inspection process for these State-operated facilities.
GAO concluded in 2019 that
“VA does not have complete information on all failures to meet quality
standards at SVHs [State Veterans Homes] and cannot track this information to
identify trends in quality across these homes.” In addition, VA does not share
quality of care information about these state-run facilities on its website,
It is my understanding that the VA has implemented
some of GAO’s recommendations, but it still does not exercise the kind of
oversight that is carried out by other Federal entities with jurisdiction over
civilian nursing homes that participate in Medicare and Medicaid. To
illustrate: the Centers for Medicare and
Medicaid Services (CMS), unlike the VA, posts quality of care information about
civilian nursing homes that participate in these two Federal financing programs
on its website, “CareCompare.”
Issues at State Veterans Homes reportedly came to a
head during the COVID-19 pandemic, when the number of COVID-19 cases among residents
exceeded half of the facility’s total capacity in “dozens” of State-owned or
operated veterans’ homes, according to a news report.
As noted in another such article last week: 77 veterans died in a “single
massive outbreak” of COVID-19 at one such home in Holyoke, Massachusetts,
leading employees of that particular facility to file a lawsuit, alleging
“complete disregard for human life and inhumane working conditions” at the
height of the pandemic.
During the pandemic, the fatality rate in State
Veterans Homes was at least double that of veterans’ homes operated directly by
the Federal government, according to Politico.
As further noted by Politico, the inspection process for these State-operated
facilities reportedly remains very decentralized: some States reportedly do not
hold State Veterans Homes to the same standards that apply to other nursing
homes, while other States rely on private companies “with mixed records” to run
these veterans’ facilities.
In addition, there reportedly is no VA
requirement that the top official at each State Veterans Home be selected based
These issues are of concern for Congress because VA
nursing home expenditures are increasing as veterans’ reliance on nursing home
care also has increased over the last decade.
With the aging of Vietnam War Veterans, these
expenditures likely only will further increase in the coming years, VA data
Accordingly, please provide answers to the
following questions no later than September 24, 2021:
1. How many State Veterans Homes are surveyed by the
VA and how frequently do these surveys occur?
How many of the homes are not surveyed by both CMS and the VA?
2. Does the VA have the authority necessary to track
how many States require State Veterans Homes to meet the same standards that
apply to other State-licensed, civilian nursing homes? If not, please explain, and if so, by what
date will the VA ensure that such information is tracked?
3. Does the VA collaborate or consult with other
agencies, such as CMS, which has adopted an extensive system for oversight of
State-licensed civilian nursing homes that receive Federal financing? If so, how and to what extent? If not, do you
have plans to ensure that such collaboration occurs? Please explain.
4. Has the VA by now fully implemented the GAO’s
latest recommendations with respect to State Veterans Homes? If not, please identify obstacles to
implementing any open recommendations or explain why such recommendations have
not been implemented to date.
5. Does the VA intend to make additional reforms to
its oversight system for State-run nursing homes beyond those recommended by
the GAO in its 2020 report? Please explain.
6. What, if any, changes to its website has the VA
made, or will it make, to ensure that quality of care information about State
Veterans Homes is shared with the public?
7. Does the VA recommend that Congress provide
statutory authority to facilitate the adoption of additional reforms to the
oversight system for State Veterans Homes receiving Federal resources? If so, please provide details.
Thank you for your prompt attention to this
matter. Please contact Evelyn Fortier of
my committee staff at 202-224-4324 if you have any questions.
Charles E. Grassley
Tester, Chairman, Chairman, U.S. Senate Committee on Veterans Affairs
Jerry Moran, Ranking Member, U.S. Senate Committee
on Veterans Affairs
Accountability Offc. [hereinafter “GAO”], VA
Nursing Home Care: VA Has Opportunities
to Enhance Its Oversight and Provide More Comprehensive Information on Its
, GAO-19-428 (Jul. 3, 2019), available at https://www.gao.gov/products/gao-19-428
Marselas, Let’s Give Vets a Fighting
McKnights Long-Term Care News, available
. See also Scott Fallon and Lindy Washburn, COVID delta variant spreads in NJ nursing homes as two units at
veterans homes quarantined, NorthJersey.com (Aug. 4, 2021), available at https://www.northjersey.com/story/news/coronavirus/2021/08/03/paramus-nj-veterans-home-delta-covid-outbreak/5468065001/
deaths of 89 residents and a staff member at Paramus Veterans Memorial Home in
New Jersey); Clark Kauffman, State-run
veterans home tops all Iowa care facilities in COVID-19 outbreaks,
Iowa Capitol Dispatch, available at https://iowacapitaldispatch.com/2021/08/09/state-run-veterans-home-tops-all-iowa-care-facilities-in-covid-19-outbreaks/
Kenen, Sadness and Death: Inside the VA’s
state nursing home disaster
GAO, VA Nursing Home
Care: VA Has Opportunities to Enhance
Its Oversight and Provide More Comprehensive Information on Its Website, supra
note 1 (“VA's nursing home expenditures increased
17 percent (8 percent adjusted for inflation), from $4.9 billion to $5.7
billion, from fiscal years 2012 to 2017.”).
(citing VA data
suggesting that veterans’ use of nursing home care increased 3 percent--from an
average of 37,687 veterans daily to 38,880 daily--between fiscal years 2012 and
2017, and noting that “VA projects that use will increase 16 percent from fiscal
years 2017 to 2022 with the aging of Vietnam War veterans.”).