VA Bureaucracy Cannot Handle Approval of Non-VA Care
The VA Office of Inspector General (OIG) recently conducted a health care investigation regarding access to homemaker/home health aide (H/HHA), skilled home health care, respite care, hospice and palliative care, and other “in-home services to enhance or build a comprehensive array of resources necessary to address the short-term or long-term care needs of enrolled veterans.” The investigation centered on allegations that the wait time for H/HHA services was well over a year, and a complaint filed on behalf of a veteran who died while waiting for H/HHA services.
The VA offers a program titled the Home and Community Based Services (HCBS) to veterans who need help in “restoring or improving their health status, maintaining their independence, or are in need of comfort-oriented support for the end of life.” The request for these types of services and care originates with a VA or non-VA facility. The request goes to bureaucrats in Washington, D.C. who determine on a case-by-case basis whether a patient qualifies for H/HHA services as part of the HCBS program.
The complaint that prompted the investigation is related to a veteran who passed away in April 2014 while awaiting VA approval of H/HHA services. The veteran’s ordeal started in August 2013 when he got admitted to a non-VA hospital in Bethesda, Maryland after suffering a stroke that left him with slurred and delayed speech. According to the OIG investigation, the patient’s medical record at the non-VA facility showed “a complicated medical history, including episodes of altered mental status, thought to be due to mini strokes, a mechanical aortic valve replacement, heart and blood vessel disease, and carotid artery stenosis.” The veteran was suffering from several serious conditions that required special care inside and outside of his home, which is why a social worker at the facility submitted a request for H/HHA services, but he never received the services despite chronic conditions that were getting worse each passing day.
The veteran was admitted to a non-VA hospital in November 2013 for “a urinary tract infection that contributed to a change in his mental status.” During this hospital stay, staff documented that the veteran had “generalized weakness and balance issues.” The veteran was discharged after six days, with several diagnoses, including the inability to speak and left-sided weakness, that clearly showed his condition worsening and the need for H/HHA services. However, he continued to wait with thousands of other veterans for the VA to approve H/HHA services.
The OIG investigation determined that facility wait times exceeded one year for veterans needing H/HHA services, and the aforementioned patient did not receive H/HHA services before his death. The OIG reported that veterans who need H/HHA services are placed on Electronic Wait Lists (EWL) when bureaucrats deem that their medical conditions do not warrant immediate care, or when budget resources are not sufficient. It appears that fed gov bureaucrats are practicing medicine without licenses, and rationing care.
The bureaucracy in D.C. is not alone when it comes to rationing health care. In a report released in September 2013, an OIG audit found that 114 facilities limited access to H/HHA “by using more restrictive eligibility criteria than VA policy required, applying non-standard review processes, and relying on inaccurate and non-standard eligibility information.” The report determined that VA facilities added requirements to limit veterans’ access because facility administrators had arbitrarily set limits on the costs of non-institutional care and redirected funds toward “higher priorities.” Bonuses?
Despite the nefarious activities of VA personnel, the VA handed out $142 million in bonuses to 156,000 officials for outstanding performance. The Veterans Affairs Secretary, Robert McDonald, said, in response to criticism of the VA for awarding bonuses, “We have to do it to retain top talent.” The waiting lists are no big deal.
The OIG uncovered that as of September 15, 2014, “27 VA facilities had HCBS waiting lists totaling 1,721 patients. Seven facilities reported more than 75 patients on the HCBS EWL.” The problems have not been addressed, but the number of veterans on the EWL continues to grow. The OIG investigation states, “As of March 31, 2105, VHA Support Service Center reports show the total number of patients on the national HCBS EWL increased to 2,566. Eleven facilities reported more than 75 patients. VA facilities in Los Angeles, California; Puget Sound, Washington; Northport, New York; Salem, Virginia; and Portland, Oregon accounted for more than half of the patients on the EWL.
The problems that plague the VA seem widespread despite Hillary Clinton’s claim to the contrary. The VA is a huge, bloated bureaucracy incapable of delivering quality care in an efficient manner. The problems that plague the VA cannot be solved because it is a department made up of unionized bureaucrats immune from termination no matter their job performance. The government should not provide health care to anyone, especially veterans who have earned better than the VA will ever be able to provide them.