Review of the Management of the Homemaker/Home Health Aide Services at the Eastern Oklahoma VA Health Care System in Muskogee and Oklahoma City VA Healthcare System

The VA Office of Inspector General (OIG) conducted a healthcare inspection at the Eastern Oklahoma VA Health Care System in Muskogee (System 1) and Oklahoma City VA Healthcare System (System 2), from September 30, 2025, through March 18, 2026, to assess allegations involving homemaker/home health aide (H/HHA) services. The OIG conducted an on-site visit from December 9 through 11, 2025, and virtual interviews through January 8, 2026. The OIG reviewed allegations from complainants that System 1 leaders and staff reduced patients’ H/HHA hours without clinical justification, and System 2 leaders and staff delayed H/HHA services and did not track or resolve related complaints. The OIG also reviewed System 1 clinical appeals and how leaders addressed concerns about the programs. The OIG substantiated that the System 1 H/HHA coordinator and interim coordinator reduced patients’ H/HHA hours and the coordinator did not consistently document clinical justification in patients’ electronic health records (EHRs), as required. Prior to the OIG inspection, the Veterans Integrated Service Network (VISN) Geriatric and Extended Care (GEC) lead and System 1 Director identified H/HHA program issues and initiated changes. The OIG substantiated that System 2 staff did not reauthorize H/HHA services, resulting in gaps in services until May 2024 when program changes were initiated. The OIG substantiated that patient complaints regarding reauthorizations were not tracked from March 2024 through early 2025, as required. System 2 leaders implemented H/HHA program improvements. The OIG determined that due to limited Veterans Health Administration (VHA) data, VISN, System 1, and System 2 leaders were unable to fully evaluate H/HHA hours and services.

The OIG made two recommendations, one to the VHA GEC Executive Director regarding guidance to evaluate H/HHA program compliance and one to the VISN Director to ensure actions to address findings from the System 1 H/HHA internal audit and site visits.