Opportunities Exist to Improve Management of Noninstitutional Care through the Veteran-Directed Care Program

The Veteran-Directed Care (VDC) program provides veterans with a budget to hire caregivers and purchase the goods and services that will best meet their needs and allow them to remain in their homes longer. The Veterans Health Administration (VHA) administers the program to maximize veterans’ functional independence and prevent or lessen the burden of disability on older, frail, and chronically ill patients, as well as their families and caregivers. Since fiscal year (FY) 2017, the VDC program has grown significantly. The number of veterans in the program has more than doubled to 4,400 in FY 2020. During this time, VDC program expenditures have increased by about 97 percent. The VA Office of Inspector General (OIG) audited the program to determine if VHA budgets and manages resources to ensure veterans in the program receive authorized goods and services to help them remain in their homes. The OIG found that VHA provided VDC services to veterans that addressed their care needs. However, due to weaknesses in program management, VHA lacks assurance that veterans are safe, provider agencies are paid correctly, and taxpayer dollars are properly spent. The OIG also identified opportunities for VHA to improve VDC policies and funding to ensure medical facilities can effectively implement and manage the program to help veterans stay in their homes. The OIG recommended the under secretary for health ensure program coordinators document their quarterly monitoring of the services veterans receive, improve the provider agency billing and payment process, and establish guidance to ensure veterans do not receive the same personal care services through the VDC program and the Family Caregiver Program. The OIG also recommended establishing procedures to assist in identifying staffing needs and tracking demand for program services.