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Long-term care.

The cost of meeting the long-term care needs of sick and disabled veterans is skyrocketing out of sight, whether it's in a VA-operated nursing home, a state veterans' home or a community-based facility. And with nearly 10 million of America's veterans now over the age of 65, it is clear the VA faces some real challenges in the years ahead.

From 2003 to 2005, the number of veterans receiving VA-funded nursing home care rose about 3.5 percent to an average of 34,375 a day. More than half of those veterans are in state veterans' homes. During the same two-year period, the VA's overall spending for nursing home care went from $2.3 billion to $3.2 billion, a whopping 39 percent increase, according to the Government Accountability Office.

The implications of the GAO report are vital to the VA's long-term care planning. The first challenge is to estimate how many veterans will seek care from the VA and just what their nursing home needs will be. That includes estimating how many will be eligible for nursing home care based on law and VA policy, and to what extent veterans will need short-stay care after an acute medical incident or extended care for chronic needs.

Then there is the question of money. VA-operated facilities account for about three-quarters of the $3.2 billion VA spends on nursing home care. The rest goes to state veterans' homes and community nursing homes. State veterans' homes accounted for just 12 percent of the VA's overall nursing home care budget. That's because the VA pays about one-third the costs of care veterans receive in state veterans' homes, compared to the full cost in other settings.

Looking ahead, the challenge is whether and how much the VA will pay for long-term care in each of the three nursing home settings. Or will veterans need to rely more on other non-VA programs, such as Medicare and Medicaid?

Most veterans do not receive nursing home care from the VA program. The cost of their care is covered by programs such as Medicaid, Medicare, private health or long-term care insurance or "self financing" by patients.

In any case, nursing home care is a costly proposition and one that will be increasingly more difficult to meet in the years ahead.

This makes it all the more important for the VA to move ahead in meeting the requirements of the Veterans Millennium Health Care and Benefits Act to offer a broader range of long-term care services to eligible veterans. These include noninstitutional care, such as adult day health care, geriatric evaluation and respite care. That is in addition to mandated nursing home care for veterans in need of such care for a service-connected disability and those needing nursing home care with service-connected disabilities rated 70 percent or above.

The VA has yet to complete its long-term care strategic plan, which Secretary of Veterans Affairs R. James Nicholson has acknowledged is needed to help the VA achieve its goal of ensuring that veterans have access to an appropriate range of services.

But meeting veterans' long-term care needs is a responsibility shared by both the VA and Congress. While it is the VA's duty to develop and provide the full range of long-term care services to veterans, Congress has a duty to provide adequate funding that will allow the VA to fulfill its obligations.

Assuring a reliable, stable funding stream for veterans health care would enable the VA to adequately plan for and meet the long-term care needs of our nation's elderly, sick and disabled veterans, now and in the future.
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Title Annotation:from the NATIONAL ADJUTANT; for disabled veterans
Author:Wilson, Arthur H.
Publication:DAV Magazine
Geographic Code:1USA
Date:Mar 1, 2006
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