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Submission For The Record of Mr. Kimo S. Hollingsworth, American Veterans (AMVETS), National Legislative Director

Mr. Chairman and Members of the Subcommittee:

I am pleased to offer testimony on behalf of American Veterans (AMVETS) regarding the Department of Veterans Affairs long-term care program.

The Department of Veterans Affairs (VA) offers a fairly robust variety of inpatient long-term care services for veterans enrolled in the VA health care system.  VA services are generally divided into non-institutional care and institutional care.  More than 90 percent of VA medical centers provide home and community-based outpatient long-term care programs.  Overall, eligible veterans can receive home-based primary care, contract home health care, adult day health care, homemaker and home health aide services, home respite care, home hospice care and community residential care.  In addition, VA nursing home programs include VA-operated nursing home care units, contract community nursing homes and state homes.

As this Committee is aware, AMVETS hosted the “National Symposium for the Needs of Young Veterans” in Chicago, Illinois last year.  More than 500 veterans, active duty and National Guard and reserve personnel, family members, and others who care for veterans examined the growing needs of our returning veterans.  One of they Symposium findings revealed a general lack of knowledge about VA long-term care programs among veterans and their family members.

Mr. Chairman, the changing dynamics within the enrollee population, such as aging, changes in morbidity, and VA enrollees shifting to a higher cost priority level will continue to impact medical care expenditures.  In testimony before the House Committee on Appropriations, VA recently reported, “that there is a great and growing need for long-term care services for elderly and disabled veterans.”  VA projects that between 2005 and 2012, the number of enrolled veterans aged 65 and will increase from 3.45 million to 3.92 million, and the number of enrolled veterans aged 85 and older will increase from 337,000 to 741,000 during the same period.  The latter group will most likely require long-term care services and other health care services along the continuum of care such as acute care and preventive care.

Public Law 106-117 mandated that VA prioritize care for those veterans most in need of VA services, to include veterans returning from OEF/OIF service, veterans with service-connected disabilities, those with lower incomes, and veterans with special health care needs such as serious chronic mental illness and spinal cord injury and disease.  It is within the guidelines of this mandate that VA is currently focused.   AMVETS reaffirms its commitment that service-disabled veterans should have the highest priority access to VA health care services and these services should be of the highest quality.   AMVETS believes that service-connected veterans currently have that level of access and quality in VA today.

In 2004, VA commissioned a study on VA Long-Term Care Patients’ Medicare and Medicaid Expenditures.  The study concluded that three quarters of VA long-term care patients rely to some extent on the national Medicare and Medicaid programs.  The study also found that VA funds approximately 90 percent of the care provided for these veterans.  Given these dynamics of cross enrollment, AMVETS believes that it is in the interest of both the government and veterans to coordinate the benefits of their various programs and work together toward the goal of providing compassionate, and high-quality care.

Overall, the Veterans Health Administration’s efforts in long-term care case management are driven by the clinical needs of each patient, the patient’s preferences, and the benefit options available to that patient.  As part of this process, VA health care providers work closely with patients and family to ensure veterans receive appropriate care.  Despite VA’s best efforts to coordinate care through its many programs and with other federal, state and private organizations, the cost of long-term care is expensive and continues to rapidly increase.

To VA’s credit, the department has effectively managed its health care expenditures and it provides a significant dollar cost value compared to other federal and private programs.  From 1996 through 2004, the Medical Consumer price index increased by approximately 40 percent.  During this same period, the average Medicare cost per payment per enrollee increased by almost 45 percent.  The VA cost per patient during this same time period increased less than one percent, yet VA customer service and satisfaction ratings have increased.  Ultimately, good business practices make sense, but VA is in the people business and taking care of veterans remains paramount.  VA has done both!

AMVETS will continue to support VA long-term care programs and believes that the department continues to set the standard for excellence in care and dollar cost value per patient.  AMVETS would continue to urge Congress to support VA long-term care programs and seriously consider allowing VA to recoup Medicare and Medicaid reimbursements as a way to save money for the federal government.

Mr. Chairman, this concludes my testimony.