Soldiers and Afghan border police walk together in Afghanistan. (Army Photo/Staff Sgt. Andrew Smith)

The Department of Veterans Affairs (VA) provides long-term care (LTC) for about 46,000 elderly and disabled veterans through a network of 132 nursing homes, and it is having trouble with handling care quality problems.

Officials from the U.S. Government Accountability Office (GAO) give that assessment of VA LTC quality control efforts.

The VA hired the Long Term Care Institute Inc., Madison, Wis., to conduct reviews of the VA nursing homes, which are called community living centers (CLCs), in 2007-2008 and again in 2010-2011.

Members of Congress asked the GAO to review the institute’s work.

VA officials themselves found after looking at institute data that, for example, that 90% of 116 nursing homes with deficiencies had problems with protecting residents’ dignity.

In some cases, for example, aides would apply ointments to a resident’s upper body in the nursing home dining room, in front of other patients, and leave uncovered catheter bags attached to residents’ wheelchairs.

The officials found problems with infection control at 59% of the nursing homes. At many of those nursing homes, “staff did not follow handwashing policies and procedures,” Randall Williamson, a GAO director, writes in a report summarizing the GAO’s findings.

The VA developed training guidelines and checklists for evaluating nursing home employees, and nursing homes were supposed to report on efforts to meet quality requirements.

But “VA headquarters cannot provide reasonable assurance of resolution of deficiencies because it does not clearly document the feedback that it provides” to the nursing homes, Williamson says.

The VA also does not have a systematic approach to verify the quality performance information the CLCs are sending it, Williamson says.

The GAO is advising the VA to require more reporting on how well the nursing homes are adhering to corrective action plans and to come up with a process for verying the information reported by the nursing homes.

The VA also should develop and implement a process to identify and deal with nursing home quality risks by doing a better of analyzing VA nursing home care quality and quality of life data, Williamson says.