As veterans age and the population of senior veterans grows dramatically in the next eight years, Congress worries the Department of Veterans Affairs isn’t prepared for what lawmakers called a “silver tsunami.”
The number of veterans older than 75 enrolled in VA health care is expected to nearly double by 2028, VA leaders told Congress during a House Veterans Affairs Committee hearing Tuesday. About half of the 9 million total veterans who receive care at VA are older than 65.
As the veteran population gets older, their need for care also significantly increases, particularly for those with service-connected disabilities. The number of veterans with service-connected disabilities is expected to increase by more than a third by 2028, such as Vietnam veterans ill from Agent Orange exposure or Gulf War and post-9/11 veterans exposed to other toxins. The demand for long-term care -- anything from help around the house to round-the-clock care, including help eating or bathing -- is expected to rise in particular.
But VA may struggle to meet that demand, according to a recent Government Accountability Office (GAO) report.
VA faces workforce shortages for nursing assistants and other jobs, which result in waitlists for long-term care and challenges reaching veterans in rural or remote areas, where about a third of all veterans live, according to Nikki Clowers, managing director of health care at GAO.
VA will need to spend $14 billion annually to keep up with this increasing demand for long-term care, according to GAO. In 2018, VA provided or paid for long-term care for more than half a million veterans.
VA officials promised Congress Tuesday that the department was working on a strategic plan to care for senior veterans.
The number of veterans 85 and older has increased nearly 300 percent between 2003 and 2018 and is expected “to surge close to 500 percent by 2038,” said Teresa Boyd, an assistant deputy undersecretary at the Veteran Health Administration.
Many of the veterans who use long-term care services are significantly disabled, some in the "catastrophically disabled" category. Others are more likely to be low-income or live in remote or rural areas, according to Adrian Atizado, deputy national legislative director for Disabled American Veterans.
About 80 percent of aging veterans will need long-term services and support, Boyd told lawmakers, and in the past, most of that care has been provided by family members, with women taking on the greatest burden of care.
The number of possible caregivers for each veteran in America is about seven. But that number is expected to decrease to about four by 2030. The availability of caregivers can be jeopardized by work responsibilities outside the home and other factors, Boyd said.
“Many veterans are divorced, have no children, are estranged from their families or live long distances from family members," Boyd said, making it difficult to get care from family members -- something VA has depended on in the past -- and passing the responsibility on to VA.
And the lack of a strong family caregiver is especially true for the increasing number of aging women veterans “who are at higher risk for needing (long-term care) due to their longer life expectancies and greater risk of disability than men at any age,” Boyd said.
"Demands for all types of long-term care will continue to grow into the foreseeable future," Atizado told lawmakers.
"VA must enable as many family caregivers to assist as possible" in addition to expanding and improving its own programs, he said.
Reps. Julia Brownley, D-Calif., and Neal Dunn, R-Fla., both asked about the VA caregiver expansion, especially in light of a “healthcare market that is increasingly tight.”
Previously, VA was expected to expand eligibility for caregiver benefits to pre-9/11 veterans. But it missed the deadline to expand that program last year and delayed it until this year. Last week, VA Secretary Robert Wilkie told lawmakers they could expect an update on that program in coming weeks, with the program expected to begin its expansion this summer.
With an expected decrease in availability of family caregivers, Boyd said VA will likely need to increase the care it, or its networked private partners, provide. The number of veterans using nursing homes is also increasing.
“The costs to VA for providing nursing home care for enrolled veterans are expected to significantly increase,” Boyd said.
Dunn also asked how VA is preparing its oldest and possibly most vulnerable veterans for a possible outbreak of coronavirus, specifically COVID-19, in the United States.
Boyd said VA has “tremendous experience with infectious diseases” but did not say what specific actions VA is taking to protect those veterans, only advising them to wash their hands and take other measures to prevent infection.
No VA patient has been diagnosed with COVID-19 as of Feb.3, but the department has activated its emergency management coordination cell and provided a guide for veterans and their families. That guide includes asking veterans who believe they are infected to call their VA hospital before showing up.
Last week, Wilkie declined Congress’ offer of additional resources for an outbreak, saying his department was prepared.
Brownley and Dunn stressed the importance of long-term care for aging and disabled veterans, repeating that it is a service “VA cannot afford to get wrong.”
“Millions of veterans rely on us to ensure their later years are as dignified as possible,” Brownley said. “These veterans will live longer with more complicated needs … than any American health system has had to contend with … this is unlike anything the United States has seen before.”
VA needs to spend $14B annually to keep up with veteran demand for long-term care, report says
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