GAO Report Details Expansion and Satisfaction with VA Medical Foster Home Program

A report released by the U.S. Government Accountability Office (GAO) provides an overview of the Department of Veterans Affairs’ (VA) Medical Foster Home Program, highlighting its role in offering long-term care in a home-like setting for aging veterans. The program allows eligible veterans to reside in a caregiver’s home, receiving 24/7 assistance with daily living activities, alongside primary healthcare services provided by a VA home care team. As of May 2025, approximately 700 veterans were participating in the program, with both veterans and VA staff generally expressing satisfaction with the care and support received.

The Medical Foster Home Program is part of the VA’s broader strategy to increase access to home-based long-term care services as the veteran population ages. Eligibility for the program requires veterans to qualify for nursing-home care, enroll for primary care at home from the VA, and have an available, approved medical foster home in their area. While in the program, a dedicated caregiver provides round-the-clock supervision and aid with essential tasks such as bathing, eating, and dressing. To complement this, VA staff, including nurses, conduct regular visits to monitor the veteran’s health, and other professionals like recreation therapists may offer services to enhance overall well-being, subject to availability. Typically, veterans are responsible for covering the costs associated with their stay in a medical foster home, including room and board, while the VA delivers the home-based primary care.

The VA’s Office of Geriatrics and Extended Care, in collaboration with regional offices, establishes and monitors policies for the Medical Foster Home Program, with individual VA medical centers responsible for local implementation and oversight. Since December 2021, the VA has been actively working to expand the program’s reach by increasing the number of participating VA medical centers. This expansion effort, which incurred approximately $18.6 million in costs from fiscal years 2021 through 2024, has led to 42 additional VA medical centers establishing local Medical Foster Home Programs. By May 2025, the program was associated with 483 homes across 150 VA medical centers, accommodating 707 veteran participants.

Feedback from veterans, caregivers, and program staff generally indicates a positive experience with the quality of care and support offered through the Medical Foster Home Program. However, staff at five selected VA medical centers identified several challenges that could impact program sustainability. These challenges include difficulties in recruiting both veterans and caregivers, as well as navigating state-specific regulations.

The Joseph Maxwell Cleland and Robert Joseph Dole Memorial Veterans Benefits and Health Care Improvement Act of 2022, commonly known as the Cleland-Dole Act, aims to address some of these challenges. This legislation provides the VA with the authority to make payments for certain veteran medical foster home costs, such as room and board, for a period of five years. Despite this authority, as of May 2025, the VA had not yet begun issuing these payments. VA central office officials cited competing priorities that delayed the necessary updates to payment systems. They are reportedly exploring manual payment options in the interim. The Cleland-Dole Act also mandates the creation of a system for the VA to monitor the program, including the tracking of specific data points. VA officials anticipate implementing these data tracking requirements by the end of 2025, which they believe will improve program oversight.

The GAO’s study was initiated in response to the increasing demand for home-based long-term care services driven by the aging veteran population and the provisions within the Cleland-Dole Act. The act specifically authorizes VA payments for eligible veterans in private medical foster homes and requires data tracking, with a mandate for GAO to review the implementation of these sections. The report draws upon GAO’s review of VA documentation and program data from fiscal year 2021 through May 2025. The GAO also conducted interviews with officials from VA central office, five selected VA medical centers, and associated regional offices, chosen for their varied program maturity, geographical location, and the number of medical foster homes involved. Further insights were gathered through interviews with participating veterans and caregivers, observations of two medical foster home annual inspections, and outreach to veterans’ service organizations.

Article by Mel Anara, based upon information from the U.S. Government Accountability Office

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