What GAO Found

The Department of Veterans Affairs (VA) Medical Foster Home Program is one of VA’s long-term-care programs for veterans who are no longer able to live independently. Veteran participation in the program is voluntary. Veterans are eligible for the program if they qualify for nursing-home care, enroll to receive primary care at home from VA, and an approved home is available in their area, among other things. While in a medical foster home, a caregiver provides supervision and assistance for activities of daily living 24 hours a day, including bathing, eating, and dressing. In addition, a home care team comprised of VA staff, such as nurses, makes routine visits to the home to check on the veteran. Other VA staff, such as recreation therapists, may also provide services to improve overall well-being, depending on availability. Generally, veterans are responsible for paying the costs, such as room and board, for their stay in the medical foster home while VA provides home-based primary care services.

Care Provided to Veterans as Part of the Department of Veterans Affairs (VA) Medical Foster Home Program

VA’s Office of Geriatrics and Extended Care (VA central office), with support from regional offices, sets and oversees VA policy on medical foster homes. Local VA medical centers implement and oversee the Medical Foster Home Program.

VA central office began an effort to expand access to the Medical Foster Home Program in December 2021 by increasing the number of participating VA medical centers. VA spent approximately $18.6 million on expansion from fiscal years 2021 through 2024, resulting in 42 additional VA medical centers establishing the Medical Foster Home Program locally. As of May 2025, 483 homes were aligned with 150 VA medical centers and 707 veterans were participating in the program.

Veterans, caregivers, and Medical Foster Home Program staff generally indicated satisfaction with the quality of care and support provided through the program, based on national VA survey data and interviews. Staff at five selected VA medical centers also described challenges that included problems sustaining the program, recruiting veterans and caregivers, and working with certain state requirements.

Some of these challenges may be addressed by provisions in the Joseph Maxwell Cleland and Robert Joseph Dole Memorial Veterans Benefits and Health Care Improvement Act of 2022 (Cleland-Dole Act), according to VA officials. The Cleland-Dole Act provided VA with the authority to make payments for veteran medical foster home costs, such as room and board, for a 5-year period for certain veterans. As of May 2025, VA had not begun making payments for veterans’ medical foster home costs as VA was not able to update its payment systems due to competing priorities, according to VA central office officials. Officials added they were exploring manual payment options until the systems were updated. The Cleland-Dole Act also requires VA to create a system to monitor the program, including tracking specified data, which VA officials said may help with program oversight. VA expects to implement the data tracking requirements by the end of 2025

Why GAO Did This Study

Veterans’ needs for home-based long-term care services are increasing as the country’s veteran population ages. One way that VA is increasing the availability of home-based long-term care services is through the Medical Foster Home Program.

The Cleland-Dole Act included provisions authorizing VA to make payments for a 5-year period for eligible veterans’ costs of care in private medical foster homes as well as to track specific data. The act also included a provision for GAO to review the implementation of these sections relating to the Medical Foster Home Program.

This report describes the program and how it is overseen, local experiences, and how VA is planning for changes related to the Cleland-Dole Act. To conduct this work, GAO reviewed agency documentation and data on the Medical Foster Home Program from fiscal year 2021 through May 2025. GAO interviewed and obtained information from officials at VA central office, five selected VA medical centers, and associated VA regional offices. The VA medical centers were selected for variation in the number of medical foster homes in the program, maturity of the program, and geography. GAO also interviewed participating veterans and caregivers about their experiences and observed two medical foster home annual inspections. In addition, GAO reached out to some veterans’ service organizations.

For more information, contact Sharon Silas at Silass@gao.gov.