Summary: The Armed Forces Retirement Home (AFRH), an independent executive branch entity, operates two continuing care retirement communities (CCRC). It provides care in three settings--independent living, assisted living, and a nursing home--and also operates a health and dental clinic for residents. The responsibilities of a CCRC generally include (1) appropriately transitioning residents from independent living to other settings as their care needs increase, (2) ensuring the availability of appropriate health services as residents progress to higher-level settings, and (3) ensuring residents' access to community-based or on-site health care. The law establishing AFRH sets forth the framework for its oversight and management. The NDAA for Fiscal Year 2006 required GAO to assess the regulatory oversight and monitoring of health care and nursing home care services provided by AFRH. As discussed with the committees of jurisdiction, we focused our review on (1) the standards that could be used to monitor health care provided by AFRH and (2) the adequacy of DOD oversight of AFRH health care. To address these issues, we (1) identified existing standards applicable to health services in the three settings at AFRH and similar facilities; (2) discussed accreditation process and follow-up between accreditation surveys with officials from standard-setting organizations; (3) reviewed the statutory oversight structure for AFRH; (4) reviewed relevant DOD and AFRH reports related to oversight issues, including complaints; (5) interviewed DOD, DOD inspector general (IG), and service IG officials involved in oversight, including the Under Secretary's Principal Deputy (PDUS); (6) interviewed two civilian experts in health care for the elderly and retirement home administration serving on the AFRH-Washington Local Advisory Board; and (7) compared health care-related problems identified during Joint Commission accreditation reviews with those identified during service IG inspections.
Oversight of health care at AFRH is inadequate. Currently, there are no inspections of AFRH's independent and assisted living settings. Such oversight is important to ensure that residents are receiving appropriate care and are transitioned to other care settings as their care needs increase. Although the primary oversight responsibility for AFRH has been delegated to PDUS, this office's health care oversight has been limited and the sources of independent information to inform PDUS oversight have shortcomings. For example, the Joint Commission and service IG inspections occur triennially in the same year and, according to the PDUS, a Joint Commission inspection once every 3 years may be insufficient. In addition, PDUS shifted the focus of service IG inspections away from health care in 2005, but directed the service IGs to review Joint Commission accreditation reports to ensure AFRH follow-up. Our review of service IG and Joint Commission inspection reports demonstrated that this decision may result in health care problems remaining unidentified. Moreover, according to the service IG team that conducted the 2005 AFRH inspection, it was not provided the data that it needed on Joint Commission findings, such as the full accreditation report, to enable it to provide adequate oversight. Although Local Boards have the potential to assist in the PDUS's oversight, they have not been allowed to fulfill their advisory roles to the COO, which could provide useful information to the PDUS. The PDUS response to the 2005 service IG inspection findings that the Local Boards were not fulfilling their advisory role has been limited. In March 2007, however, the PDUS directed the COO to find ways to effectively use the Local Boards.
