The Department of Veterans Affairs (VA) has yet to address a recommendation made by the U.S. Government Accountability Office (GAO) to identify additional enforcement actions for VA nursing homes, and to ensure such facilities comply with quality standards.

The recommendation was made as part of a November 2022 report to help the VA oversee these homes, but this year, VA officials said they are no longer pursuing additional enforcement actions and corresponding legislative authority. A follow-up report on VA nursing home care published on Tuesday serves as a reminder that opportunities remain to enhance oversight of state veterans homes.

The change in rhetoric tracks with the current administration’s preference for deregulation and efficiency among federal agencies. Prior to 2025, VA officials said they were considering seeking legislative authority to take additional enforcement actions to ensure compliance with quality standards.

“While the department has taken steps to improve its oversight, VA’s oversight could be strengthened if it had a range of available enforcement actions to help ensure its standards are met,” GAO said in the latest report. “We will continue to monitor VA’s efforts to address this recommendation.”

VA nursing homes need to have a range of enforcement options to help meet its program goals, align the VA’s practices with the Centers for Medicare and Medicaid Services (CMS), and help ensure veterans receive quality care in state veterans homes, GAO said.

The VA in 2024 did develop a new enforcement plan involving strengthened timelines and increasing follow-ups with deficient nursing homes, but the plan doesn’t include a mechanism to compel compliance with the VA’s quality standards, GAO found.

Unlike CMS, VA lacks a range of enforcement actions. VA only has the ability to withhold payment for daily veteran care, while CMS enforcement actions include civil monetary penalties, denial of payment for newly admitted eligible residents, state monitoring and termination from the Medicare and Medicaid programs.

More than 40% of VA homes were deficient between 2019 and 2021, GAO reported. The VA never used its only enforcement action, considering it too severe for most situations. While the most common scope and severity ratings for deficiencies during this time were low-level ratings and isolated in scope and no actual harm, more than 21% were rated as causing actual harm, GAO found.

While the VA is the only federal agency to inspect all state veterans homes, CMS oversees many of them, depending on Medicare and Medicaid participation.

In 2023, VA paid about $1.5 billion for veteran nursing home care, provided in state veterans homes. The November 2022 study is based on information collected from 153 state veterans homes providing nursing home care. GAO also reviewed laws and VA documents, and interviewed federal and state officials, along with state veterans homes’ officials and other organizations involved in veteran care.

Three other recommendations from the GAO report have been implemented by the VA, including data analytic capabilities, oversight of corrective action plans, and formalizing its oversight structure