GAO Report: VA Not Fully Implementing Caregiver Support Recommendations

GAO Reports & Testimonies

Published March 2nd, 2026

Detected March 3rd, 2026

Summary

A GAO report released March 2, 2026, found the Department of Veterans Affairs (VA) has not fully implemented GAO's recommendations to improve access to community care and caregiver support programs. The report highlights ongoing issues with timely appointment scheduling, referral coordination, and communication, despite legislative mandates from the Dole Act.

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What changed

The Government Accountability Office (GAO) has reported that the Department of Veterans Affairs (VA) has failed to fully implement several key recommendations aimed at improving the Veterans Community Care Program and caregiver support. Specifically, the GAO report (GAO-26-108943), released on March 2, 2026, details that the VA has not adequately addressed staffing needs for timely appointment scheduling, has not fully integrated referral coordination initiatives into national policy, and has not ensured clear communication from its Office of Integrated Veteran Care. These findings are particularly relevant given the mandates of the 2025 Senator Elizabeth Dole 21st Century Veterans Healthcare and Benefits Improvement Act, which requires VA to take action on staffing models and performance metrics to ensure timely care.

For compliance officers overseeing VA-related operations or those involved in veteran care, this report indicates a need for increased scrutiny of VA's implementation progress. While the VA has agreed in principle to many recommendations, the lack of full implementation suggests potential ongoing risks to veterans' access to timely care and support. Regulated entities should be aware that the Dole Act imposes requirements on the VA, and continued non-compliance could lead to further oversight or legislative action. While no direct penalties for regulated entities are mentioned, the findings highlight systemic issues within the VA that could impact service delivery and veteran satisfaction. The report also notes ongoing work on the Caregiver Support Program, indicating that further developments in this area are expected.

What to do next

Review GAO report GAO-26-108943 for specific details on VA's implementation gaps.
Assess internal processes related to community care referrals and caregiver support to identify potential alignment with GAO recommendations.
Monitor VA's progress in implementing recommendations and complying with the Dole Act provisions.

Source document (simplified)

GAO-26-108943 Published: Mar 04, 2026. Publicly Released: Mar 02, 2026.

Highlights

What GAO Found

The Department of Veterans Affairs (VA) allows eligible veterans to receive health care from community providers through the Veterans Community Care Program. Since 2020, GAO has made several recommendations to improve access to the Veterans Community Care Program in areas also highlighted by the 2025 Senator Elizabeth Dole 21st Century Veterans Healthcare and Benefits Improvement Act (Dole Act). As of February 2026, VA has not fully implemented GAO’s recommendations. For example:

Timely appointment scheduling. In 2020, GAO found that most Veterans Health Administration (VHA) facilities from the region included in its review did not have the recommended number of staff needed to manage community care referrals, creating potential risks to timely scheduling. GAO recommended that VHA assess community care staffing needs to identify and address any risks. VHA agreed with this recommendation and is working to enable its staffing tool to identify and report such risks, according to officials. GAO also recommended that VHA establish a wait time measure for community care appointments and align its performance metrics. VHA disagreed with this recommendation but has defined time frames for some steps. VHA has not fully implemented these recommendations. The Dole Act requires VA to take action on its staffing model and performance metrics to ensure timely care for veterans.
Referral coordination and communication. In 2025, GAO reported that VHA facilities had mixed results in implementing the Referral Coordination Initiative, which aimed to improve referral coordination and streamline appointment scheduling. VHA had not documented key elements of the initiative in policy, which may contribute to inconsistences in implementation and limit staff and veterans’ understanding of community care options. GAO recommended that VHA include this initiative in its national policy. VHA concurred in principle with the recommendation, but has not yet implemented it. GAO also reported in 2025 that the Office of Integrated Veteran Care, which VHA created to improve coordination of community care, did not always clearly communicate information to its facilities. GAO recommended that VHA ensure this information is clearly communicated. VHA concurred with this recommendation but has not yet implemented it. The Dole Act also requires VA to review facilities’ processes for making such referrals. GAO also has ongoing work on VHA’s Caregiver Support Program. Preliminary results show that VHA responded to challenges caregivers reported with accessing in-person support by implementing a virtual therapy program. VHA also established goals to assess the effectiveness of its outreach efforts. These include a goal to increase program enrollment by 15 percent each fiscal year, which it met in fiscal year 2025. However, VHA has not set quantitative targets and time frames for its other goals. Doing so would better position VHA to assess its efforts and make any needed adjustments. The Dole Act also includes provisions addressing caregivers’ access to and awareness of VHA’s Caregiver Support Program.

Why GAO Did This Study

The Dole Act authorized significant expansions of health care programs for veterans and support for their caregivers. These programs are administered by VHA.

An increasing number of veterans receive their care from providers outside of VHA facilities through the Veterans Community Care Program; in 2024, about 3.1 million veterans received such care. VHA also provides services and support to nearly 100,000 caregivers of veterans who suffered serious injuries in the line of duty through its Caregiver Support Program. Concerns have been raised about the mental health of veterans’ caregivers who often provide around the clock care that enables veterans to live at home and help with their recovery.

GAO has a large body of work related to aspects of the community care and caregiver programs, both of which were addressed in the Dole Act. This statement summarizes recommendations and related work on the Community Care program. It is based on three GAO reports issued from 2020 through 2025 (GAO-20-643, GAO-25-106678, and GAO-25-107212). This statement also includes preliminary results from GAO’s ongoing work examining VA’s efforts to provide mental health support to caregivers. To do this work, GAO reviewed VHA documents on its caregiver program and interviewed VHA officials, program staff, and participating caregivers at four selected VHA facilities.

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

Full Report

Highlights Page (1 page)

Full Report (20 pages)

GAO Contacts

Sharon M. Silas Director Health Care silass@gao.gov

Media Inquiries

Sarah Kaczmarek Managing Director Office of Public Affairs media@gao.gov

Public Inquiries

Topics

Health Care Veterans Caregivers Access to health care Medical facilities Health care Human capital management Mental health Respite care Specialty care Veterans health care