" GAO and others have highlighted the need for an adequate and qualified nurse workforce to provide quality and timely care to veterans. VHA faces challenges such as increased competition for skilled clinicians in hard-to-fill occupations such as nurses. As GAO has previously reported, recruitment and retention is particularly difficult for nurses with advanced professional skills, knowledge, and experience, which is critical given veterans' needs for more complex specialized services. GAO was asked to provide information on the recruitment and retention of nurses within VHA. This report reviews (1) the initiatives VHA has to recruit and retain its nurse workforce and (2) the extent to which VHA oversees its nurse recruitment and retention initiatives. GAO reviewed documents and interviewed officials from VHA, four VA medical centers selected to reflect variation in factors such as nurse turnover, and regional offices for these medical centers. GAO used federal internal control standards to evaluate VHA's oversight. GAO also interviewed selected stakeholder organizations. "

VA partners with university-affiliated hospitals, medical schools, and practice groups (affiliates) to provide educational opportunities in VAMCs. Under special contracting authority, VA can use SSACs to obtain physician services from affiliates that are not available in VAMCs. GAO was asked to review VA's use of SSACs. This report, among other issues, examines (1) VHA's time frames for developing and awarding high-value, long-term SSACs; (2) VHA's use of short-term SSACs and how it oversees their development and use; and (3) how much experience the VA workforce that develops SSACs has and what, if any, specialized training VA provides. GAO reviewed VA and VHA policies and guidance. GAO visited five VAMCs and five network contracting offices based on geographic dispersion and use of SSACs. GAO also reviewed a nongeneralizable sample of 25 SSACs. GAO contacted supervisors from each of VHA's 21 network contracting offices to gather information on SSAC development and contracting officer experience. GAO is making eight recommendations, including that VA develop performance standards for the timely development of high-value, longterm SSACs, develop standards for the minimum amount of time necessary to develop and award short-term SSACs, and take steps to increase the retention and competence of the contracting workforce.

Among the issues confronting America is long-term care for frail, older persons and others with chronic conditions and functional limitations that limit their ability to care for themselves. Improving the Quality of Long-Term Care takes a comprehensive look at the quality of care and quality of life in long-term care, including nursing homes, home health agencies, residential care facilities, family members and a variety of others. This book describes the current state of long-term care, identifying problem areas and offering recommendations for federal and state policymakers. Who uses long-term care? How have the characteristics of this population changed over time? What paths do people follow in long term care? The committee provides the latest information on these and other key questions. This book explores strengths and limitations of available data and research literature especially for settings other than nursing homes, on methods to measure, oversee, and improve the quality of long-term care. The committee makes recommendations on setting and enforcing standards of care, strengthening the caregiving workforce, reimbursement issues, and expanding the knowledge base to guide organizational and individual caregivers in improving the quality of care.