Demand for home-based, long-term care is expected to rise more than 50 percent by 2040 as the nation’s veteran population continues to age.
The vulnerable veteran population is estimated to increase 51% from 2020 to 2038, according to the Department of Veterans Affairs (VA). A new Government Accountability Office (GAO) report released Sept. 29 found that while the VA’s Medical Foster Home Program is expanding to meet needs, progress in implementing recent reforms has been slower than expected.
The program allows veterans who need nursing-home-level care to live in private homes with 24-hour caregivers.
“In a medical foster home, caregivers provide supervision and assistance in their homes to eligible veterans in need of nursing home care,” the GAO report reads, noting the goal is to have at least one foster home aligned with each of the VA’s 170 medical centers by 2026.
The VA did not respond to a request for comment, noting that its input was already included in the GAO report.
As of May 2025, 707 veterans were participating across 483 homes—a figure that has remained steady despite expansion efforts. VA officials attributed the slow growth to pandemic-related disruptions and “high costs for veterans and licensure barriers for caregivers” in certain states.
The 2022 Joseph Maxwell Cleland and Robert Joseph Dole Memorial Veterans Benefits and Health Care Improvement Act, also known as the Cleland-Dole Act, was signed into law with bipartisan support with the intent to expand veteran healthcare and benefits.
It authorized the VA to cover veterans’ foster home costs for a five-year period, along with other benefits like state and federal efforts to assist with veteran homelessness and accessibility to long-term mental health care. Its most important provision included benefits to all World War II veterans, since before they were denied VA health care eligibility.
But the GAO found that as of May 2025, the VA had not begun paying for veterans’ medical foster home costs. They cited delays in updating payment systems.
The VA’s Office of Information and Technology “had not completed the work required to make payments due to competing priorities,” with officials telling the GAO that they would need another year to complete necessary technical and system updates once funding is secured.
Once the updates are completed, the VA will be able to cover eligible veterans’ costs.
New System In 2025
The GAO credited the VA for completing most activities related to data tracking and oversight under the Cleland-Dole Act.
A new nationwide system, expected to be fully operational by late 2025, will allow officials to track program participation and inspection data in real time. VA officials said the new system “is intended to provide a better view of local oversight and compliance with VA policy.”
Overall, satisfaction remains high. In fiscal year 2023, 92% of veterans and 98% of caregivers reported being satisfied with the program and its outcomes. Caregivers described “feeling supported by Medical Foster Home Program staff and deriving personal benefit from participation.”
Yet sustainability and recruitment remain hurdles. Program staff told the GAO they struggle to find caregivers and veterans able to afford costs that range from $2,100 to over $8,000 a month.
“Most prospective veterans cannot afford the monthly out-of-pocket program costs,” staff from five VA medical centers said. Others cited “arduous and costly” state licensing rules and a lack of staff needed to expand.
Those five VA medical centers are located in Denver, Colorado; Dublin, Georgia; Sacramento/Redding, California; Biloxi, Mississippi; and San Antonio, Texas.
The GAO concluded that while the VA “has made progress implementing requirements of the Cleland-Dole Act,” key challenges–especially delayed payments and uneven state regulations–continue to limit access.
VA officials said they are exploring “manual workarounds” to begin payments before 2027 and remain committed to improving, growing the program.
