VA Health Care: Recommendations and Observations to Improve Community Care and Support for Caregivers Related to the Dole Act

Why It Matters

Delays and fragmented coordination risk veterans’ access to timely care and strain caregiver resources, potentially undermining the Dole Act’s goal of expanded, high‑quality veteran health services.

Key Takeaways

• VA staffing gaps delay community care appointments.
• Wait‑time metrics remain undefined for community referrals.
• Referral coordination policies lack national documentation.
• Caregiver program lacks quantitative targets beyond enrollment.
• VA has not fully complied with Dole Act mandates.

Pulse Analysis

The Veterans Community Care Program has grown dramatically, serving over three million veterans in 2024. This expansion was a central promise of the 2025 Dole Act, which sought to broaden access to non‑VA providers while maintaining oversight. GAO’s series of reports since 2020 highlight a persistent gap between legislative intent and operational reality, emphasizing the need for robust staffing models and transparent performance metrics to safeguard timely care.

A core obstacle identified by GAO is the chronic understaffing of VHA facilities tasked with managing community referrals. Without adequate personnel, appointment scheduling lags, and veterans experience unnecessary delays. Moreover, the absence of standardized wait‑time measures prevents VA leadership from monitoring performance or holding regional offices accountable. These deficiencies not only erode confidence in the VA’s ability to deliver promised services but also expose veterans to potential health complications due to postponed treatment.

Parallel challenges affect the Caregiver Support Program, where VA has introduced virtual therapy and met enrollment growth goals, yet it lacks concrete quantitative targets for broader outcomes. Without clear benchmarks, assessing program effectiveness remains speculative, limiting the ability to refine services for the nearly 100,000 caregivers who depend on VA support. Addressing these gaps—through enforceable staffing tools, defined wait‑time metrics, and measurable caregiver objectives—will align VA operations with the Dole Act’s vision and improve health outcomes for veterans and their families.