This evaluation of the Health Care Benefits and Services Program was conducted in accordance with Veterans Affairs Canada's (VAC) approved multi-year, risk-based Evaluation Plan 2012-2017. The Health Care Benefits and Services Program, commonly referred to as the Treatment Benefits Program, provides Veteran recipients with access to extended health care. There are 14 benefits and services groups comprising a wide range of offerings. An overview of the benefits and services can be found in Appendix A. The evaluation examined the relevance and performance of the Program, and was conducted in accordance with Treasury Board policy requirements and related Treasury Board Secretariat guidance material. The evaluation findings and conclusions are based on the analysis of multiple lines of qualitative and quantitative evidence.

The evaluation of the Veterans Independence Program was conducted in accordance with the Veterans Affairs Canada Multi-Year Risk-Based Evaluation Plan 2015-20. The evaluation covers the time period from April 1, 2010 to March 31, 2015, and was conducted between June 2015 and January 2016. The objective of the Program is to assist eligible recipients to remain in their homes and communities as long as possible by providing financial assistance towards services which support and promote independence and health. Depending on circumstances and health needs, the Program can contribute to services such as housekeeping, grounds maintenance, personal care, access to nutrition, and health and support services. When home care is no longer practical, the Program assists Veterans to remain in their communities through financial support for intermediate care in community facilities (i.e., nursing home care). The evaluation focused on the housekeeping and grounds maintenance components of the Program because: * these two components combine for 77% of total program expenditures; and * significant changes were made to the method of payment for these components during the period of the evaluation.

The Veterans Independence Program (VIP) was introduced in 1981 to respond to an aging demographic Veteran population and to help reduce long-term care (LTC) bed waitlists by providing care to Veterans at home. The national Veterans Affairs Canada (VAC) home care program assists qualified Veterans, still-serving Canadian Forces (CF) disability pensioners, surviving spouses/primary caregivers, and certain civilians to maintain their health, quality of life and independence in their own home for as long as possible. At the point where care in the home is no longer possible, the VIP will assist in providing care in long-term care facilities in the community of the Veteran. The VIP is not intended to duplicate or replace existing provincial/territorial or community services, but complements these programs to best meet the needs of Veterans. Under the VIP, a recipient may receive funds to help pay for: • ambulatory health care services (e.g., adult day programs); • access to nutrition (e.g., Meals on Wheels); • health and support services (e.g., nurses, occupational therapists); • personal care (e.g., bathing and dressing); • housekeeping (e.g., laundry, vacuuming, meal preparation); • grounds maintenance (e.g., grass cutting, snow removal); • social transportation (e.g., to activities, shopping, banking) • home adaptations; and • nursing home intermediate care. A goal of the evaluation was to provide timely and value added information to assist management and serve as a basis for decision-making regarding future program direction and design. The VIP evaluation team used multiple lines of evidence, including: statistical data, a literature review, research studies, survey results, file reviews, internal analysis reports, key informant interviews and peer reviews.

The Long Term Care Program works in cooperation with provinces/territories, health authorities and long term care facilities to financially support eligible Veterans in an appropriate long term care setting. Veterans Affairs Canada provides funding for qualified Veterans who occupy a contract bed or those in a community bed. As of March 31, 2011, there were 9,376 recipients of funding support from Veterans Affairs Canada in non-departmental institutions across Canada. 2,782 recipients were in contract beds and 6,594 were in community beds. These numbers are forecasted to decline between 2012 and 2020 when there will be a decline in demand for Long Term Care. Forecasts estimate that there will be 5,780 Veterans in long term care in five years (2016-2017). The purpose of this audit was to provide assurance that the management control framework governing the Long Term Care Program is effective and the internal controls surrounding the program are adequate and functioning well. The scope included Long Term Care recipients in community beds and contract beds governed by a Memorandum of Understanding with provincial health authorities, from April 1, 2010 to March 31, 2011.

Since 1981, Veterans Affairs Canada has administered a community-based, national program to eligible Veterans, their families, and other primary care-givers. These services include home care, home adaptations, ambulatory health care, and intermediate nursing home care. Now known as the Veterans Independence Program, it offers self-managed care in co-operation with provinces and regional health authorities. The program allows eligible Veterans, their families, and other primary care-givers to focus on maintaining their health, independence, and their quality of life. Every effort is being made to integrate the Veterans Independence Program administration with provincial and local resources to ensure a cost-efficient choice of service is available and to avoid duplication of service delivery. Veterans Affairs Canada is responsible for setting up and amending the contribution arrangements while an external Contractor, Medavie Blue Cross, is responsible for processing the claims. In the Spring of 2011, Senior Management requested an audit of the Veterans Independence Program reimbursement process to identify opportunities to further improve the process. This audit builds off the results of a 2010 audit of Veterans Independence Program and is focused on a single objective to assess the efficiency and effectiveness of the reimbursement process. The scope covered the period from November 2010 to April 2011.

The War Veterans Allowance (WVA) Program, which began in 1930, provides monthly financial support to low-income war service Veterans and civilians (e.g., Overseas Welfare Workers, Auxiliary Services Personnel) or their survivors/dependents to help them meet their basic needs. This evaluation was conducted in accordance with Section 42.1 of the *Financial Administration Act* which requires that every federal department conducts a review of the relevance and effectiveness of each ongoing program of grants and contributions programs every five years.

The Veterans Affairs Canada Health Care Benefits Program provides eligible Veterans and other qualified individuals with benefits and services, such as medical, surgical and dental care, prosthetic devices and home adaptations, through 14 Programs of Choice. Under the Veterans Health Care Regulations and Canadian Forces Members and Veterans Re-establishment and Compensation Act, eligible Veterans and other qualified individuals have access to benefits and services, such as medical, surgical and dental care, prosthetic devices and home adaptations. Related Health Services are services provided by health care professionals other than physicians, dentists and nurses. Examples of these types of services include occupational therapy, physiotherapy, massage therapy, chiropractic, acupuncture, speech language pathology and psychological counseling. The objective of this audit was to assess Veterans Affairs Canada’s management control framework, and compliance with applicable policies and processes, and to identify any potential opportunities to improve efficiency of decision making for Related Health Services. The scope covered transactions processed from April 1, 2012 to March 31, 2013.

The Career Transition Services (CTS) Program evaluation was conducted in accordance with Veterans Affairs Canada’s (VAC) approved Multi-Year Risk-Based Evaluation Plan 2012-17. The Terms and Conditions of CTS were valid until March 31, 2016. The Career Transition Services Program was established in 2006 under the authority of the Canadian Forces Members and Veterans Re-establishment and Compensation Act. Policies and practices have been modified over the years but its essential mission has remained unchanged; i.e., to provide eligible Veterans and survivors with practical help finding a job as they transition from military to civilian life. CTS reimburses costs for services such as career counselling, job-search training and job-finding assistance for eligible Veterans and survivors to a lifetime maximum of $1,000 (including tax). The current program design differs from that originally established in 2006 with respect to eligibility, dollar limits and service providers. The evaluation examined the relevance and performance of the Career Transition Services Program, and was conducted in accordance with Treasury Board of Canada Secretariat (TBS) policy requirements and related TBS guidance. The evaluation findings and conclusions are based on the analysis of multiple lines of qualitative and quantitative evidence.

The evaluation of the Financial Benefits Program was conducted in accordance with the Veterans Affairs Canada Multi-Year Risk-Based Evaluation Plan 2014-19. The program was last evaluated as part of an overall New Veterans Charter Evaluation in 2010-11. The Financial Benefits Program was established in 2006 under the authority of the Canadian Forces Members and Veterans Re-establishment and Compensation Act, with subsequent amendments expanding eligibility and adding programs. It provides economic support to eligible Canadian Armed Forces Veterans, survivors, and dependents in recognition of the economic impact that a career ending and/or service-related injury or death can have on a Veteran’s ability to earn income, advance in a career or save for retirement. As per Treasury Board Secretariat policy requirements and guidance, this evaluation examined the Financial Benefits Program’s relevance and performance. The evaluation findings and conclusions are based on the analysis of multiple lines of qualitative and quantitative evidence.

In 2012, Veterans Affairs Canada (VAC) and Service Canada entered into a Partnership whereby Service Canada would use their web, in-person and telephone services to provide general information on VAC’s benefits and services to individuals who visit Service Canada’s website, visit a Service Canada Centre or call VAC’s toll-free line. In addition, Service Canada would accept and review applications for the Disability Benefits Program and the Veterans Independence Program (VIP). The intention of the Partnership was that Veterans would have broader access to VAC’s services on the web, in-person and on the phone. By having Service Canada answer general inquiries on VAC’s behalf, it was expected that VAC would be able to re-focus their resources on more complex cases. The Partnership was also intended to increase points of access for VAC Services, particularly for residents in rural and remote areas. In addition, Service Canada would use their expertise and experience with all Government of Canada programs and bundle VAC’s information with a broader array of related Government of Canada programs and services. In February 2014 the Partnership was expanded to include employee hosting services, whereby Service Canada would provide office and meeting space for a VAC representative to be co-located in the Service Canada Centre closest to each of the VAC area offices that were closing. As part of the approval of the Partnership, an evaluation was required which would assess whether applicable service standards for Veterans had improved, whether resources were effectively refocused on improving case management and if efficiencies had materialized that could provide longer term operational savings without reducing the level of service to Veterans. The evaluation would also determine if there was compliance with the documented agreement between VAC and Service Canada, and identify any areas for improvement.