This evaluation of the Intermediate and Long Term Care Programs was conducted in accordance with the approved Veterans Affairs Canada Multi-Year Risk-Based Evaluation Plan 2012-2017. The Veterans Independence Program Intermediate Care (VIP IC) Program and the Long Term Care (LTC) Program, hereinafter referred to as "the Programs", support eligible Veterans and other individuals who require facility-based long term care. There are two types of beds under the Programs: community beds and contract beds. Community beds are beds in a facility operated by health authorities, private and not-for-profit sectors. Contract beds are beds that are set aside in a community facility pursuant to a contractual arrangement between the facility and VAC. Eligibility for these bed types varies. Community beds fall under both the VIP IC Program and the LTC Program, while Contract beds fall solely under the mandate of the LTC Program. The evaluation examined the relevance and performance of the Programs, and was conducted in accordance with Treasury Board policy requirements and guidance material. The evaluation findings and conclusions are based on the analysis of multiple lines of qualitative and quantitative evidence.

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.

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.

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.

Healthcare professional service contractors are individuals with “significant training, qualifications and expertise in a professional field.” With the support of Public Works and Government Services Canada, these contractors are used to obtain expert knowledge and to complement the existing workforce. At Veterans Affairs Canada (VAC), these healthcare professional service contractors review or conduct assessments of Veterans' health needs for services or benefits as well as provide consultation with VAC staff. During the 2012/13 fiscal year, there were 55 healthcare professional service contracts for Occupational Therapists, Nurses, Doctors and a Dentist, excluding those at Ste. Anne’s Hospital. The purpose of the audit was to provide assurance that the departmental activities relating to healthcare professional service contracts were conducted in compliance with VAC procedures, and Treasury Board (TB) policies and regulations. Overall governance and the payment process were also assessed. Fieldwork was conducted from April to July 2013.

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.

Vocational Rehabilitation Services is a component of the Veterans Affairs Rehabilitation Program. It provides vocational assistance services and benefits to eligible Veterans who have a health problem, and their families, to assist them in their re-establishment to civilian life. Vocational services and benefits include vocational assessments, employability skills, training, career exploration, job placement and follow-up support. The purpose of the audit was to provide assurance that financial controls were working as intended, to deliver results in accordance with related authorities. This is the first audit of Vocational Rehabilitation since its inception in 2006.

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 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.

Veterans Affairs Canada has 60 points of service or responsibility centres, including regional and district offices that provide a wide range of services and programs. District offices provide direct service for programs, with regional offices providing functional direction and oversight. The three largest points of direct service are the Quebec, Halifax and Edmonton district offices which combined serve almost one-third of participants in the Rehabilitation Program. All three District Offices have approximately three client service teams and a varied mix of program participants. This audit was the second of two phases and was developed at the request of senior management to assess the internal controls surrounding the delegated authorities, the adequacy of the management control framework and to identify opportunities to improve efficiency. The first phase of the cyclical audit which was completed October 2010, focussed on operations in the Quebec District Office. This site was chosen because new delegated authorities were being piloted there. The audit team used the results from the Quebec audit to focus and inform the planning for the second phase, which focussed on operations in the Halifax and Edmonton district offices.