Community Living Centers: The VA’s Own Nursing Homes, at Four Times the Price
Alongside the state homes and contract homes, the VA operates 134 nursing homes of its own — Community Living Centers, attached to VA medical centers, caring for nearly 9,000 veterans a day. They are the premium tier of the system: GAO's FY2019 figures put CLC care at $3.81 billion for an average daily census of 8,817 veterans — roughly $1,184 per veteran per day — against about $329 a day in community nursing homes serving a larger census. The premium buys the setting where, per GAO, the VA cannot even say whether complaints get resolved.
Complaints that vanish by design
VA policy requires staff to document only complaints elevated to medical-center officials. The predictable result, per GAO: "most complaints about CLC care are likely not documented," and the VA "cannot have assurance that complaints are resolved." A complaint system that records only what reaches the top is a system for not hearing things.
Abuse complaints that never reach leadership
GAO found most abuse-related complaints in its review did not result in an issue brief — the mechanism that alerts VA leadership — because VA has never clearly specified which serious complaints must be elevated. In GAO's six-CLC review, staff at four centers did not always follow even the existing complaint policies; in one case a complaint about unsanitary conditions waited a month before anyone began addressing it.
The cost context — how CLC pricing compares line-by-line with state homes and contract homes in VA's own FY2025 budget figures — is on the per-diem page. The pattern across all three settings is the same: the most expensive care setting in the system is the one the VA runs itself, and its feedback loop is the one it documents least.
Sources: GAO, Community Living Centers: VA Needs to Strengthen Its Approach for Addressing Resident Complaints · GAO-20-697T, fn. 15 (FY2019 cost/census figures; per-day figures are arithmetic on GAO's published totals) · GAO-25-108441. Part of the VA Fraud record.