VA Form 10-3567b: State Home Nursing Care Inspection Guide – VA Form 10-3567b is the official State Home Inspection checklist used by the U.S. Department of Veterans Affairs (VA) to evaluate compliance with nursing home care standards in State Veterans Homes (SVHs). This form outlines detailed criteria across governance, safety, environment, infection control, medical care, nursing services, and more.
Purpose of VA Form 10-3567b in State Veterans Home Oversight
The form serves as a comprehensive tool for VA surveyors to assess whether State Veterans Homes substantially meet, partially meet, or fail to meet required standards for nursing home care. Inspections ensure resident safety, quality of care, and proper use of VA funding. There are currently over 170 State Veterans Homes across the U.S. providing nursing home care.
Key goals include:
- Protecting veteran residents’ health, safety, and rights
- Ensuring facilities maintain high standards for clinical care and operations
- Supporting per diem payments under 38 CFR Part 51
- Identifying and correcting deficiencies promptly
Key Standards Covered in VA Form 10-3567b
The form evaluates facilities across multiple critical areas. Surveyors mark each standard as Substantially Met (S), Partially Met (P), Not Met (N), or Not Applicable (NA), with explanatory statements.
Governance and Operation
Requires an effective governing body, compliance with laws, qualified administrator, written policies, and regular reviews.
Safety
Facilities must be structurally safe, equipped with emergency power, nurse call systems, and comply with Life Safety Code and fire marshal certifications.
Environment and Infection Control
Ensures a clean, sanitary, comfortable setting with proper infection prevention programs, pest control, and ventilation.
Medical Care, Nursing Services, and Rehabilitation
Covers medical direction, 24/7 nursing staffing, individualized care plans, rehabilitation services, and social services.
Additional Areas
Includes patient activities, dietetics, medical records, pharmaceutical services, and utilization review.
The State Veterans Home Inspection Process
VA conducts annual (or as-needed) unannounced surveys of recognized State Veterans Homes. Survey teams typically include physicians, nurses, pharmacists, and other specialists. Homes must submit staffing profiles (related VA Form 10-3567) and address any deficiencies with corrective action plans to maintain certification and per diem eligibility.
Non-compliance can affect VA payments and may lead to provisional certification or further oversight.
VA Per Diem Payments and Nursing Home Care
Eligible veterans in certified State Veterans Homes receive care funded partly through VA per diem rates. These rates support quality nursing home services and are adjusted annually. Veterans with service-connected conditions may qualify for higher prevailing rates.
Download VA Form 10-3567b PDF
Download the official VA Form 10-3567b (State Home Inspection Standards – Nursing Home Care) PDF
Note: This form dates to November 1992 and reflects longstanding standards. Current detailed regulations are in 38 CFR Part 51 Subpart D.
Eligibility for State Veterans Home Nursing Care
Veterans typically apply through their state veterans affairs office and submit VA Form 10-10SH. Priority often goes to those with service-connected disabilities, but eligibility varies by state and facility.