Military housing: strengthened oversight needed to make and sustain improvements to living conditions
Abstract: Junior-enlisted service members without dependents (e.g., a spouse or child) typically live in military-managed barracks. GAO reported in September 2023 that some barracks pose serious health and safety risks. As part of site visits to selected installations, GAO observed a variety of living conditions that service members and unit leaders stated were negatively affecting their quality of life, such as sewage overflow, mold and mildew, and broken windows and locks. GAO found numerous challenges in the Department of Defense's (DOD) approach to managing its barracks, including the following: DOD standards for health and safety in barracks were not well defined. Some barracks do not meet DOD standards for privacy and configuration, such as minimum number of bedrooms, in part because the military services' guidance for privacy and configuration do not reflect DOD standards. DOD does not provide sufficient oversight of housing programs for barracks, such as through appropriate guidance or direction to the military services on tracking, assessing, and remediating deficiencies in barracks conditions. GAO's work similarly shows that DOD needs to continue to improve privatized military housing, which includes about 200,000 homes for service members and their families in the United States. Around 2018, reports of lead-based paint and other hazards, such as pest infestation, raised questions about DOD's management of privatized housing. In March 2020, GAO made several recommendations to improve DOD oversight, and DOD has taken steps to implement them. However, in April 2023, GAO reported that gaps remain in DOD's efforts. For example, GAO found that DOD had not (1) set clear and consistent inspection standards for homes undergoing change of occupancy or (2) provided adequate guidance or training to officials on assisting residents in using a new formal dispute resolution process. Improved oversight and addressing GAO's recommendations would position DOD to improve the quality of living conditions for its service members.
Abstract: Context: In response to the opioid crisis, federal guidelines were implemented, including the Veterans Health Administration's (VA) Opioid Safety Initiative in 2013. The impact of policies on patients near the end of life is unknown. Objective: Examine temporal trends in opioid prescribing, pain, and opioid overdoses among Veterans near the end of life. Methods: Retrospective, time series analysis of VA decedents between October 2009 and September 2018 whose next-of-kin participated in VA's Bereaved Family Survey (BFS). Using multivariate regression to adjust for sociodemographic and clinical covariates, we examined temporal trends in outpatient opioid prescribing, uncontrolled pain based on BFS report, and opioid overdose-related hospitalizations, in the last month of life, overall and by clinical diagnosis (cancer versus non-cancer). Results: Among 79,409 decedents, mean daily outpatient opioid dose in morphine milligram equivalents in the last month of life decreased from 4.6 mg in 2010 to 2.1 mg in 2018 (adjusted change -0.20 mg/year; P