Jan Dyer

A recent worldwide survey found the United States to have the highest reported prevalence of type 2 diabetes mellitus (T2DM) among young people aged 10 to 19 years. Research on the prevalence of the disease among Indigenous populations is scarce, however, leaving these individuals at a potentially greater risk.

The estimated prevalence of T2DM has nearly doubled over the past 2 decades, with cases per 1000 youths aged 10 to 19 years increasing from 0.34 in 2001 to 0.46 in 2009 to 0.67 in 2017, a relative increase of 95.3% over 16 years. In 2012, the SEARCH study of youth-onset T2DM found American Indians and non-Hispanic Black individuals had the highest incidence (46.5/100,000/year in American Indians and 32.6/100,000/year in non-Hispanic Black individuals), compared with non-Hispanic White individuals (3.9/100,000/year).

About 28,000 US youth aged < 20 years had T2DM in 2017, a figure expected to reach 48,000 in 2060 based on increasing prevalence and incidence rates. Assuming the trends observed between 2002 and 2017 continue, an estimated 220,000 young people will have T2DM. 

However, the lack of recent research of T2DM in young indigenous populations may have masked a serious problem among Native Americans. A 2025 literature review of 49 studies call it a “type 2 diabetes crisis” among Indigenous communities; not because of the disease, but due to high rates of complications. Though Indigenous peoples are estimated to inhabit > 90 countries and collectively represent > 370 million people, the studies included in the review involved individuals from 6 countries and 2 self-governing states (US, Canada, Australia, Aotearoa New Zealand, Nauru, Argentina, the Cook Islands, and Niue) and at least 45 Indigenous populations after search criteria were satisfied. Data were derived from population-based screening and health databases, including from 432 IHS facilities and 6 IHS regions.

Of the study populations, 27 (75%) reported diabetes prevalence above 1 per 1000. Age-specific data, available in 44 studies, showed increased prevalence with age: 0 to 4 per 1000 at age < 10 years; 0 to 44 per 1000 at age 10 to 19 years; and 0 to 64 per 1000 at age 15 to 25 years. 

In young adults aged 15 to 25 years, prevalence was highest in Akimel O’odham and Tohono O’odham Peoples from the Gila River Indian Community in Arizona. Among children aged < 10 years, the highest prevalence was reported in Cherokee Nation children. Some groups reported no diabetes, such as the Northern Plains Indians from Montana and Wyoming.

Statistics showing the speed of expanding prevalence were particularly notable. For Akimel O’odham and Tohono O’odham Indian youth, diabetes prevalence increased more than eightfold over 2 decades (particularly in those aged < 15).

A 2021 study of 500 participants who were diagnosed with T2DM in youth were followed for a mean of 13 years. By the time they were 26, 67.5% had hypertension, 51.6% had dyslipidemia, 54.8% had diabetic kidney disease, and 32.4% had nerve disease. 

Indigenous North American children may also have an even greater risk for later complications. A Canadian study found that among Canadian First Nations Peoples the incidence of end-stage kidney disease was 2.8 times higher and the mortality rate was double that of non-Indigenous people with youth-onset T2DM despite similar age at diagnosis and duration of disease. 

To combat the steady increase of T2DM prevalence among Indigenous youth, researchers advise “urgent action” to improve data equity through the inclusion of Indigenous populations in health surveillance, routine disaggregation by Indigenous status, and culturally safe research partnerships led by Indigenous communities. Standardized age group classifications, age- and gender-specific reporting, and assessment of comorbid obesity are essential, they add, to define health care needs and identify regions that would benefit from enhanced early detection and management.

A recent worldwide survey found the United States to have the highest reported prevalence of type 2 diabetes mellitus (T2DM) among young people aged 10 to 19 years. Research on the prevalence of the disease among Indigenous populations is scarce, however, leaving these individuals at a potentially greater risk.

The estimated prevalence of T2DM has nearly doubled over the past 2 decades, with cases per 1000 youths aged 10 to 19 years increasing from 0.34 in 2001 to 0.46 in 2009 to 0.67 in 2017, a relative increase of 95.3% over 16 years. In 2012, the SEARCH study of youth-onset T2DM found American Indians and non-Hispanic Black individuals had the highest incidence (46.5/100,000/year in American Indians and 32.6/100,000/year in non-Hispanic Black individuals), compared with non-Hispanic White individuals (3.9/100,000/year).

About 28,000 US youth aged < 20 years had T2DM in 2017, a figure expected to reach 48,000 in 2060 based on increasing prevalence and incidence rates. Assuming the trends observed between 2002 and 2017 continue, an estimated 220,000 young people will have T2DM. 

However, the lack of recent research of T2DM in young indigenous populations may have masked a serious problem among Native Americans. A 2025 literature review of 49 studies call it a “type 2 diabetes crisis” among Indigenous communities; not because of the disease, but due to high rates of complications. Though Indigenous peoples are estimated to inhabit > 90 countries and collectively represent > 370 million people, the studies included in the review involved individuals from 6 countries and 2 self-governing states (US, Canada, Australia, Aotearoa New Zealand, Nauru, Argentina, the Cook Islands, and Niue) and at least 45 Indigenous populations after search criteria were satisfied. Data were derived from population-based screening and health databases, including from 432 IHS facilities and 6 IHS regions.

Of the study populations, 27 (75%) reported diabetes prevalence above 1 per 1000. Age-specific data, available in 44 studies, showed increased prevalence with age: 0 to 4 per 1000 at age < 10 years; 0 to 44 per 1000 at age 10 to 19 years; and 0 to 64 per 1000 at age 15 to 25 years. 

In young adults aged 15 to 25 years, prevalence was highest in Akimel O’odham and Tohono O’odham Peoples from the Gila River Indian Community in Arizona. Among children aged < 10 years, the highest prevalence was reported in Cherokee Nation children. Some groups reported no diabetes, such as the Northern Plains Indians from Montana and Wyoming.

Statistics showing the speed of expanding prevalence were particularly notable. For Akimel O’odham and Tohono O’odham Indian youth, diabetes prevalence increased more than eightfold over 2 decades (particularly in those aged < 15).

A 2021 study of 500 participants who were diagnosed with T2DM in youth were followed for a mean of 13 years. By the time they were 26, 67.5% had hypertension, 51.6% had dyslipidemia, 54.8% had diabetic kidney disease, and 32.4% had nerve disease. 

Indigenous North American children may also have an even greater risk for later complications. A Canadian study found that among Canadian First Nations Peoples the incidence of end-stage kidney disease was 2.8 times higher and the mortality rate was double that of non-Indigenous people with youth-onset T2DM despite similar age at diagnosis and duration of disease. 

To combat the steady increase of T2DM prevalence among Indigenous youth, researchers advise “urgent action” to improve data equity through the inclusion of Indigenous populations in health surveillance, routine disaggregation by Indigenous status, and culturally safe research partnerships led by Indigenous communities. Standardized age group classifications, age- and gender-specific reporting, and assessment of comorbid obesity are essential, they add, to define health care needs and identify regions that would benefit from enhanced early detection and management.

A recent worldwide survey found the United States to have the highest reported prevalence of type 2 diabetes mellitus (T2DM) among young people aged 10 to 19 years. Research on the prevalence of the disease among Indigenous populations is scarce, however, leaving these individuals at a potentially greater risk.

The estimated prevalence of T2DM has nearly doubled over the past 2 decades, with cases per 1000 youths aged 10 to 19 years increasing from 0.34 in 2001 to 0.46 in 2009 to 0.67 in 2017, a relative increase of 95.3% over 16 years. In 2012, the SEARCH study of youth-onset T2DM found American Indians and non-Hispanic Black individuals had the highest incidence (46.5/100,000/year in American Indians and 32.6/100,000/year in non-Hispanic Black individuals), compared with non-Hispanic White individuals (3.9/100,000/year).

About 28,000 US youth aged < 20 years had T2DM in 2017, a figure expected to reach 48,000 in 2060 based on increasing prevalence and incidence rates. Assuming the trends observed between 2002 and 2017 continue, an estimated 220,000 young people will have T2DM. 

However, the lack of recent research of T2DM in young indigenous populations may have masked a serious problem among Native Americans. A 2025 literature review of 49 studies call it a “type 2 diabetes crisis” among Indigenous communities; not because of the disease, but due to high rates of complications. Though Indigenous peoples are estimated to inhabit > 90 countries and collectively represent > 370 million people, the studies included in the review involved individuals from 6 countries and 2 self-governing states (US, Canada, Australia, Aotearoa New Zealand, Nauru, Argentina, the Cook Islands, and Niue) and at least 45 Indigenous populations after search criteria were satisfied. Data were derived from population-based screening and health databases, including from 432 IHS facilities and 6 IHS regions.

Of the study populations, 27 (75%) reported diabetes prevalence above 1 per 1000. Age-specific data, available in 44 studies, showed increased prevalence with age: 0 to 4 per 1000 at age < 10 years; 0 to 44 per 1000 at age 10 to 19 years; and 0 to 64 per 1000 at age 15 to 25 years. 

In young adults aged 15 to 25 years, prevalence was highest in Akimel O’odham and Tohono O’odham Peoples from the Gila River Indian Community in Arizona. Among children aged < 10 years, the highest prevalence was reported in Cherokee Nation children. Some groups reported no diabetes, such as the Northern Plains Indians from Montana and Wyoming.

Statistics showing the speed of expanding prevalence were particularly notable. For Akimel O’odham and Tohono O’odham Indian youth, diabetes prevalence increased more than eightfold over 2 decades (particularly in those aged < 15).

A 2021 study of 500 participants who were diagnosed with T2DM in youth were followed for a mean of 13 years. By the time they were 26, 67.5% had hypertension, 51.6% had dyslipidemia, 54.8% had diabetic kidney disease, and 32.4% had nerve disease. 

Indigenous North American children may also have an even greater risk for later complications. A Canadian study found that among Canadian First Nations Peoples the incidence of end-stage kidney disease was 2.8 times higher and the mortality rate was double that of non-Indigenous people with youth-onset T2DM despite similar age at diagnosis and duration of disease. 

To combat the steady increase of T2DM prevalence among Indigenous youth, researchers advise “urgent action” to improve data equity through the inclusion of Indigenous populations in health surveillance, routine disaggregation by Indigenous status, and culturally safe research partnerships led by Indigenous communities. Standardized age group classifications, age- and gender-specific reporting, and assessment of comorbid obesity are essential, they add, to define health care needs and identify regions that would benefit from enhanced early detection and management.

According to the National Institute on Drug Abuse, > 1 in 10 veterans have been diagnosed with substance use disorder (SUD). Additionally, 7 out of every 100 veterans will have posttraumatic stress disorder (PTSD) at some point in their life, per research from the US Department of Veterans Affairs (VA). However, a common and perhaps unsuspected parallel is found in those statistics: loneliness.

Of the 4069 veterans who participated in the 2019-2020 National Health and Resilience in Veterans Survey, 56.9% reported they felt lonely sometimes or often, while 1 in 5 reported feeling lonely often.

An Epidemic

In his 2023 advisory, Former US Surgeon General Vivek Murthy called it an epidemic noting that when he spoke with veterans during a cross-country listening tour, he heard how they felt “isolated, invisible, and insignificant.” About 1 in 2 adults in America experience loneliness, even before the COVID-19 pandemic isolation.

Loneliness can have individual and synergistic ill effects, including a greater risk of cardiovascular disease, dementia, stroke, depression, anxiety, and premature death. It also can both trigger and exacerbate substance use and PTSD.

A study using data from the RAND Health and Retirement Study Longitudinal File 2020 (N = 5259) found significant associations between loneliness and being unmarried/unpartnered, and greater depressive symptoms for both veterans and civilians, as well as significant negative associations between loneliness and greater life satisfaction and positive affect. Health conditions that limited an individual's ability to work was a “unique risk factor for loneliness among veterans.”

The National Health and Resilience in Veterans Study found that those aged ≤ 50 years were 3 times more likely to screen positive for PTSD compared to older veterans. In a survey of 409 veterans, many who engaged in problematic substance use during the COVID-19 pandemic reported that despite having social supports they still felt lonely. In regression analyses, higher levels of loneliness were associated with more negative impacts of the pandemic, greater substance use, and poorer physical and mental health functioning.

Addressing Loneliness

Researchers believe an answer to some mental health and substance abuse problems may lie in addressing loneliness. Positive psychology is providing promising results in the treatment of SUD. Bryant Stone, from the Johns Hopkins Bloomberg School of Public Health, emphasizes focusing on well-being and quality of life rather than solely on abstinence with “positive psychological interventions,” or activities and behavioral interventions that target positive variables to promote adaptive functioning.

Veterans can face tough challenges as they rejoin civilian life. How successfully they meet and conquer those challenges, especially if they include drug problems, may directly relate to their general feeling of well-being.

The PERMA model outlines 5 core elements to assess well-being: Positive emotions, Engagement, Relationships, Meaning, and Accomplishment. A study based on that model found loneliness to be a “particularly significant factor” among key variables influencing the prevention and treatment of SUDs. The study of 156 veterans with self-reported mental health conditions found the ability to engage in social roles and activities was positively correlated with overall well-being and negatively correlated with degree of problems related to drug abuse. 

Rural Veterans

The estimated 4.4 million veterans living in rural communities may benefit most from interventions that tackle isolation. Compared with urban counterparts, they’re more likely to be older, have more complex medical issues, have a service-connected disability, and be unemployed. Those factors, compounded by geographical and social isolation, can have a substantial impact on well-being.

A study centered on the initial validation of a short (5-item) version of PERMA found that individuals who scored higher on the short form tended to report higher levels of optimism, resilience, and happiness. Thus, the short form may be particularly useful for rural veterans who do not always have easy access to health care.

VA has instituted a variety of programs to encourage and support social connection. During the COVID-19 pandemic, telehealth interventions targeted social support and loneliness among veterans—albeit with mixed results. VA CONNECT, a 10-session group telehealth intervention that integrated peer support, did not show significant changes in loneliness, but did significantly reduce perceived stress. 

Another initiative, Compassionate Contact Corps, trained volunteers made weekly phone calls aimed at reducing loneliness and fostering social connection. Started in Columbus, Ohio, in 2020, > 80 sites had adopted the initiative by 2021, with 310 volunteers, 5320 visits, and 4757 hours spent with veterans.

In 2014, VA peer specialists developed and co-hosted Veterans Socials through community partnerships between VA, veteran-serving organizations, and veteran community leaders. As of 2025, 178 known Veterans Socials were spread across 26 states and territories.

The researchers say their case examples collectively demonstrate that Veterans Socials have the potential to serve as a vital platform for peer support, resource sharing, and health service use among veterans. Virtual Veterans Socials also provided hosts with a channel to reach potentially isolated veterans who might not otherwise access services while simultaneously offering veterans an opportunity for social connection.

According to the National Institute on Drug Abuse, > 1 in 10 veterans have been diagnosed with substance use disorder (SUD). Additionally, 7 out of every 100 veterans will have posttraumatic stress disorder (PTSD) at some point in their life, per research from the US Department of Veterans Affairs (VA). However, a common and perhaps unsuspected parallel is found in those statistics: loneliness.

Of the 4069 veterans who participated in the 2019-2020 National Health and Resilience in Veterans Survey, 56.9% reported they felt lonely sometimes or often, while 1 in 5 reported feeling lonely often.

An Epidemic

In his 2023 advisory, Former US Surgeon General Vivek Murthy called it an epidemic noting that when he spoke with veterans during a cross-country listening tour, he heard how they felt “isolated, invisible, and insignificant.” About 1 in 2 adults in America experience loneliness, even before the COVID-19 pandemic isolation.

Loneliness can have individual and synergistic ill effects, including a greater risk of cardiovascular disease, dementia, stroke, depression, anxiety, and premature death. It also can both trigger and exacerbate substance use and PTSD.

A study using data from the RAND Health and Retirement Study Longitudinal File 2020 (N = 5259) found significant associations between loneliness and being unmarried/unpartnered, and greater depressive symptoms for both veterans and civilians, as well as significant negative associations between loneliness and greater life satisfaction and positive affect. Health conditions that limited an individual's ability to work was a “unique risk factor for loneliness among veterans.”

The National Health and Resilience in Veterans Study found that those aged ≤ 50 years were 3 times more likely to screen positive for PTSD compared to older veterans. In a survey of 409 veterans, many who engaged in problematic substance use during the COVID-19 pandemic reported that despite having social supports they still felt lonely. In regression analyses, higher levels of loneliness were associated with more negative impacts of the pandemic, greater substance use, and poorer physical and mental health functioning.

Addressing Loneliness

Researchers believe an answer to some mental health and substance abuse problems may lie in addressing loneliness. Positive psychology is providing promising results in the treatment of SUD. Bryant Stone, from the Johns Hopkins Bloomberg School of Public Health, emphasizes focusing on well-being and quality of life rather than solely on abstinence with “positive psychological interventions,” or activities and behavioral interventions that target positive variables to promote adaptive functioning.

Veterans can face tough challenges as they rejoin civilian life. How successfully they meet and conquer those challenges, especially if they include drug problems, may directly relate to their general feeling of well-being.

The PERMA model outlines 5 core elements to assess well-being: Positive emotions, Engagement, Relationships, Meaning, and Accomplishment. A study based on that model found loneliness to be a “particularly significant factor” among key variables influencing the prevention and treatment of SUDs. The study of 156 veterans with self-reported mental health conditions found the ability to engage in social roles and activities was positively correlated with overall well-being and negatively correlated with degree of problems related to drug abuse. 

Rural Veterans

The estimated 4.4 million veterans living in rural communities may benefit most from interventions that tackle isolation. Compared with urban counterparts, they’re more likely to be older, have more complex medical issues, have a service-connected disability, and be unemployed. Those factors, compounded by geographical and social isolation, can have a substantial impact on well-being.

A study centered on the initial validation of a short (5-item) version of PERMA found that individuals who scored higher on the short form tended to report higher levels of optimism, resilience, and happiness. Thus, the short form may be particularly useful for rural veterans who do not always have easy access to health care.

VA has instituted a variety of programs to encourage and support social connection. During the COVID-19 pandemic, telehealth interventions targeted social support and loneliness among veterans—albeit with mixed results. VA CONNECT, a 10-session group telehealth intervention that integrated peer support, did not show significant changes in loneliness, but did significantly reduce perceived stress. 

Another initiative, Compassionate Contact Corps, trained volunteers made weekly phone calls aimed at reducing loneliness and fostering social connection. Started in Columbus, Ohio, in 2020, > 80 sites had adopted the initiative by 2021, with 310 volunteers, 5320 visits, and 4757 hours spent with veterans.

In 2014, VA peer specialists developed and co-hosted Veterans Socials through community partnerships between VA, veteran-serving organizations, and veteran community leaders. As of 2025, 178 known Veterans Socials were spread across 26 states and territories.

The researchers say their case examples collectively demonstrate that Veterans Socials have the potential to serve as a vital platform for peer support, resource sharing, and health service use among veterans. Virtual Veterans Socials also provided hosts with a channel to reach potentially isolated veterans who might not otherwise access services while simultaneously offering veterans an opportunity for social connection.

According to the National Institute on Drug Abuse, > 1 in 10 veterans have been diagnosed with substance use disorder (SUD). Additionally, 7 out of every 100 veterans will have posttraumatic stress disorder (PTSD) at some point in their life, per research from the US Department of Veterans Affairs (VA). However, a common and perhaps unsuspected parallel is found in those statistics: loneliness.

Of the 4069 veterans who participated in the 2019-2020 National Health and Resilience in Veterans Survey, 56.9% reported they felt lonely sometimes or often, while 1 in 5 reported feeling lonely often.

An Epidemic

In his 2023 advisory, Former US Surgeon General Vivek Murthy called it an epidemic noting that when he spoke with veterans during a cross-country listening tour, he heard how they felt “isolated, invisible, and insignificant.” About 1 in 2 adults in America experience loneliness, even before the COVID-19 pandemic isolation.

Loneliness can have individual and synergistic ill effects, including a greater risk of cardiovascular disease, dementia, stroke, depression, anxiety, and premature death. It also can both trigger and exacerbate substance use and PTSD.

A study using data from the RAND Health and Retirement Study Longitudinal File 2020 (N = 5259) found significant associations between loneliness and being unmarried/unpartnered, and greater depressive symptoms for both veterans and civilians, as well as significant negative associations between loneliness and greater life satisfaction and positive affect. Health conditions that limited an individual's ability to work was a “unique risk factor for loneliness among veterans.”

The National Health and Resilience in Veterans Study found that those aged ≤ 50 years were 3 times more likely to screen positive for PTSD compared to older veterans. In a survey of 409 veterans, many who engaged in problematic substance use during the COVID-19 pandemic reported that despite having social supports they still felt lonely. In regression analyses, higher levels of loneliness were associated with more negative impacts of the pandemic, greater substance use, and poorer physical and mental health functioning.

Addressing Loneliness

Researchers believe an answer to some mental health and substance abuse problems may lie in addressing loneliness. Positive psychology is providing promising results in the treatment of SUD. Bryant Stone, from the Johns Hopkins Bloomberg School of Public Health, emphasizes focusing on well-being and quality of life rather than solely on abstinence with “positive psychological interventions,” or activities and behavioral interventions that target positive variables to promote adaptive functioning.

Veterans can face tough challenges as they rejoin civilian life. How successfully they meet and conquer those challenges, especially if they include drug problems, may directly relate to their general feeling of well-being.

The PERMA model outlines 5 core elements to assess well-being: Positive emotions, Engagement, Relationships, Meaning, and Accomplishment. A study based on that model found loneliness to be a “particularly significant factor” among key variables influencing the prevention and treatment of SUDs. The study of 156 veterans with self-reported mental health conditions found the ability to engage in social roles and activities was positively correlated with overall well-being and negatively correlated with degree of problems related to drug abuse. 

Rural Veterans

The estimated 4.4 million veterans living in rural communities may benefit most from interventions that tackle isolation. Compared with urban counterparts, they’re more likely to be older, have more complex medical issues, have a service-connected disability, and be unemployed. Those factors, compounded by geographical and social isolation, can have a substantial impact on well-being.

A study centered on the initial validation of a short (5-item) version of PERMA found that individuals who scored higher on the short form tended to report higher levels of optimism, resilience, and happiness. Thus, the short form may be particularly useful for rural veterans who do not always have easy access to health care.

VA has instituted a variety of programs to encourage and support social connection. During the COVID-19 pandemic, telehealth interventions targeted social support and loneliness among veterans—albeit with mixed results. VA CONNECT, a 10-session group telehealth intervention that integrated peer support, did not show significant changes in loneliness, but did significantly reduce perceived stress. 

Another initiative, Compassionate Contact Corps, trained volunteers made weekly phone calls aimed at reducing loneliness and fostering social connection. Started in Columbus, Ohio, in 2020, > 80 sites had adopted the initiative by 2021, with 310 volunteers, 5320 visits, and 4757 hours spent with veterans.

In 2014, VA peer specialists developed and co-hosted Veterans Socials through community partnerships between VA, veteran-serving organizations, and veteran community leaders. As of 2025, 178 known Veterans Socials were spread across 26 states and territories.

The researchers say their case examples collectively demonstrate that Veterans Socials have the potential to serve as a vital platform for peer support, resource sharing, and health service use among veterans. Virtual Veterans Socials also provided hosts with a channel to reach potentially isolated veterans who might not otherwise access services while simultaneously offering veterans an opportunity for social connection.

Despite the ongoing shutdown of the US federal government, the Indian Health Service (IHS) continues to maintain the status quo while operating on an island of relatively insulated stability.

“IHS will continue to operate business-as-usual during a lapse of appropriations,” US Department of Health and Human Services press secretary Emily G. Hilliard said at a recent meeting with the National Congress of American Indians (NCAI). “100% of IHS staff will report for work, and health care services across Indian Country will not be impacted.” 

The protective cocoon around IHS and its services provided is largely due to advance appropriations, and lessons learned from previous government shutdowns. During the historically long 35-day government shutdown in 2018 and 2019, all federal government operations had to halt operations unless they were deemed indispensable. IHS was not considered indispensable and consequently, about 60% of IHS employees did not receive a paycheck.

In preparation for another potential shutdown in 2023, IHS was more proactive. “Because of the fact that now we have advanced appropriations for Indian Health Services, on Oct. 1, whether or not there’s a federal budget in place, will continue providing services,” then-HHS Secretary Xavier Becerra, said at the time.

The safeguards have held for the current shutdown, aided by tribal pressure. As the federal shutdown loomed in September, a delegation led by NCAI spent 3 days lobbying Congress—focusing primarily on the new leadership in the Senate Indian Affairs Committee—to guarantee some protection for federal employees who work with tribal governments.

At the quarterly meeting of the United Indian Nations of Oklahoma (UINO) in Tulsa, Rear Adm. Travis Watts, director of the IHS Oklahoma City Area and a citizen of the Choctaw Nation of Oklahoma, told attendees, “The advance appropriations allow us to keep our doors open at this particular time. We want to thank the tribal nations for their advocacy for those advance appropriations.”

IHS is funded through 2026. All 14,801 IHS staff will be paid through advance appropriations, multi-year or supplemental appropriations, third-party collections, or carryover balances. 

However, according to the proposed 2026 budget some key health-related funding is at risk, including about $128 million in Tribal set-aside funding for mental and behavioral health funding: $60 million from the Tribal Opioid Response Grants, $22.75 million from Tribal Behavioral Health Grants, $14.5 million from Medication-Assisted Treatment for Prescription and Opioid Addiction, and $3.4 million Tribal set-aside for the Zero Suicide program. Six IHS accounts are not funded by advance appropriations: Electronic Health Record System, Indian Health Care Improvement Fund, Contract Support Costs, Payments for Tribal Leases, Sanitation Facilities Construction, and Health Care Facilities Construction.

In a public statement, Cherokee Nation Principal Chief Chuck Hoskin Jr. said, “[W]e’re hopeful that Congress’ foresight to provide an advance appropriation for the Indian Health Service will prevent any severe disruptions as experienced during the 2013 and 2018 shutdowns. I urge both sides of the aisle to work on a path forward and reopen the government as soon as possible and call on the administration to honor the government’s Treaty and Trust responsibilities, avoid needless cuts to Tribal programs and personnel, and use its authorities to minimize harm to tribes and tribal citizens.”

Hoskin Jr. cautioned, though, that not every tribe has the same resources. Many smaller, direct-service tribes depend entirely on IHS to deliver care.

“Thank goodness for forward funding,” he said. “But we have to make that permanent in federal statute. No one in this country should be at the mercy of political dysfunction to get health care. “The United States can keep its lights off,” Hoskin Jr. said. “We’ll still be moving forward.”

Despite the ongoing shutdown of the US federal government, the Indian Health Service (IHS) continues to maintain the status quo while operating on an island of relatively insulated stability.

“IHS will continue to operate business-as-usual during a lapse of appropriations,” US Department of Health and Human Services press secretary Emily G. Hilliard said at a recent meeting with the National Congress of American Indians (NCAI). “100% of IHS staff will report for work, and health care services across Indian Country will not be impacted.” 

The protective cocoon around IHS and its services provided is largely due to advance appropriations, and lessons learned from previous government shutdowns. During the historically long 35-day government shutdown in 2018 and 2019, all federal government operations had to halt operations unless they were deemed indispensable. IHS was not considered indispensable and consequently, about 60% of IHS employees did not receive a paycheck.

In preparation for another potential shutdown in 2023, IHS was more proactive. “Because of the fact that now we have advanced appropriations for Indian Health Services, on Oct. 1, whether or not there’s a federal budget in place, will continue providing services,” then-HHS Secretary Xavier Becerra, said at the time.

The safeguards have held for the current shutdown, aided by tribal pressure. As the federal shutdown loomed in September, a delegation led by NCAI spent 3 days lobbying Congress—focusing primarily on the new leadership in the Senate Indian Affairs Committee—to guarantee some protection for federal employees who work with tribal governments.

At the quarterly meeting of the United Indian Nations of Oklahoma (UINO) in Tulsa, Rear Adm. Travis Watts, director of the IHS Oklahoma City Area and a citizen of the Choctaw Nation of Oklahoma, told attendees, “The advance appropriations allow us to keep our doors open at this particular time. We want to thank the tribal nations for their advocacy for those advance appropriations.”

IHS is funded through 2026. All 14,801 IHS staff will be paid through advance appropriations, multi-year or supplemental appropriations, third-party collections, or carryover balances. 

However, according to the proposed 2026 budget some key health-related funding is at risk, including about $128 million in Tribal set-aside funding for mental and behavioral health funding: $60 million from the Tribal Opioid Response Grants, $22.75 million from Tribal Behavioral Health Grants, $14.5 million from Medication-Assisted Treatment for Prescription and Opioid Addiction, and $3.4 million Tribal set-aside for the Zero Suicide program. Six IHS accounts are not funded by advance appropriations: Electronic Health Record System, Indian Health Care Improvement Fund, Contract Support Costs, Payments for Tribal Leases, Sanitation Facilities Construction, and Health Care Facilities Construction.

In a public statement, Cherokee Nation Principal Chief Chuck Hoskin Jr. said, “[W]e’re hopeful that Congress’ foresight to provide an advance appropriation for the Indian Health Service will prevent any severe disruptions as experienced during the 2013 and 2018 shutdowns. I urge both sides of the aisle to work on a path forward and reopen the government as soon as possible and call on the administration to honor the government’s Treaty and Trust responsibilities, avoid needless cuts to Tribal programs and personnel, and use its authorities to minimize harm to tribes and tribal citizens.”

Hoskin Jr. cautioned, though, that not every tribe has the same resources. Many smaller, direct-service tribes depend entirely on IHS to deliver care.

“Thank goodness for forward funding,” he said. “But we have to make that permanent in federal statute. No one in this country should be at the mercy of political dysfunction to get health care. “The United States can keep its lights off,” Hoskin Jr. said. “We’ll still be moving forward.”

Despite the ongoing shutdown of the US federal government, the Indian Health Service (IHS) continues to maintain the status quo while operating on an island of relatively insulated stability.

“IHS will continue to operate business-as-usual during a lapse of appropriations,” US Department of Health and Human Services press secretary Emily G. Hilliard said at a recent meeting with the National Congress of American Indians (NCAI). “100% of IHS staff will report for work, and health care services across Indian Country will not be impacted.” 

The protective cocoon around IHS and its services provided is largely due to advance appropriations, and lessons learned from previous government shutdowns. During the historically long 35-day government shutdown in 2018 and 2019, all federal government operations had to halt operations unless they were deemed indispensable. IHS was not considered indispensable and consequently, about 60% of IHS employees did not receive a paycheck.

In preparation for another potential shutdown in 2023, IHS was more proactive. “Because of the fact that now we have advanced appropriations for Indian Health Services, on Oct. 1, whether or not there’s a federal budget in place, will continue providing services,” then-HHS Secretary Xavier Becerra, said at the time.

The safeguards have held for the current shutdown, aided by tribal pressure. As the federal shutdown loomed in September, a delegation led by NCAI spent 3 days lobbying Congress—focusing primarily on the new leadership in the Senate Indian Affairs Committee—to guarantee some protection for federal employees who work with tribal governments.

At the quarterly meeting of the United Indian Nations of Oklahoma (UINO) in Tulsa, Rear Adm. Travis Watts, director of the IHS Oklahoma City Area and a citizen of the Choctaw Nation of Oklahoma, told attendees, “The advance appropriations allow us to keep our doors open at this particular time. We want to thank the tribal nations for their advocacy for those advance appropriations.”

IHS is funded through 2026. All 14,801 IHS staff will be paid through advance appropriations, multi-year or supplemental appropriations, third-party collections, or carryover balances. 

However, according to the proposed 2026 budget some key health-related funding is at risk, including about $128 million in Tribal set-aside funding for mental and behavioral health funding: $60 million from the Tribal Opioid Response Grants, $22.75 million from Tribal Behavioral Health Grants, $14.5 million from Medication-Assisted Treatment for Prescription and Opioid Addiction, and $3.4 million Tribal set-aside for the Zero Suicide program. Six IHS accounts are not funded by advance appropriations: Electronic Health Record System, Indian Health Care Improvement Fund, Contract Support Costs, Payments for Tribal Leases, Sanitation Facilities Construction, and Health Care Facilities Construction.

In a public statement, Cherokee Nation Principal Chief Chuck Hoskin Jr. said, “[W]e’re hopeful that Congress’ foresight to provide an advance appropriation for the Indian Health Service will prevent any severe disruptions as experienced during the 2013 and 2018 shutdowns. I urge both sides of the aisle to work on a path forward and reopen the government as soon as possible and call on the administration to honor the government’s Treaty and Trust responsibilities, avoid needless cuts to Tribal programs and personnel, and use its authorities to minimize harm to tribes and tribal citizens.”

Hoskin Jr. cautioned, though, that not every tribe has the same resources. Many smaller, direct-service tribes depend entirely on IHS to deliver care.

“Thank goodness for forward funding,” he said. “But we have to make that permanent in federal statute. No one in this country should be at the mercy of political dysfunction to get health care. “The United States can keep its lights off,” Hoskin Jr. said. “We’ll still be moving forward.”

This article has been updated with a response from the US Department of Veterans Affairs.

The number of US Department of Veterans Affairs (VA) geriatric mental health professionals is failing to keep pace with a growing population of older veterans: nearly 8 million are aged ≥ 65 years. VA psychologists may treat older veterans in primary care settings or community living centers, but many lack formal training in geropsychology.

Some psychologists with the proper training to treat this population are leaving the workforce; a survey by the VA Office of Inspector General found psychology was the most frequently reported severe clinical occupational staffing shortage and the most frequently reported Hybrid Title 38 severe shortage occupation, with 57% of 139 facilities reporting it as a shortage. According to the September Workforce Dashboard, the VA has lost > 200 psychologists in 2025.

Veterans aged ≥ 65 years have higher rates of combined medical and mental health diagnoses than younger veterans and older nonveterans. Nearly 1 of 5 older veterans enrolled in US Department of Veterans Affairs (VA) health care services have confirmed mental health diagnoses, and another 26% have documented mental health concerns without a formal diagnosis in their health record. 

Older veterans also tend to have more complex mental health issues than younger adults. Posttraumatic stress nearly doubles their risk of dementia, and their psychiatric diagnoses may be complicated by co-occurring delirium, social isolation/loneliness, and polypharmacy.

According to reporting by The War Horse, the VA has been instituting limits on one-on-one mental health therapy and transitioning veterans to lower levels of treatment after having been told to stop treating them for long, indeterminate periods prior to referring them to group therapy, primary care, or discharging them altogether. In a statement to Federal Practitioner, VA Press Secretary Pete Kasperowicz refuted the reporting from The War Horse.

"The War Horse story is false. VA does not put caps on one-on-one mental health sessions for veterans with clinical care needs," he told Federal Practitioner. "VA works with veterans over an initial eight to 15 mental health sessions, and collaboratively plans any needed follow-on care. As part of this process, veterans and their health care team decide together how to address ongoing needs, including whether to step down to other types of care and self-maintenance, or continue with VA therapy."

The smaller pool of qualified mental health practitioners also may be due to medical students not knowing enough about the category. A study of 136 medical students and 61 internal medicine residents at an academic health center evaluated their beliefs and attitudes regarding 25 content areas essential to the primary care of older adults. Students and residents expressed similar beliefs about the importance of content areas, and attitudes toward aging did not appreciably differ. However, students rated lower in knowledge in areas surrounding general primary care, such as chronic conditions and medications. Residents reported larger gap scores in areas that reflected specialists’ expertise (eg, driving risk, cognition, and psychiatric symptoms).

VA does have channels for filling the gap in geriatric health care. Established in 1975, Geriatric Research, Education, and Clinical Centers (GRECCs), are the department’s centers of excellence focused on aging. Currently, there are 20 GRECCs across the country, each connected with a major research university. Studies focus on aging, for example, examining the effects of Alzheimer’s disease or traumatic brain injuries. 

Geriatric Scholars 

To specifically fill the gap in mental health care, the Geriatric Scholars Program (GSP) was developed in 2008. Initially focused on primary care physicians, nurse practitioners, physician assistants, and pharmacists, the program later expanded to include other disciplines, including psychiatrists. In 2013, the GSP–Psychology Track (GSP-P) was developed because there were no commercially available training in geropsychology for licensed psychologists. GSP-P is based on an evidence-based educational model for the VA primary care workforce and includes a stepwise curriculum design, pilot implementation, and program evaluation. 

A recent survey that assessed the track’s effectiveness found respondents “strongly agreed” that participation in the program improved their geropsychology knowledge and skills. That positive reaction led to shifts in practice that had a positive impact on VA organizational goals. Several GSP-P graduates have become board certified in geropsychology and many proceed to supervise geropsychology-focused clinical rotations for psychology practicum students, predoctoral interns, and postdoctoral fellows.

Whether programs such as GSP-P can adequately address the dwindling number of VA mental health care professionals remains to be seen. More than 160 doctors, psychologists, nurses, and researchers sent a letter to VA Secretary Doug Collins, the VA inspector general, and congressional leaders on Sept. 24 warning that workforce reductions and moves to outsource care will harm veterans.

“We have witnessed these ongoing harms and can provide evidence and testimony of their impacts,” the letter read. By the next day, the number of signees had increased to 350. 

Though these shortages may impact their mental health care, older veterans could have an edge in mental resilience. While research in younger adults has found positive linear associations between physical health difficulties and severity of psychiatric symptoms, older veterans may benefit from what researchers have called an “aging paradox,” in which mental health improves later in life despite declining physical and cognitive function. A 2021 study suggests that prevention and treatment strategies designed to foster attachment security, mindfulness, and purpose in life may help enhance psychological resilience to physical health difficulties in older veterans.

This article has been updated with a response from the US Department of Veterans Affairs.

The number of US Department of Veterans Affairs (VA) geriatric mental health professionals is failing to keep pace with a growing population of older veterans: nearly 8 million are aged ≥ 65 years. VA psychologists may treat older veterans in primary care settings or community living centers, but many lack formal training in geropsychology.

Some psychologists with the proper training to treat this population are leaving the workforce; a survey by the VA Office of Inspector General found psychology was the most frequently reported severe clinical occupational staffing shortage and the most frequently reported Hybrid Title 38 severe shortage occupation, with 57% of 139 facilities reporting it as a shortage. According to the September Workforce Dashboard, the VA has lost > 200 psychologists in 2025.

Veterans aged ≥ 65 years have higher rates of combined medical and mental health diagnoses than younger veterans and older nonveterans. Nearly 1 of 5 older veterans enrolled in US Department of Veterans Affairs (VA) health care services have confirmed mental health diagnoses, and another 26% have documented mental health concerns without a formal diagnosis in their health record. 

Older veterans also tend to have more complex mental health issues than younger adults. Posttraumatic stress nearly doubles their risk of dementia, and their psychiatric diagnoses may be complicated by co-occurring delirium, social isolation/loneliness, and polypharmacy.

According to reporting by The War Horse, the VA has been instituting limits on one-on-one mental health therapy and transitioning veterans to lower levels of treatment after having been told to stop treating them for long, indeterminate periods prior to referring them to group therapy, primary care, or discharging them altogether. In a statement to Federal Practitioner, VA Press Secretary Pete Kasperowicz refuted the reporting from The War Horse.

"The War Horse story is false. VA does not put caps on one-on-one mental health sessions for veterans with clinical care needs," he told Federal Practitioner. "VA works with veterans over an initial eight to 15 mental health sessions, and collaboratively plans any needed follow-on care. As part of this process, veterans and their health care team decide together how to address ongoing needs, including whether to step down to other types of care and self-maintenance, or continue with VA therapy."

The smaller pool of qualified mental health practitioners also may be due to medical students not knowing enough about the category. A study of 136 medical students and 61 internal medicine residents at an academic health center evaluated their beliefs and attitudes regarding 25 content areas essential to the primary care of older adults. Students and residents expressed similar beliefs about the importance of content areas, and attitudes toward aging did not appreciably differ. However, students rated lower in knowledge in areas surrounding general primary care, such as chronic conditions and medications. Residents reported larger gap scores in areas that reflected specialists’ expertise (eg, driving risk, cognition, and psychiatric symptoms).

VA does have channels for filling the gap in geriatric health care. Established in 1975, Geriatric Research, Education, and Clinical Centers (GRECCs), are the department’s centers of excellence focused on aging. Currently, there are 20 GRECCs across the country, each connected with a major research university. Studies focus on aging, for example, examining the effects of Alzheimer’s disease or traumatic brain injuries. 

Geriatric Scholars 

To specifically fill the gap in mental health care, the Geriatric Scholars Program (GSP) was developed in 2008. Initially focused on primary care physicians, nurse practitioners, physician assistants, and pharmacists, the program later expanded to include other disciplines, including psychiatrists. In 2013, the GSP–Psychology Track (GSP-P) was developed because there were no commercially available training in geropsychology for licensed psychologists. GSP-P is based on an evidence-based educational model for the VA primary care workforce and includes a stepwise curriculum design, pilot implementation, and program evaluation. 

A recent survey that assessed the track’s effectiveness found respondents “strongly agreed” that participation in the program improved their geropsychology knowledge and skills. That positive reaction led to shifts in practice that had a positive impact on VA organizational goals. Several GSP-P graduates have become board certified in geropsychology and many proceed to supervise geropsychology-focused clinical rotations for psychology practicum students, predoctoral interns, and postdoctoral fellows.

Whether programs such as GSP-P can adequately address the dwindling number of VA mental health care professionals remains to be seen. More than 160 doctors, psychologists, nurses, and researchers sent a letter to VA Secretary Doug Collins, the VA inspector general, and congressional leaders on Sept. 24 warning that workforce reductions and moves to outsource care will harm veterans.

“We have witnessed these ongoing harms and can provide evidence and testimony of their impacts,” the letter read. By the next day, the number of signees had increased to 350. 

Though these shortages may impact their mental health care, older veterans could have an edge in mental resilience. While research in younger adults has found positive linear associations between physical health difficulties and severity of psychiatric symptoms, older veterans may benefit from what researchers have called an “aging paradox,” in which mental health improves later in life despite declining physical and cognitive function. A 2021 study suggests that prevention and treatment strategies designed to foster attachment security, mindfulness, and purpose in life may help enhance psychological resilience to physical health difficulties in older veterans.

This article has been updated with a response from the US Department of Veterans Affairs.

The number of US Department of Veterans Affairs (VA) geriatric mental health professionals is failing to keep pace with a growing population of older veterans: nearly 8 million are aged ≥ 65 years. VA psychologists may treat older veterans in primary care settings or community living centers, but many lack formal training in geropsychology.

Some psychologists with the proper training to treat this population are leaving the workforce; a survey by the VA Office of Inspector General found psychology was the most frequently reported severe clinical occupational staffing shortage and the most frequently reported Hybrid Title 38 severe shortage occupation, with 57% of 139 facilities reporting it as a shortage. According to the September Workforce Dashboard, the VA has lost > 200 psychologists in 2025.

Veterans aged ≥ 65 years have higher rates of combined medical and mental health diagnoses than younger veterans and older nonveterans. Nearly 1 of 5 older veterans enrolled in US Department of Veterans Affairs (VA) health care services have confirmed mental health diagnoses, and another 26% have documented mental health concerns without a formal diagnosis in their health record. 

Older veterans also tend to have more complex mental health issues than younger adults. Posttraumatic stress nearly doubles their risk of dementia, and their psychiatric diagnoses may be complicated by co-occurring delirium, social isolation/loneliness, and polypharmacy.

According to reporting by The War Horse, the VA has been instituting limits on one-on-one mental health therapy and transitioning veterans to lower levels of treatment after having been told to stop treating them for long, indeterminate periods prior to referring them to group therapy, primary care, or discharging them altogether. In a statement to Federal Practitioner, VA Press Secretary Pete Kasperowicz refuted the reporting from The War Horse.

"The War Horse story is false. VA does not put caps on one-on-one mental health sessions for veterans with clinical care needs," he told Federal Practitioner. "VA works with veterans over an initial eight to 15 mental health sessions, and collaboratively plans any needed follow-on care. As part of this process, veterans and their health care team decide together how to address ongoing needs, including whether to step down to other types of care and self-maintenance, or continue with VA therapy."

The smaller pool of qualified mental health practitioners also may be due to medical students not knowing enough about the category. A study of 136 medical students and 61 internal medicine residents at an academic health center evaluated their beliefs and attitudes regarding 25 content areas essential to the primary care of older adults. Students and residents expressed similar beliefs about the importance of content areas, and attitudes toward aging did not appreciably differ. However, students rated lower in knowledge in areas surrounding general primary care, such as chronic conditions and medications. Residents reported larger gap scores in areas that reflected specialists’ expertise (eg, driving risk, cognition, and psychiatric symptoms).

VA does have channels for filling the gap in geriatric health care. Established in 1975, Geriatric Research, Education, and Clinical Centers (GRECCs), are the department’s centers of excellence focused on aging. Currently, there are 20 GRECCs across the country, each connected with a major research university. Studies focus on aging, for example, examining the effects of Alzheimer’s disease or traumatic brain injuries. 

Geriatric Scholars 

To specifically fill the gap in mental health care, the Geriatric Scholars Program (GSP) was developed in 2008. Initially focused on primary care physicians, nurse practitioners, physician assistants, and pharmacists, the program later expanded to include other disciplines, including psychiatrists. In 2013, the GSP–Psychology Track (GSP-P) was developed because there were no commercially available training in geropsychology for licensed psychologists. GSP-P is based on an evidence-based educational model for the VA primary care workforce and includes a stepwise curriculum design, pilot implementation, and program evaluation. 

A recent survey that assessed the track’s effectiveness found respondents “strongly agreed” that participation in the program improved their geropsychology knowledge and skills. That positive reaction led to shifts in practice that had a positive impact on VA organizational goals. Several GSP-P graduates have become board certified in geropsychology and many proceed to supervise geropsychology-focused clinical rotations for psychology practicum students, predoctoral interns, and postdoctoral fellows.

Whether programs such as GSP-P can adequately address the dwindling number of VA mental health care professionals remains to be seen. More than 160 doctors, psychologists, nurses, and researchers sent a letter to VA Secretary Doug Collins, the VA inspector general, and congressional leaders on Sept. 24 warning that workforce reductions and moves to outsource care will harm veterans.

“We have witnessed these ongoing harms and can provide evidence and testimony of their impacts,” the letter read. By the next day, the number of signees had increased to 350. 

Though these shortages may impact their mental health care, older veterans could have an edge in mental resilience. While research in younger adults has found positive linear associations between physical health difficulties and severity of psychiatric symptoms, older veterans may benefit from what researchers have called an “aging paradox,” in which mental health improves later in life despite declining physical and cognitive function. A 2021 study suggests that prevention and treatment strategies designed to foster attachment security, mindfulness, and purpose in life may help enhance psychological resilience to physical health difficulties in older veterans.

The number of US Department of Veterans Affairs (VA) hospitals receiving high scores in the Centers for Medicare & Medicaid Services (CMS) annual survey of quality measures is on the rise.

In 2023, VA hospitals became eligible to receive Overall Hospital Quality Star Ratings from the survey. In 2025, the survey covered 4609 hospitals (VA and non-VA). CMS analyzed 45 hospital quality measures across 5 different groups: mortality, safety of care, readmission, patient experience, and timely and effective care. The better the performance in these areas, the higher the star rating.

In the current ratings, 77% of surveyed VA hospitals earned 4- or 5-star ratings, a double digit increase over the previous 2 years (67% in 2023 and 58% in 2024). No VA hospitals received a 1-star rating, and > 90% of VA hospitals that received ratings maintained or improved on their 2024 mark. 

“These ratings highlight the excellent care VA hospitals provide,” VA Secretary Doug Collins said. “Our job is to continue raising the bar for customer service and convenience throughout the department, so VA works better for the Veterans, families, caregivers and survivors we are charged with serving.”

According to a report from the Advisory Board, fewer hospitals are receiving 5-star ratings than ever, possibly due to the COVID-19 pandemic. According to CMS, of all the hospitals that received a rating, 291 earned 5 stars, 90 fewer than in 2024. At the same time, the number of hospitals with 1-star ratings dropped slightly, from 277 in 2024 to 233 in 2025.

The VA publishes its own data on its medical centers. VA Core Hospital Measures have been available from the Joint Commission since 2005. Additional performance measures, including safety, effectiveness, efficiency, timeliness, patient centeredness, and equity, have been published by the VA since 2008. In 2010, the VA began reporting on Hospital Compare, which has information about the quality of care at > 4000 Medicare-certified hospitals, including > 130 VA medical centers and > 50 military hospitals.

The number of US Department of Veterans Affairs (VA) hospitals receiving high scores in the Centers for Medicare & Medicaid Services (CMS) annual survey of quality measures is on the rise.

In 2023, VA hospitals became eligible to receive Overall Hospital Quality Star Ratings from the survey. In 2025, the survey covered 4609 hospitals (VA and non-VA). CMS analyzed 45 hospital quality measures across 5 different groups: mortality, safety of care, readmission, patient experience, and timely and effective care. The better the performance in these areas, the higher the star rating.

In the current ratings, 77% of surveyed VA hospitals earned 4- or 5-star ratings, a double digit increase over the previous 2 years (67% in 2023 and 58% in 2024). No VA hospitals received a 1-star rating, and > 90% of VA hospitals that received ratings maintained or improved on their 2024 mark. 

“These ratings highlight the excellent care VA hospitals provide,” VA Secretary Doug Collins said. “Our job is to continue raising the bar for customer service and convenience throughout the department, so VA works better for the Veterans, families, caregivers and survivors we are charged with serving.”

According to a report from the Advisory Board, fewer hospitals are receiving 5-star ratings than ever, possibly due to the COVID-19 pandemic. According to CMS, of all the hospitals that received a rating, 291 earned 5 stars, 90 fewer than in 2024. At the same time, the number of hospitals with 1-star ratings dropped slightly, from 277 in 2024 to 233 in 2025.

The VA publishes its own data on its medical centers. VA Core Hospital Measures have been available from the Joint Commission since 2005. Additional performance measures, including safety, effectiveness, efficiency, timeliness, patient centeredness, and equity, have been published by the VA since 2008. In 2010, the VA began reporting on Hospital Compare, which has information about the quality of care at > 4000 Medicare-certified hospitals, including > 130 VA medical centers and > 50 military hospitals.

The number of US Department of Veterans Affairs (VA) hospitals receiving high scores in the Centers for Medicare & Medicaid Services (CMS) annual survey of quality measures is on the rise.

In 2023, VA hospitals became eligible to receive Overall Hospital Quality Star Ratings from the survey. In 2025, the survey covered 4609 hospitals (VA and non-VA). CMS analyzed 45 hospital quality measures across 5 different groups: mortality, safety of care, readmission, patient experience, and timely and effective care. The better the performance in these areas, the higher the star rating.

In the current ratings, 77% of surveyed VA hospitals earned 4- or 5-star ratings, a double digit increase over the previous 2 years (67% in 2023 and 58% in 2024). No VA hospitals received a 1-star rating, and > 90% of VA hospitals that received ratings maintained or improved on their 2024 mark. 

“These ratings highlight the excellent care VA hospitals provide,” VA Secretary Doug Collins said. “Our job is to continue raising the bar for customer service and convenience throughout the department, so VA works better for the Veterans, families, caregivers and survivors we are charged with serving.”

According to a report from the Advisory Board, fewer hospitals are receiving 5-star ratings than ever, possibly due to the COVID-19 pandemic. According to CMS, of all the hospitals that received a rating, 291 earned 5 stars, 90 fewer than in 2024. At the same time, the number of hospitals with 1-star ratings dropped slightly, from 277 in 2024 to 233 in 2025.

The VA publishes its own data on its medical centers. VA Core Hospital Measures have been available from the Joint Commission since 2005. Additional performance measures, including safety, effectiveness, efficiency, timeliness, patient centeredness, and equity, have been published by the VA since 2008. In 2010, the VA began reporting on Hospital Compare, which has information about the quality of care at > 4000 Medicare-certified hospitals, including > 130 VA medical centers and > 50 military hospitals.

The size of the Veterans Health Administration (VHA) workforce continues to contract according to the latest data released by the US Department of Veterans Affairs (VA). Applications for employment are down 44% in fiscal year (FY) 2025 with just 14,485 cumulative new hires and 28,969 losses. In 2024, the VHA had 416,667 workers—it now has 401,224. 

The reductions align with VA Secretary Doug Collins’ goal of downsizing the VA’s workforce by 30,000 employees by the end of 2025. In August, Collins outlined how a federal hiring freeze, deferred resignations, retirements, and normal attrition have eliminated the need for the "large-scale" reduction-in-force he proposed earlier this year.

Compared with July’s numbers, the VHA now employs 139 fewer medical officers/physicians, 418 fewer registered nurses, 107 fewer social workers, and 65 fewer psychologists. Staffing of licensed practical nurses, medical support assistants, and nursing assistants is also down (reduced by 77, 129, and 29, respectively). 

Retention rates for the first 2 years of onboarding hover around 80% for physicians and nurses. However, retention incentives have dropped from 19,484 to 8982 and recruitment incentives from 6069 to 1299.

In voluntary exit surveys, 78% of 6762 medical and dental staff who left said they would work again for the VA, while 79% said they would recommend the VA as an employer. These rates are down from a similar survey in May 2023 when 81% noted that they would work again for the VA and 82% would recommend the VA to others. Personal matters, geographic relocation, and poor working relationships with supervisors or colleagues were among the reasons cited for leaving in August 2025. 

Of 435 psychologists, 69% said they would work again for the VA, and 62% said they would recommend the VA as an employer (71% and 67%, respectively in May 2023). Their reasons for leaving in August 2025 included a lack of trust in senior leaders and policy or technology barriers to getting the work done.

An August survey from the Office of the Inspector General found that VHA facilities reported 4434 staffing shortages this fiscal year—a 50% increase from fiscal year 2024. Most (94%) of the 139 facilities reported severe shortages for medical officers, and 79% of facilities reported severe shortages for nurses. Due to the timing of the questionnaire, the responses did not yet reflect the full impact from workforce reshaping efforts.

The size of the Veterans Health Administration (VHA) workforce continues to contract according to the latest data released by the US Department of Veterans Affairs (VA). Applications for employment are down 44% in fiscal year (FY) 2025 with just 14,485 cumulative new hires and 28,969 losses. In 2024, the VHA had 416,667 workers—it now has 401,224. 

The reductions align with VA Secretary Doug Collins’ goal of downsizing the VA’s workforce by 30,000 employees by the end of 2025. In August, Collins outlined how a federal hiring freeze, deferred resignations, retirements, and normal attrition have eliminated the need for the "large-scale" reduction-in-force he proposed earlier this year.

Compared with July’s numbers, the VHA now employs 139 fewer medical officers/physicians, 418 fewer registered nurses, 107 fewer social workers, and 65 fewer psychologists. Staffing of licensed practical nurses, medical support assistants, and nursing assistants is also down (reduced by 77, 129, and 29, respectively). 

Retention rates for the first 2 years of onboarding hover around 80% for physicians and nurses. However, retention incentives have dropped from 19,484 to 8982 and recruitment incentives from 6069 to 1299.

In voluntary exit surveys, 78% of 6762 medical and dental staff who left said they would work again for the VA, while 79% said they would recommend the VA as an employer. These rates are down from a similar survey in May 2023 when 81% noted that they would work again for the VA and 82% would recommend the VA to others. Personal matters, geographic relocation, and poor working relationships with supervisors or colleagues were among the reasons cited for leaving in August 2025. 

Of 435 psychologists, 69% said they would work again for the VA, and 62% said they would recommend the VA as an employer (71% and 67%, respectively in May 2023). Their reasons for leaving in August 2025 included a lack of trust in senior leaders and policy or technology barriers to getting the work done.

An August survey from the Office of the Inspector General found that VHA facilities reported 4434 staffing shortages this fiscal year—a 50% increase from fiscal year 2024. Most (94%) of the 139 facilities reported severe shortages for medical officers, and 79% of facilities reported severe shortages for nurses. Due to the timing of the questionnaire, the responses did not yet reflect the full impact from workforce reshaping efforts.

The size of the Veterans Health Administration (VHA) workforce continues to contract according to the latest data released by the US Department of Veterans Affairs (VA). Applications for employment are down 44% in fiscal year (FY) 2025 with just 14,485 cumulative new hires and 28,969 losses. In 2024, the VHA had 416,667 workers—it now has 401,224. 

The reductions align with VA Secretary Doug Collins’ goal of downsizing the VA’s workforce by 30,000 employees by the end of 2025. In August, Collins outlined how a federal hiring freeze, deferred resignations, retirements, and normal attrition have eliminated the need for the "large-scale" reduction-in-force he proposed earlier this year.

Compared with July’s numbers, the VHA now employs 139 fewer medical officers/physicians, 418 fewer registered nurses, 107 fewer social workers, and 65 fewer psychologists. Staffing of licensed practical nurses, medical support assistants, and nursing assistants is also down (reduced by 77, 129, and 29, respectively). 

Retention rates for the first 2 years of onboarding hover around 80% for physicians and nurses. However, retention incentives have dropped from 19,484 to 8982 and recruitment incentives from 6069 to 1299.

In voluntary exit surveys, 78% of 6762 medical and dental staff who left said they would work again for the VA, while 79% said they would recommend the VA as an employer. These rates are down from a similar survey in May 2023 when 81% noted that they would work again for the VA and 82% would recommend the VA to others. Personal matters, geographic relocation, and poor working relationships with supervisors or colleagues were among the reasons cited for leaving in August 2025. 

Of 435 psychologists, 69% said they would work again for the VA, and 62% said they would recommend the VA as an employer (71% and 67%, respectively in May 2023). Their reasons for leaving in August 2025 included a lack of trust in senior leaders and policy or technology barriers to getting the work done.

An August survey from the Office of the Inspector General found that VHA facilities reported 4434 staffing shortages this fiscal year—a 50% increase from fiscal year 2024. Most (94%) of the 139 facilities reported severe shortages for medical officers, and 79% of facilities reported severe shortages for nurses. Due to the timing of the questionnaire, the responses did not yet reflect the full impact from workforce reshaping efforts.

A mid-season analysis of the influenza vaccine by the US Department of Defensive (DoD) Global Respiratory Pathogen Surveillance Program (DoDGRPSP) has reported low to moderate vaccine effectiveness (VE). 

The study included 295 Military Health System (MHS) beneficiaries (adults and children) who tested positive for influenza and 965 controls who tested negative. Vaccinated patients had received the 2024-2025 influenza vaccine at least 14 days prior to symptom onset. The study conducted VE analyses for influenza A (any subtype), influenza A(H1N1)pdm09, and influenza A(H3N2). 

Overall, moderate effectiveness against influenza A(H1N1)pdm09 was reported in all beneficiaries and children aged 6 months to 17 years. In adults aged 18 to 64 years—and all beneficiaries—there was moderate effectiveness against influenza A(H3N2). VE estimates against influenza A (any subtype) for all beneficiaries, children, and adults were not significant; VE estimates were also not effective among children for influenza A(H3N2) and in adults for influenza A(H1N1)pdm09.

Adjusted VE estimates among all participants for influenza A (any subtypes), influenza A(H1N1)pdm09, and influenza A(H3N2) were 25%, 58%, and 42%, respectively. VE for influenza B was not calculated due to a low number of cases.

Flu vaccination rates for adults are usually in the 30% to 60% range despite the recommended target of 70%. Flu vaccination rates were rising by around 1% to 2% annually before 2020, but began dropping after the COVID-19 pandemic, especially in higher-risk groups. In adults aged ≥ 65 years, flu vaccination rates dropped from 52% in 2019-2020 to 43% in 2024-2025.

According to the Centers for Disease Control and Prevention (CDC), at the end of the 2023-2024 flu season, 9.2 million fewer doses were administered in pharmacies and doctors offices compared with the baseline before the COVID-19 pandemic. Since 2022, private manufacturers have distributed significantly fewer influenza vaccine doses. 

Each March, the US Food and Drug Association (FDA) Vaccines and Related Biological Products Advisory Committee (VRBPAC) meets to analyze the current influenza season and forecast the next. The committee reviews and discusses data on influenza strain circulation and VE, which come from DoDGRPSP analyses. In February, US Department of Health and Human Services officials indefinitely postponed a public meeting of the CDC Advisory Committee on Immunization Practice (ACIP), at which members were also expected to discuss, among other things, VE and vaccine recommendations. The FDA canceled a March 13 VRBPAC meeting and provided no reason for the cancelation to members. That day, however, the FDA issued new recommendations for the influenza vaccine for the 2025-2026 season without the input of VRBPAC. Instead, experts from the FDA, CDC, and DoD made recommendations after reviewing surveillance data from the US and globally.

For the 2025-2026 influenza season, the FDA recommends the vaccines be trivalent and target 2 strains of influenza A and 1 strain of influenza B. The FDA anticipates there will be an “adequate and diverse supply” of approved trivalent seasonal influenza vaccines. Trivalent flu vaccines are formulated to protect against 3 influenza viruses: an A(H1N1) virus, an A(H3N2) virus, and a B/Victoria virus. All influenza vaccines for the 2025-2026 season are anticipated to be trivalent in the US.

A mid-season analysis of the influenza vaccine by the US Department of Defensive (DoD) Global Respiratory Pathogen Surveillance Program (DoDGRPSP) has reported low to moderate vaccine effectiveness (VE). 

The study included 295 Military Health System (MHS) beneficiaries (adults and children) who tested positive for influenza and 965 controls who tested negative. Vaccinated patients had received the 2024-2025 influenza vaccine at least 14 days prior to symptom onset. The study conducted VE analyses for influenza A (any subtype), influenza A(H1N1)pdm09, and influenza A(H3N2). 

Overall, moderate effectiveness against influenza A(H1N1)pdm09 was reported in all beneficiaries and children aged 6 months to 17 years. In adults aged 18 to 64 years—and all beneficiaries—there was moderate effectiveness against influenza A(H3N2). VE estimates against influenza A (any subtype) for all beneficiaries, children, and adults were not significant; VE estimates were also not effective among children for influenza A(H3N2) and in adults for influenza A(H1N1)pdm09.

Adjusted VE estimates among all participants for influenza A (any subtypes), influenza A(H1N1)pdm09, and influenza A(H3N2) were 25%, 58%, and 42%, respectively. VE for influenza B was not calculated due to a low number of cases.

Flu vaccination rates for adults are usually in the 30% to 60% range despite the recommended target of 70%. Flu vaccination rates were rising by around 1% to 2% annually before 2020, but began dropping after the COVID-19 pandemic, especially in higher-risk groups. In adults aged ≥ 65 years, flu vaccination rates dropped from 52% in 2019-2020 to 43% in 2024-2025.

According to the Centers for Disease Control and Prevention (CDC), at the end of the 2023-2024 flu season, 9.2 million fewer doses were administered in pharmacies and doctors offices compared with the baseline before the COVID-19 pandemic. Since 2022, private manufacturers have distributed significantly fewer influenza vaccine doses. 

Each March, the US Food and Drug Association (FDA) Vaccines and Related Biological Products Advisory Committee (VRBPAC) meets to analyze the current influenza season and forecast the next. The committee reviews and discusses data on influenza strain circulation and VE, which come from DoDGRPSP analyses. In February, US Department of Health and Human Services officials indefinitely postponed a public meeting of the CDC Advisory Committee on Immunization Practice (ACIP), at which members were also expected to discuss, among other things, VE and vaccine recommendations. The FDA canceled a March 13 VRBPAC meeting and provided no reason for the cancelation to members. That day, however, the FDA issued new recommendations for the influenza vaccine for the 2025-2026 season without the input of VRBPAC. Instead, experts from the FDA, CDC, and DoD made recommendations after reviewing surveillance data from the US and globally.

For the 2025-2026 influenza season, the FDA recommends the vaccines be trivalent and target 2 strains of influenza A and 1 strain of influenza B. The FDA anticipates there will be an “adequate and diverse supply” of approved trivalent seasonal influenza vaccines. Trivalent flu vaccines are formulated to protect against 3 influenza viruses: an A(H1N1) virus, an A(H3N2) virus, and a B/Victoria virus. All influenza vaccines for the 2025-2026 season are anticipated to be trivalent in the US.

A mid-season analysis of the influenza vaccine by the US Department of Defensive (DoD) Global Respiratory Pathogen Surveillance Program (DoDGRPSP) has reported low to moderate vaccine effectiveness (VE). 

The study included 295 Military Health System (MHS) beneficiaries (adults and children) who tested positive for influenza and 965 controls who tested negative. Vaccinated patients had received the 2024-2025 influenza vaccine at least 14 days prior to symptom onset. The study conducted VE analyses for influenza A (any subtype), influenza A(H1N1)pdm09, and influenza A(H3N2). 

Overall, moderate effectiveness against influenza A(H1N1)pdm09 was reported in all beneficiaries and children aged 6 months to 17 years. In adults aged 18 to 64 years—and all beneficiaries—there was moderate effectiveness against influenza A(H3N2). VE estimates against influenza A (any subtype) for all beneficiaries, children, and adults were not significant; VE estimates were also not effective among children for influenza A(H3N2) and in adults for influenza A(H1N1)pdm09.

Adjusted VE estimates among all participants for influenza A (any subtypes), influenza A(H1N1)pdm09, and influenza A(H3N2) were 25%, 58%, and 42%, respectively. VE for influenza B was not calculated due to a low number of cases.

Flu vaccination rates for adults are usually in the 30% to 60% range despite the recommended target of 70%. Flu vaccination rates were rising by around 1% to 2% annually before 2020, but began dropping after the COVID-19 pandemic, especially in higher-risk groups. In adults aged ≥ 65 years, flu vaccination rates dropped from 52% in 2019-2020 to 43% in 2024-2025.

According to the Centers for Disease Control and Prevention (CDC), at the end of the 2023-2024 flu season, 9.2 million fewer doses were administered in pharmacies and doctors offices compared with the baseline before the COVID-19 pandemic. Since 2022, private manufacturers have distributed significantly fewer influenza vaccine doses. 

Each March, the US Food and Drug Association (FDA) Vaccines and Related Biological Products Advisory Committee (VRBPAC) meets to analyze the current influenza season and forecast the next. The committee reviews and discusses data on influenza strain circulation and VE, which come from DoDGRPSP analyses. In February, US Department of Health and Human Services officials indefinitely postponed a public meeting of the CDC Advisory Committee on Immunization Practice (ACIP), at which members were also expected to discuss, among other things, VE and vaccine recommendations. The FDA canceled a March 13 VRBPAC meeting and provided no reason for the cancelation to members. That day, however, the FDA issued new recommendations for the influenza vaccine for the 2025-2026 season without the input of VRBPAC. Instead, experts from the FDA, CDC, and DoD made recommendations after reviewing surveillance data from the US and globally.

For the 2025-2026 influenza season, the FDA recommends the vaccines be trivalent and target 2 strains of influenza A and 1 strain of influenza B. The FDA anticipates there will be an “adequate and diverse supply” of approved trivalent seasonal influenza vaccines. Trivalent flu vaccines are formulated to protect against 3 influenza viruses: an A(H1N1) virus, an A(H3N2) virus, and a B/Victoria virus. All influenza vaccines for the 2025-2026 season are anticipated to be trivalent in the US.