The VA “has taken little action” in response to known shortcomings in its capital planning even while it faces trends that threaten to leave the department with both shortages and excesses of space to treat veterans, GAO has said.

Those forces include geographic shifts in the veteran population, changes in health care delivery, and an aging infrastructure of current facilities that are increasingly expensive to maintain, said GAO.

“For example, a shift over time from inpatient to outpatient care will likely result in underutilized space once used for inpatient care. In such instances, it is often difficult and costly for VA to modernize, renovate, and retrofit existing facilities given the challenges associated with these older facilities,” it said.

As of 2014 VA owned 6,091 buildings covering more than 151.5 million square feet and leased 1,586 buildings covering more than 16.6 million square feet and costing more than $340 million annually in rent, GAO said.

GAO said that the department acknowledges limitations in its strategic capital investment planning process that leave questions regarding whether facility planning reflects veterans’ needs.

It said there are similar issues with a second process aimed at strategic planning. That process assumes that “all future growth in services will be provided directly through VA facilities without considering alternatives, such as purchasing care from the community”–even while the VA already is increasing use of community-based care and that share is only expected to grow–GAO said.