Ensuring Continuity of Transitional Housing for Homeless Veterans: Promoting Disaster Resilience among the Veterans Health Administration's Grant and Per Diem Providers.

The US Department of Veterans Affairs (VA) has committed significant resources toward eliminating homelessness among veterans as part of its health care mission. The VA Grant and Per Diem (GPD) program funds non-VA, community-based organizations to provide transitional housing and support services to veterans experiencing homelessness. During a disaster, GPD grantee organizations will be especially critical in ensuring the well-being of veterans residing in their programs. Recognizing the need to ensure continued access to this residential care, the VA GPD program implemented a disaster preparedness plan requirement for its grantee organizations in 2013. This study conducted semistructured interviews with leaders of 5 GPD grantee organizations, exploring their perceptions of the preparedness requirement, the assistance they would need to achieve desired preparedness outcomes, and their motivations toward preparedness. Organizations reported being extremely motivated toward improving their disaster preparedness, albeit often for reasons other than the new preparedness requirement, such as disaster risk or partnerships with local government. Two dominant themes in organizations' identified needs were (1) the need to make preparedness seem as "easy and doable" as possible and (2) the desire to be more thoroughly integrated with partners. These themes suggest the need to develop materials specifically tailored to facilitate preparedness within the GPD nonprofit grantees, an effort currently being led by the VA's Veterans Emergency Management Evaluation Center (VEMEC).

Increased Mortality Among Older Veterans Admitted to VA Homelessness Programs.

OBJECTIVE: National Death Index data were examined to describe mortality patterns among older veterans who are homeless. METHODS: Homelessness and health care records from the U.S. Department of Veterans Affairs were used to identify old (ages 55-59) and older (ages ≥60) veterans who were (N=4,475) or were not (N=20,071) homeless. Survival functions and causes of death of the two samples over an 11-year follow-up period were compared. RESULTS: Substantially more veterans who were homeless (34.9%) died compared with the control sample (18.2%). Veterans who were homeless were approximately 2.5 years younger at time of death compared with the control sample. Older veterans who were homeless had the lowest survival rate (58%). No disease category appeared to be critical in reducing survival time. Suicide was twice as frequent in the homeless (.4%) versus the control (.2%) sample. CONCLUSIONS: Older veterans who were homeless experienced excess mortality and increased suicide risk.

Health risk factors and differences in outcomes between younger and older veterans using VA transitional housing.

OBJECTIVE: This study examined age-related differences in general medical and mental health risk factors for veterans participating in the U.S. Department of Veterans Affairs (VA) Grant Per Diem (GPD) transitional supportive housing program. The subpopulation of older homeless veterans is growing, and little is known about the implications of this fact for health care providers and for supportive programs intended to meet homeless veterans' needs. METHODS: Data were obtained from the VA records of all veterans (N=40,820) who used the GPD program during fiscal years 2003 to 2009. Unconditional adjusted and unadjusted odds ratios for general medical and psychiatric characteristics were calculated and were the primary study focus. Significant predictors of homeless program completion assessed from univariate models were then evaluated in multivariate models. RESULTS: Younger (<55) and older (≥55) homeless veterans reported an equal number of days homeless before enrollment. Younger veterans averaged 19 fewer days in GPD. Older veterans had more general medical problems and approximately $500 more in program costs. CONCLUSIONS: Findings from this study indicate that older homeless veterans are at increased risk of serious medical problems. This group is especially vulnerable to experiencing negative consequences related to homelessness. Addressing these complex needs will allow the VA to provide enhanced care to older homeless veterans.

Suicidal behavior in a national sample of older homeless veterans.

OBJECTIVES: We examined self-reported suicidal behavior of older homeless veterans to establish frequencies and predictors of recent suicidal behaviors, and their impact on transitional housing interventions. METHODS: We analyzed the records of a national sample of 10,111 veterans who participated in a transition housing program over a 6-year period, ending in 2008. RESULTS: Approximately 12% of homeless veterans reported suicidal ideation before program admission; 3% reported a suicide attempt in the 30 days before program admission. Older homeless veterans exhibiting suicidal behavior had histories of high rates of psychiatric disorders and substance abuse. Regression analyses showed that self-report of depression was the primary correlate of suicidal behavior. Suicidal behavior before program entry did not predict intervention outcomes, such as program completion, housing outcome, and employment. CONCLUSIONS: Suicidal behavior was prevalent in older homeless veterans and was associated with a history of psychiatric disorder and substance abuse. Self-reported depression was associated with these behaviors at the time of housing intervention. Despite the association with poor mental health history, suicidal behavior in older homeless veterans did not impact outcomes of transitional housing interventions.

Requiring sobriety at program entry: impact on outcomes in supported transitional housing for homeless veterans.

OBJECTIVE: An important distinction in models of housing for the homeless is whether programs that require abstinence prior to program admission produce better outcomes than unrestricted programs. Data from a large transitional housing program were used to compare client characteristics of and outcomes from programs requiring abstinence at admission and programs not requiring abstinence. METHODS: The U.S. Department of Veterans Affairs (VA) Northeast Program Evaluation Center provided records of individuals who were admitted into, and discharged from, the VA Grant and Per Diem program in 2003-2005. Records contained information from intake interviews, program discharge information, and descriptions of provider characteristics. Analyses were based on 3,188 veteran records, 1,250 from programs requiring sobriety at admission and 1,938 from programs without a sobriety requirement. Group differences were examined with t tests and chi square analyses; predictors of program outcome were determined with logistic regression. RESULTS: Individuals using drugs or alcohol at program admission had more problematic histories, as indicated by several general health and mental health variables, and shorter program stays. There were significant differences between groups in the frequency of program completion, recidivism for homelessness, and employment on program discharge, but effect sizes for these analyses were uniformly small and of questionable importance. Regression analyses did not find meaningful support for the importance of sobriety on program entry on any of the outcome measures. CONCLUSIONS: The results add evidence to the small body of literature supporting the position that sobriety on program entry is not a critical variable in determining outcomes for individuals in transitional housing programs.

Collaborative initiative to help end chronic homelessness: introduction.

The Collaborative Initiative to Help End Chronic Homelessness was a coordinated effort by the US Departments of Health and Human Services (HHS), Housing and Urban Development (HUD), and Veterans Affairs (VA), and the US Interagency Council on Homelessness to house and provide comprehensive supportive services to individuals with serious psychiatric, substance use, health, and related disabilities who were experiencing long-term chronic homelessness. Eleven communities received 3-year grants from HHS and VA (2003-2006) and up to 5-year grants from HUD (2003-2008) to implement the initiative. This article provides background on chronic homelessness, describes the federal collaboration to comprehensively address chronic homelessness, and introduces the seven articles in this special issue that describe the findings and lessons learned from the participating communities in addressing chronic homelessness. Collectively, these articles offer insight into the challenges and benefits of providing housing and services to individuals experiencing chronic homelessness.