Health Services Use Among Veterans Using U.S. Department of Veterans Affairs and Mainstream Homeless Services

Abstract

We examined the use of health and behavioral health services for two groups of homeless veterans (N ¼ 1,302) in the New York City area who were enrolled in the U.S. Department of Veterans Affairs (VA) healthcare system-veterans who use VA homeless programs, and veterans who use mainstream homeless programs only. Using administrative records from the VA and the New York City Department of Homeless Services, we compared the characteristics of users of VA and mainstream homeless programs and examined between-group differences in VA inpatient and outpatient services use and within-group changes in services use prior and subsequent to onset of homelessness. Roughly 41 percent of veterans only used mainstream homeless services. There were no significant differences between users of VA and mainstream homeless services in terms of gender, age, ethnicity, and level of VA eligibility. Veterans who used only mainstream homeless assistance services were less likely to be engaged with-and made less intensive use of-VA health and behavioral health inpatient and outpatient services than those who used VA homeless services. Efforts should be made to identify and engage veterans who, while enrolled in VA healthcare, may go unidentified as homeless by the VA.

Increased risk for substance use and health‐related problems among homeless veterans

“…However, despite their access to specialty care, homeless veterans were more likely to report emergency department visits in the past year. These findings are consistent with previous research reporting that 41% of their sample only used “mainstream” homelessness services and speak to a potential gap in the continuum of care for veterans. Specifically, homeless veterans appear to underutilize available outpatient and remote clinics that could reduce emergency department visits.…”

Screening for Homelessness in the Veterans Health Administration: Monitoring Housing Stability through Repeat Screening

“…A recent study found that more than one-third of a cohort of newly homeless veterans used mainstream homeless assistance services but did not access VHA homeless programs, suggesting that a sizable number of veterans experiencing homelessness or risk of homelessness (hereinafter referred to as "risk") may not be linked with VA resources that may improve their housing stability. 4 To improve the VA's ability to identify these veterans and refer them appropriately, VHA implemented a universal, two-question screener for current homelessness and imminent risk-the Homelessness Screening Clinical Reminder (HSCR)-that is administered at all VHA health-care facilities. During the first three months of its implementation (October 1, 2012, to January 10, 2013), 0.9% of respondents reported current homelessness, 1.2% reported imminent risk, and 97.9% screened negative for both.…”

Health, Homelessness, and Poverty: A Way Forward

“…Our related publications preceding this issue addressed “Health Services Use Among Veterans Using U.S. Department of Veterans Affairs and Mainstream Homeless Services” (Byrne, Montgomery, Treglia, Roberts, & Culhane, ) and a practitioner report on “Ensuring Appropriate Discharge Practices for Hospitalized Homeless Patients” (Hochron & Brown, ). The 2014 Forum on Health, Homelessness and Poverty, and a planned event focusing on Global Food Security, will further these efforts to improve health by addressing its determinants in critical areas and informing policy and practice.…”