Table of Contents
Introduction
There have been numerous studies that have recorded an increase in the United States homeless population between 2015 and 2018. The largest portion of this population has been documented as homeless veterans. The United States Department of Veteran Affairs (VA) defines homelessness as an individual or family who lacks a fixed, regular, and adequate nighttime residence or a primary nighttime residence that is a public or private place not ordinarily used as regular sleeping accommodations for human beings (Perl, 2015). According to the 2017 Annual Homeless Assessment Report to Congress surveyed by the United States department of Housing and Urban Development (HUD) 553,742 persons experienced homelessness on a single night in 2017.
Of this 40,056 were determined to be veterans primarily in California cities. This begs the question, with the rise of homelessness in California are homeless veterans receiving the necessary and proper services? The purpose of this paper is to provide comprehensive knowledge in regards to the risk factors faced by homeless veteran including housing, health and mental health, and services outside of Veteran Affairs offered to this population. For this purpose, we will focus solely on the Californian Homeless Veteran population mainly in the Los Angeles county area. This paper explores ten published articles that record information on these subjects.
Risk Factors for Homeless Veterans: Housing
For homeless individuals one of the largest complicating factor is acquiring necessary housing assistance and there are various analyses for the reasonings behind the lack of sufficient housing for this population. One study found that by supporting permanent housing, not only do rates of homelessness decrease, but also associated health care utilization rates, cost of emergency care and inpatient hospitalizations (Montgomery, Hill, Kane, & Culhane, 2013). Abram (2017) argues that the lack of housing can be contributed to policy makers nationally, in the sate, and locally prioritizing real estate profit over a healthy housing. Schinka, Curtiss, Leventhal, Bossarte, Lapcevic and Cacey (2016) agrees utilizing a quote from HUD Secretary Ben Carson confirming that rent is rising faster than income and affordable housing needs to be established before too many are forced out of Los Angeles neighborhoods and into shelters or on the streets.
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Currently in Los Angeles County the developer, Community of Friends is expected to build 43 affordable units, 17 studio apartments and 26 single bedroom units (Chou 2017). According to Abram (2017) in 2016 14,000 potential homeless individuals were placed in housing. It should also be noted that as according to Perl (2015) the VA works with the Department of Housing and Urban Development (HUD) to provide permanent supportive housing to homeless veterans through the HUD-VA Supported Housing Program. Considering this one would assume that veterans would utilize the services currently provided to them in regards to housing by the VA. However, according to Schinka et al (2016) an unknown number of homeless veterans enter community-based homeless programs outside of the VA program or never enter homeless programs at all, as there is a bureaucratic complexity to the process. One must question if the rise of this population has a direct affect on the lack of proper and affordable housing continuing to be a barrier despite the currently implemented services.
Risk factors for Homeless Veterans: Health and Morality Rate
Outside of lack of housing, there is a sufficient risk of poor health and a high morality rate in the homeless veteran population. As stated previously, Veteran Affairs (VA) is the most obvious and encouraged method of assistance for homeless veterans however, since a complicated eligibility process exists and not all veterans are eligible for health services in the VA system (Schinka et al 2016). Weber, Lee and Martsolf (2017) states homeless veterans are at a high risk of compromised health status requiring more specific health needs and a greater understanding by healthcare providers. Individuals who are homeless not only have more complex healthcare needs than those who are housed, but they also have higher hospitalization rates and emergency department (ED) visits, often using this as a primary source of care due to its ease and accessibility (Chambers, Chiu, Katic, Kiss, Redelmeir, Levinson, and Hwang., 2013).
Homeless veterans also face challenges with obtaining medications, arranging outpatient and follow-up care, and securing transportation (Hastings et al., 2011). In addition, their higher severity of illness and lack of social support places homeless veterans at an increased risk of return to Emergency departments (Doran et al., 2013). Dubbert, Garner, Lensing, White and Sullivan (2017) support this and ad that there is as well an increased prevalence of chronic disease and hospitalization within this population. Due to this and contributing mental health factors homeless veterans hold a substantially higher morality rate than that of non-homeless (Schinka et al 2016). It is for this reason that Dubbert et al. (2017) places emphasis on the necessity of pre-established end-of life services for this population in the event that the individual is unable to provide preferences when subjected to medical care.
Risk Factors for Homeless Veterans: Mental Health
Mental health is something that is overlooked by individuals in and out of the homeless population however in homeless veterans these services are necessary to ensure over-all wellbeing. Schinka et al (2016) states that Homelessness in veterans are associated with a large number of associated conditions, such as mental illness and substance abuse. In 2016, 30 percent of those who are homeless were diagnosed with mental illness (Abram 2017). Weber et al (2017) states maintaining mental health and recovery is especially challenging for this population because more energy is expended on the attempt to satisfy basic human needs such as food, shelter, and safety.
Veterans may have several traumatic experiences which can subject them to mental illnesses such as Post Traumatic Stress Disorder (PTSD) or Depression. Therefore, mental health and substance use counselors are critical to help Veterans recover and re-establish themselves in the community (Perl 2017). However, a concern is noted in the homeless veteran population of concurrent mental health plans especially those who are subject to psychotic episodes or breaks. Dubbert et al (2017) states that in recent years to remedy this concern advanced questioning has been utilized to create a picture of preferred care for homeless individuals should they be brought in during an episode where they are unable to provide proper or coherent consent for medical treatment.
Services Outside of Veteran Affairs Offered to Homeless Veterans in California
Considering that services provided by Veteran Affairs are not equally accessed by all veterans especially those in the homeless population it is appropriate to provide other services to this population. Although Veteran Affairs is a viable resource offered to this population there are also various programs outside of the VA to support homeless veterans in California. According to Schinka et al (2016) in 2016, 139,857 veterans were estimated as using shelter programs most of these were outside of Veteran Affairs. Los Angeles city voters in November also passed Proposition HHH, a property-tax bond measure that is supposed to raise $1.2 billion to build 10,000 affordable-housing units for the homeless as stated by Abram (2017). According to Chou (2017), this funding is being utilized to support nine permanent supportive housing projects, which will pay for a total of 615 housing units that are mostly aimed at helping those who are chronically homeless or need on-site services. There are various transitional housing programs that are offered including a program that provides housing for up to 2 years designed as rehabilitation program leading to permanent housing (Schinka 2016)
Conclusion
Homeless Veterans face numerous risk factors in regards to shelter and healthcare. They have higher rates of physical illness, mental illness and higher morality rate that their non-homeless counterparts. This creates a burden on homeless veterans because they are competing for re-sources amongst themselves and the remainder of the homeless population. The majority of literature is in agreement with the risk factors and possible remedies in form of services for this population. Veteran Affairs is not always most justifiable source of services for this population as their services are in high demand and often complicated to establish. For this reason, there are programs outside of the VA that are able to be utilized by homeless veterans. Funding is being put into effect to remedy the rise in the homeless population in California specifically in the Los Angeles area not only for veterans but for the homeless population as a whole. It may be beneficial to conduct a study which looks further into the VA process to determine why homeless veterans are needing to utilize outside services.
References
Abram, S. (2017, May 31). Homelessness surges by 23 percent in LA County. Retrieved March 26, 2018, from https://www.dailynews.com/2017/05/31/homelessness-surges-by-23-percent-in-la-county/
Chambers, C., Chiu, S., Katic, M., Kiss, A., Redelmeier, D. A., Levinson, W., & Hwang, S. W. (2013). High utilizers of emergency health services in a population- based cohort of homeless adults. American Journal of Public Health, 103(S2), https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3969147/
Chou, E. (2017, August 28). LA leaders OK $85 million in Prop HHH money – including for homeless housing in Valley. Retrieved March 27, 2018, from https://www.dailynews.com/2017/06/09/la-leaders-ok-85-million-in-prop-hhh-money-including-for-homeless-housing-in-valley/
Doran, K. M., Raven, M. C., & Rosenheck, R. A. (2013). What drives frequent emergency department use in an integrated health system? National data from the Veterans health administration. Annuals of Emergency Medicine, 62(2), https://www.ncbi.nlm.nih.gov/pubmed/23582617
Dubbert, P. M., Garner, K. K., Lensing, S., White, J. G., & Sullivan, D. H. (2017). Engagement in steps of advance healthcare planning by homeless veterans. Psychological Services,14(2), 214-220. doi:10.1037/ser0000147 from http://eds.b.ebscohost.com.libproxy.chapman.edu/eds/pdfviewer/pdfviewer?vid=18&sid=9c2b4dc3-3c40-42f4-97ca-9da550c8d398%40sessionmgr103
Hastings, S. N., Smith, V. A., Weinberger, M., Schmader, K. E., Olsen, M. K., & Oddone, E. Z. (2011). Emergency department visits in Veterans affairs medical facilities. The American Journal of Managed Care, 17(6), http://www.ajmc.com/journals/issue/2011/2011-6-vol17-n6/ajmc_11jun_hastings_e215to23
Montgomery, A. E., Hill, L. L., Kane, V., & Culhane, D. P. (2013). Housing chronically homeless veterans: Evaluating the efficacy of a housing first approach to HUD- VASH. Journal of Community Psychology, https://onlinelibrary.wiley.com/doi/pdf/10.1002/jcop.21554
Perl, L. (2015). Veterans and homelessness. Congressional Research Service. Retrieved from: https://www.fas.org/sgp/crs/misc/RL34024.pdf
Schinka, J. A., Curtiss, G., Leventhal, K., Bossarte, R. M., Lapcevic, W., & Casey, R. (2016). Predictors of Mortality in Older Homeless Veterans. The Journals of Gerontology: Series B,72(6), 1103-1109. doi:10.1093/geronb/gbw042 from https://academic-oup-com.libproxy.chapman.edu/psychsocgerontology/article/72/6/1103/2632019
Weber, J., Lee, R. C., & Martsolf, D. (2017). Understanding the health of veterans who are homeless: A review of the literature. Public Health Nursing, 34(5), 505-511. doi:10.1111/phn.12338 from https://onlinelibrary-wiley-com.libproxy.chapman.edu/doi/abs/10.1111/phn.12338
