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Takeaway: Health Systems Research (HSR) investigators collaborated with VA’s National Center on Homelessness Among Veterans (NCHAV) and VISNs 1 and 6 to develop a blueprint that will facilitate VA/community partnerships to help homeless Veterans who are older and/or have physical disabilities optimize the balance between independent and assistive housing.
Nearly half of Veterans using VA healthcare are 65 years or older; further, the number of homeless Veterans aged 55 years and older increased 150% between 2010 and 2023.1 Studies show that older Veterans experiencing housing instability are at increased risk for early death, and the frequency of death by suicide is twice that of Veterans with no history of homelessness.2 To help address the needs of older Veterans who experience homelessness, in 2023 the US Department of Housing and Urban Development–Veterans Affairs Supportive Housing (HUD-VASH) disseminated a strategic plan titled “Serving Aging and Disabled Veterans: A HUD-VASH Guidebook.” The plan encouraged local HUD-VASH teams to forge partnerships with community agencies to support and facilitate the placement of older and physically disabled Veterans in the “least restrictive” non-institutional settings, if possible.
Community partnerships are vitally important to providing the best possible health outcomes for older, disabled Veterans with housing instability. Partnerships with community partners can provide mental healthcare, geriatric care, and home health services. In addition, working with community-based housing programs can lead to more age-appropriate housing options, such as assisted living facilities or medical foster homes. Collaborations between HUD-VASH and public housing agencies may also significantly shorten the waiting time for housing. Community partners may also offer job training, legal aid, and other services that help Veterans maintain housing.
With funding from VA’s National Center on Homelessness among Veterans (NCHAV), HSR investigators Drs. Nathan Boucher and Jenny Palmer sought to support the implementation of the HUD-VASH Guidebook by developing an implementation blueprint for effective partnerships within the community. Their project, titled, “Supporting Community Partnerships to Optimize HUD-VASH Services for Older and Disabled Veterans,” included the following specific aims:
Based on these findings, an implementation blueprint was drafted for use by HUD-VASH teams at VA Medical Centers.
The Blueprint outlines a strategy to strengthen partnerships between VA HUD-VASH teams and community organizations to support older and disabled Veterans. It promotes collaboration through sponsorships, joint initiatives, volunteer efforts, and resource sharing. Key actions include aligning goals, assigning VA liaisons, improving communication, formalizing agreements, and providing mutual training. The plan also emphasizes tracking performance, engaging Veterans, and ensuring long-term sustainability through ongoing partnerships and celebrating successes. The Blueprint takes the form of a worksheet that local homelessness teams can use to plan out their steps and strategies.
This research contributes to VA’s strategic efforts to address older homeless Veterans’ needs, which include the following goals: 1) Provide preventive healthcare to lessen the risk of ER visits and institutionalization; 2) Expand medical respite and hospice for those with additional medical needs; 3) Increase access to affordable housing; 4) Enhance outreach to those involved in the criminal legal system; and 5) Utilize data and research to make timely and informed decisions.
Toward these goals, the blueprint developed by Drs. Boucher and Palmer is currently being provided to HUD-VASH leaders and several HUD-VASH staff on a limited basis – and within VISN 6. Additional feedback may be used to determine how the tool might be further optimized.
VA’s National Center for Homelessness Among Veterans
VISN 1: VA New England Healthcare Network
VISN 6: VA Mid-Atlantic Healthcare Network
Co-investigators
Nathan Boucher, DrPH, is a research health scientist at HSR’s Durham Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), and Jenny Palmer, PhD, is an investigator HSR’s Center for Health Optimization & Implementation Research (CHOIR).
