3024 — Why Some Homeless Veterans Won’t Seek Care When They Need It
O'Toole TP, Johnson EE, Huang X, Redihan S, and Dutra R, Providence VAMC REAP;
Homeless Veterans have higher rates of chronic disease, mental illness and substance abuse, yet only a small proportion come to the VA for primary care. We sought to identify need, barriers, and perceptions of VA care in a community-based sample of homeless Veterans.
Face-to-face interview of a community-based sample of homeless Veterans, comparing those who had an ambulatory care visit in the previous 6 months with those who had not. Individuals were identified in a convenience sampling at area soup kitchens, shelters, and social service agencies. A structured interview included self-reported health, health conditions and health concerns, recent services use, reasons for not seeking care, and perceptions of the VA.
Overall, 130 homeless Veterans were interview: 96 with no outpatient care and 34 who had at least one visit. The average age was 46.7 years. Significantly more homeless African American Veterans received outpatient care (p < 0.01) with no differences based on service era (Vietnam vs. OEF/OIF). Those receiving care had significantly higher rates of chronic illness (94.1% vs. 70.8%; p < 0.01) and mental illness (88.2% vs. 68.8%; p = 0.02) but no difference in health rating (fair or poor), concerns about their health or Self-Efficacy and Social Support scores. The most common reasons for not receiving care among those who had not seen providers were: transportation (58.3%), embarrassment about being homeless (47.3%), and affordability (39.6%). For those who had seen an outpatient provider, they were: affordability (59.9%), keeping the appointment (55.9%), and embarrassment about being homeless (47.1%). The VA was viewed favorably by both groups with 83.8% reported the care is helpful, while 11.2% reported they did not trust the VA, with no difference between groups.
Efforts to engage homeless Veterans in VA primary care need to consider organizing care in ways that facilitate access, minimize the stigma of being homeless, proactively address affordability concerns, and assist in transportation needs.
Findings are relevant within the context of PACT implmentation and the tranformation priority areas of Ending Veteran Homelessness and providing more patient centric care.