Health Services Research & Development

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2017 HSR&D/QUERI National Conference Abstract

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1081 — Homelessness Following Disability-Related Discharges from Active Duty Military Service in Afghanistan and Iraq

Lead/Presenter: Emily Brignone, COIN - Salt Lake City
All Authors: Fargo JD (Informatics, Decision-Enhancement, and Analytic Sciences (IDEAS 2.0) Center, VA Salt Lake City Health Care System) Brignone E (Informatics, Decision-Enhancement, and Analytic Sciences (IDEAS 2.0) Center, VA Salt Lake City Health Care System) Metraux S (National Center for Homelessness Among Veterans, VA Philadelphia Health Care System) Peterson R (Informatics, Decision-Enhancement, and Analytic Sciences (IDEAS 2.0) Center, VA Salt Lake City Health Care System) Carter ME (Informatics, Decision-Enhancement, and Analytic Sciences (IDEAS 2.0) Center, VA Salt Lake City Health Care System) Barrett TS (Informatics, Decision-Enhancement, and Analytic Sciences (IDEAS 2.0) Center, VA Salt Lake City Health Care System) Palmer M (Informatics, Decision-Enhancement, and Analytic Sciences (IDEAS 2.0) Center, VA Salt Lake City Health Care System) Redd A (Informatics, Decision-Enhancement, and Analytic Sciences (IDEAS 2.0) Center, VA Salt Lake City Health Care System) Samore MH (Informatics, Decision-Enhancement, and Analytic Sciences (IDEAS 2.0) Center, VA Salt Lake City Health Care System) Gundlapalli AV (Informatics, Decision-Enhancement, and Analytic Sciences (IDEAS 2.0) Center, VA Salt Lake City Health Care System)

Objectives:
Determine whether Veterans who were discharged from active duty military service due to disability are at higher risk for homelessness, whether Veterans Health Administration (VHA) service-connected disability benefits mitigate that risk, and how the risks associated with discharge type, service-connected disability, or the interaction between them vary as a function of mental health disorders.

Methods:
A retrospective cohort study of Veterans who used VHA services between fiscal years 2005 and 2013 was conducted using administrative data from the Department of Defense and VHA. Included in the study were 364,997 active duty Veterans who deployed to Iraq or Afghanistan and were discharged from service under routine conditions or due to disability. Logistic regression and survival analyses were used to estimate risk for homelessness over time as a function of discharge type, mental health disorders, and receipt of VHA disability benefits.

Results:
Overall, disability-discharged Veterans had higher rates of homelessness compared to routinely discharged Veterans (15.1 versus 9.1 per 1000 person-years at risk). At the time of the first VHA encounter, mental health disorders were associated with differentially greater risk for homelessness among Veterans with a disability discharge relative to those with a routine discharge. During the first year of VHA service usage, higher levels of disability benefits were protective against homelessness among routinely-discharged Veterans, but not among disability-discharged Veterans. By 5-years, disability discharge was a risk factor for homelessness (adjusted odds ratio = 1.30).

Implications:
Over the course of follow-up, disability-discharged Veterans had rates of homelessness that were more than 60% higher than their routinely discharged counterparts. However, this risk emerged gradually, and varied as a function of service-connected disability benefits and mental health disorders.

Impacts:
In the long-term, disability discharge is an independent risk factor for homelessness, and this risk increases over time. More intensive and sustained benefits and case management services may be required to mitigate this risk, as VHA service-connected disability benefits may not offer sufficient protection for this subpopulation of Veterans.