Study Suggests Supportive Housing May Address Homeless Veterans' Underuse of VA Services
Veterans are over-represented among homeless adults and ending homelessness is a VA priority. The U.S. Department of Housing and Urban Development (HUD)-VA Supportive Housing (VASH) program is the linchpin of VA's plan to improve homeless Veterans' health and housing. HUD-VASH is a Housing First program that offers housing vouchers and help to move homeless Veterans into community rental units. In addition, Veterans can be referred to primary and mental healthcare through HUD-VASH case managers. This study examined rates of VA healthcare use (inpatient and outpatient) among four groups of Veterans: 1) formerly homeless Veterans housed through HUD-VASH (n=1,997); 2) currently homeless Veterans (n=1,760); 3) housed, low-income Veterans not in HUD-VASH (n=21,682); and 4) housed, not low-income Veterans (n=37,020). Veterans in this study received care at the VA Greater Los Angeles Healthcare System between 10/10 and 9/11. Investigators controlled for patient demographics, need, and number of primary care visits in analyses of VA healthcare use among these four groups.
- Currently homeless Veterans underuse healthcare relative to housed Veterans and HUD-VASH may address utilization differences by providing housing and linkages to needed services.
- Veterans who participated in HUD-VASH had more inpatient, outpatient, and emergency department visits than currently homeless Veterans.
- Among HUD-VASH Veterans, the percentage of patients with medical/surgical admissions during the study period (10%) was higher than the other groups. Housed, low-income Veterans had the second-highest percentage of admissions (7%), followed by currently homeless Veterans (6%), and those in the housed, not low-income group (4%). Rates of preventable admissions were not significantly different between groups (22% to 25%).
- In comparison, 4% of Veterans in each of the HUD-VASH and currently homeless groups had one or more psychiatric admissions, which was higher than housed, low-income Veterans (1%) and housed, not low-income Veterans (0.8%). Among patients with psychiatric hospitalizations, readmissions were most likely among currently homeless Veterans (39%) and least likely among HUD-VASH Veterans (16%).
- Higher primary care use among HUD-VASH Veterans may explain many of the differences in service use seen between HUD-VASH Veterans and their currently homeless peers.
- This study lacks patient-level data, such as homelessness chronicity and medical home enrollment, as well as organizational features that might influence care, such as clinic wait-times.
- The cross-sectional nature of this analysis did not allow attribution of causality between housing/income status and health service utilization.
All authors are part of the VA Greater Los Angeles Healthcare System. Dr. Rubenstein also Directs HSR&D's Center for Implementation Practice and Research Support, Los Angeles, CA.
Gabrielian S, Yuan A, Anderson R, Rubenstein L, and Gelberg L. VA Health Service Utilization for Homeless and Low-Income Veterans: A Spotlight on the VA Supportive Housing (VASH) Program in Greater Los Angeles. Medical Care May 2014;52(5):454-61.