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Study Suggests Supportive Housing May Address Homeless Veterans' Underuse of VA Services


BACKGROUND:
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.

FINDINGS:

  • 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.

LIMITATIONS:

  • 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.

AUTHOR/FUNDING INFORMATION:
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.


PubMed Logo 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.

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What are HSR&D Publication Briefs?

HSR&D requires notification by HSR&D-funded investigators about all articles accepted for publication. These journal articles are reviewed by HSR&D and publication briefs or summaries are written for a select number of articles that are then forwarded to VHA Central Office leadership to keep them informed about important findings or information. Articles to be summarized are selected by HSR&D based on timeliness of the findings, interest of leadership, or potential impact on the organization. Publication briefs are written for only a small number of HSR&D published articles. Visit the HSR&D citations database for a complete listing of HSR&D articles and presentations.