Homeless veterans in the United States

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Homeless veterans are persons who have served in the armed forces who are homeless or living without access to secure and appropriate accommodation. [1]

Contents

Background

Many of these veterans suffer from post traumatic stress disorder, an anxiety disorder that often occurs after extreme emotional trauma involving threat or injury. Causes of homelessness include: [2]

Demographics

Veteran homelessness in America is not a phenomenon only of the 21st century; as early as the Reconstruction Era, homeless veterans were among the general homeless population. [3] In 1932, homeless veterans were part of the Bonus Army. [4] In 1934, there were as many as a quarter million veterans living on the streets. [5] During the Truman Administration, there were one hundred thousand homeless veterans in Chicago, and a quarter of that number in Washington, D.C. [6] In 1987, the number of homeless veterans was as high as three hundred thousand. [7]

Estimates of the homeless population vary as these statistics are very difficult to obtain. [8] In 2007, the first veterans of Operation Enduring Freedom - Afghanistan and Operation Iraqi Freedom began to be documented in homeless shelters. [9] By 2009 there were 154,000 homeless, with slightly less than half having served in South Vietnam. [10] According to the VA in 2011, veterans made up 14% of homeless adult males, and 2% of homeless adult females, and both groups were overrepresented within the homeless population compared to the general population. [11] The overall count in 2012 showed 62,619 homeless veterans in the United States. [12] In January 2013, there were an estimated 57,849 homeless veterans in the U.S., or 12% of the homeless population. [13] Just under 8% were female. [14] In July 2014, the largest population of homeless veterans lived in Los Angeles County, with there being over 6,000 homeless veterans, out of the total estimated 54,000 homeless within that area. [15] In 2015, a report issued by HUD counted over 47,000 homeless veterans nationwide, the majority of whom were White and male. [16] In 2016, there were over 39,000 homeless veterans nationwide. [17] A Corps in terms of military size. As of January 2017, the state of California had the highest number of veterans experiencing homelessness. There were an estimated 11,472 homeless veterans. [18] The biggest population of homeless veterans, after California, in 2017 lived in Florida - an estimated 2,817, and in Texas - 2,200.

Aid

Many programs and resources have been implemented across the United States in an effort to help homeless veterans. [19]

HUD-VASH, a housing voucher program by the United States Department of Housing and Urban Development and Veterans Administration, gives out a certain number of Section 8 subsidized housing vouchers to eligible homeless and otherwise vulnerable U.S. Armed Forces veterans. [20]

Historical

In 1887, the Sawtelle Veterans Home was constructed to care for disabled veterans, and housed more than a thousand homeless veterans. [21] Other such old soldiers' homes were built throughout the United States, [22] such as the one in New York. [23] These homes became the predecessors of the Veteran Affairs' medical facilities. [24]

Risk factors

According to a study in 2014, veterans are slightly more likely than non-veterans to be homeless; 9.7% of the general population are veterans, but 12.3% of the homeless population are veterans. [25] These risk factors were found by using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). This is the first systemic review to summarize research on risk factors for US veterans experiencing homelessness. They evaluated thirty-one studies from 1987 through 2014. The risk factors that are most common among this population are substance abuse disorders and poor mental health, followed by low income and other income related issues, a lack of support from family and friends, or weak social networks. [25]

Supportive housing for veterans compared to non-veterans

The needs between veterans and non-veterans experiencing homelessness can differ. A study was implemented by the Collaborative Initiative to Help End Chronic Homelessness (CICH) in 2004 by the Interagency Council on Homelessness. They used eleven sites around the United States tracked data for one year by comparing 162 chronically homeless veterans to 388 chronically homeless non-veterans. [25]

Both groups were enrolled in a national supported housing initiative over a one-year period and several differences were noted. The first was that the veterans tended to be from an older age group, identified as male, and were more likely to have completed high school. [25] While in enrolled in supported housing, the mental health of both groups improved through mental health services offered. However, veterans were reported to make greater use of the outpatient mental health services compared to non-veterans. Both groups also gradually reduced the use of health services once housing was obtained, therefore, this suggests that the program is effective in reducing clinical needs among chronically homeless of adults in general.

Department of Veterans Affairs

On November 3, 2009, United States Secretary Eric K. Shinseki spoke at the National Summit on Homeless Veterans and announced his plan.[ undue weight? discuss ]

Along with President Barack Obama, Shinseki outlined a comprehensive five-year plan to strengthen the Department of Veterans Affairs and its efforts to end veteran homeless. [26] The goal was to end veteran homelessness by 2015, but because of budget constraints that has now been pushed to 2017. [27] The plan focused on prevention of homelessness along with help for those living on the streets. [28] The plan would expand mental health care and housing options for veterans, and would collaborate with: [28]

The prominent role of the Department of Veterans Affairs and its joined up approach to veteran welfare help to distinguish the US response to veteran homelessness internationally. [29] In 2009, a hotline was established to assist homeless veterans. As of December 2014, of the 79,500 veterans who contacted the call center, 27% were unable to speak to a counselor, and 47% of referrals led to no support services provided to the homeless veteran. [30]

A study published in the American Journal of Addiction showed a link between veterans' trauma of mental disorders and their substance abuse. [31]

Housing interventions with veterans

A study conducted by O’Connell, Kasprow and Rosenheck is a secondary analysis of data from the evaluation of the HUD-VASH initiative that began in 1992 to provide housing for veterans with psychiatric disorders. They compared the results of three kinds of interventions with 460 veterans across nineteen sites in the country. They were assigned to three groups; one group was given a voucher and intensive case management, one group was given intensive case management only, and one group was given standard care only. [32] Intensive case management included help locating an apartment, while standard care which consisted of short-term broker case management provided by the Health Care for Homeless Veterans outreach workers. An evaluation assistant conducted follow up interviews every three months for up to five years. Through that they found that individuals in the intensive case management group had lower scores on quality of life which was measured by the Lehman Quality of Life Interview. This is a structured questionnaire to assess the life circumstances of persons with severe and persistent mental illness. [33]

Housing failure is defined as experiencing homelessness for at least one day. Before intake, 43% (n=170) has been homeless between one and six months and 27% (n=105) has experienced homelessness for two years or more. [32] The risk factors are the greatest in the first few months of being housed due to the more structured and supervised setting. Weekly face to face contact, community-based care and services offered by the VA were encouraged, which is vastly different from the life they were used to before this program. The veterans were tracked for five years and the statistics changed vastly over that time. 72% of participants remained housed after one year (N=282), 60% after two (N=235), 52% after three (N=204), 47% after four years (N=184) and 36% after five years (N=141) (5). Those in the HUD-VASH group has a lower risk of returning to homelessness over the course of five years had an 87% lower risk compared to those in intensive care management only group and 76% compared to those in standard care. [32] The greatest risk factor for returning to homelessness was either due to drugs or due to PTSD. Overall, after five years of follow up, 44% of all participants (N=172) returned to homelessness for at least one day after being successfully placed into housing. [32]

Studies of housing first for veterans

To end homelessness among veterans, new resources and program expansions were introduced. One of the goals set by the U.S. Department of Housing and Urban Developments Veterans Affairs Supportive Housing (HUD-VASH) is to place veterans experiencing homelessness in permanent housing. A housing first approach has been introduced to help support this initiative. One of the goals of Housing First is the rapid placement of veterans to directly from the streets to a permanent home.

Housing first approach works with the HUD supplying housing assistance through a voucher program while the VA provides case management and supportive services through its healthcare system. [34] By having permanent housing, there is a decrease in the usage of shelters, hospitals and correctional facilities. This program is available in all 50 states, the District of Columbia and Guam.  

A study by Montgomery, Hill, Kane and Culhane was a demonstration that was initiated in 2010 and studied the housing methods in the United States for homeless veterans. They evaluated the efficiency of the Housing First (HF) approach compared to a Treatment as Usual (TAU) approach. HF targeted those were experiencing street homelessness while TAU served more women and families. Veterans placed in HF were offered services such as social workers, vocational trainers, a housing specialist and access to a psychiatrist.  Most importantly, HF would issue a housing voucher at the time of lease signing for pre-inspected apartments which were maintained by a contractor. Veterans in the TAU approach received the standard VA case management services for HUD-VASH. [35] In TAU, they remained at their current placement, which could sometimes include an emergency shelter, or they were placed in transitional housing or residential treatment programs.

The study found that the HF has the most effective model in accessing permanent housing and has shown efficiency in reducing rates of homelessness with veterans. [35] Compared to TAU, HF was more successful at quickly moving veterans into permanent housing, their moving process took approximately one month while the TAU approach took about six months. [35] The housing retention rate for HF was 98% and 86% for TAU, meaning that those using the HF model were more likely to maintain housing stability. [35]

Charity

JROTC cadet from Wilson High School assists at a "Stand Down" event.

In addition to government provided aid, private charities provide assistance to homeless veterans as well. [36] These include providing some homeless veterans vehicles to live in, [37] and building permanent housing for others. [38] Advocating for the rights of homeless veterans through policy implementation and recommendations. [39] Throughout the nation, multiple organizations and agencies host "Stand Down" events where homeless veterans are provided items and services; [40] the first of these was held in San Diego, organized by Vietnam veterans, in 1988. [41]

Homes For Heroes is a US for-profit and non-profit company that provides partner-savings to Veterans buying a home, and offers monetary grants to Veterans, and other medical professionals and first-responders buying a home. [42]

Homes For Angels is a Texas program that provides discounted, affordable real estate services to Veterans and other first-responder service professions buying a home. [43]

Ending veteran homelessness

In November 2009, Secretary of Veterans Affairs (VA) Eric K. Shinseki set out the goal of ending veterans experiencing homelessness by 2017.  While not all veterans are housed, the current housing initiatives such as the housing first model are ensuring that housing is obtained for a larger portion of veterans experiencing homelessness. In 2019, the HUD-VASH program was able to house more than 11,000 veterans. [44] Overall, since 2008, more than 114,000 veterans experiencing homelessness have been served through the HUD-VASH program. [44] Also, more resources are being implemented to assist with mental health and addiction. As of 2019, more than 78 communities and the entire states of Connecticut, Delaware and Virginia have effectively ended homelessness among veterans. [44]

Related Research Articles

<span class="mw-page-title-main">United States Department of Housing and Urban Development</span> Federal government department

The United States Department of Housing and Urban Development (HUD) is one of the executive departments of the U.S. federal government. It administers federal housing and urban development laws. It is headed by the secretary of housing and urban development, who reports directly to the president of the United States and is a member of the president's Cabinet.

<span class="mw-page-title-main">United States Department of Veterans Affairs</span> Department of the United States government

The United States Department of Veterans Affairs (VA) is a Cabinet-level executive branch department of the federal government charged with providing lifelong healthcare services to eligible military veterans at the 170 VA medical centers and outpatient clinics located throughout the country. Non-healthcare benefits include disability compensation, vocational rehabilitation, education assistance, home loans, and life insurance. The VA also provides burial and memorial benefits to eligible veterans and family members at 135 national cemeteries.

<span class="mw-page-title-main">Veteran</span> Experienced worker or military retiree

A veteran is a person who has significant experience and expertise in an occupation or field.

<span class="mw-page-title-main">Homelessness in the United States</span>

In the United States, the number of homeless people on a given night in January 2023 was more than 650,000 according to the Department of Housing and Urban Development. Homelessness has increased in recent years, in large part due to an increasingly severe housing shortage and rising home prices in the United States.

<span class="mw-page-title-main">Homeless shelter</span> Service agency that provides temporary residence for homeless people

Homeless shelters are a type of service that provides temporary residence for homeless individuals and families. Shelters exist to provide residents with safety and protection from exposure to the weather while simultaneously reducing the environmental impact on the community. They are similar to, but distinguishable from, various types of emergency shelters, which are typically operated for specific circumstances and populations—fleeing natural disasters or abusive social circumstances. Extreme weather conditions create problems similar to disaster management scenarios, and are handled with warming centers, which typically operate for short durations during adverse weather.

<span class="mw-page-title-main">Veterans Health Administration</span> Health service for former United States military personnel

The Veterans Health Administration (VHA) is the component of the United States Department of Veterans Affairs (VA) led by the Under Secretary of Veterans Affairs for Health that implements the healthcare program of the VA through a nationalized healthcare service in the United States, providing healthcare and healthcare-adjacent services to veterans through the administration and operation of 146 VA Medical Centers (VAMC) with integrated outpatient clinics, 772 Community Based Outpatient Clinics (CBOC), and 134 VA Community Living Centers Programs. It is the largest division in the department, and second largest in the entire federal government, employing over 350,000 employees. All VA hospitals, clinics and medical centers are owned by and operated by the Department of Veterans Affairs, and all of the staff employed in VA hospitals are federal employees. Because of this, veterans that qualify for VHA healthcare do not pay premiums or deductibles for their healthcare but may have to make copayments depending on the medical procedure. VHA is not a part of the US Department of Defense Military Health System.

The National Coalition for Homeless Veterans (NCHV) — an American 501(c)(3) nonprofit organization governed by a 17-member board of directors is a resource and technical assistance center for some community-based service providers and local, state and federal agencies that provide emergency and supportive housing, food, health services, job training and placement assistance, legal aid and case management support for homeless veterans.

<span class="mw-page-title-main">Homeless women in the United States</span>

Out of 10,000 female individuals 13 are homeless in the United States. Although studies reflect that circumstances vary depending on each individual, the average homeless woman is 35 years old, has children, is a member of a minority community, and has experienced homelessness more than once in their lifetime.

Housing First is a policy that offers unconditional, permanent housing as quickly as possible to homeless people, and other supportive services afterward. It was first discussed in the 1990s, and in the following decades became government policy in certain locations within the Western world. There is a substantial base of evidence showing that Housing First is both an effective solution to homelessness and a form of cost savings, as it also reduces the use of public services like hospitals, jails, and emergency shelters. Cities like Helsinki and Vienna in Europe have seen dramatic reductions in homelessness due to the adaptation of Housing First policies, as have the North American cities Columbus, Ohio, Salt Lake City, Utah, and Medicine Hat, Alberta.

Endeavors, formerly known as Family Endeavors, is a non-profit organization that provides programs and services towards community, disaster relief, employment, housing, mental health, and veteran family services in the United States.

<span class="mw-page-title-main">Housing</span> Living spaces

Housing refers to the usage and possibly construction of shelter as living spaces, individually or collectively. Housing is a basic human need and a human right, playing a critical role in shaping the quality of life for individuals, families, and communities, As such it is the main issue of housing organization and policy.

<span class="mw-page-title-main">Homelessness</span> Lacking stable, safe, functional housing

Homelessness, also known as houselessness or being unhoused or unsheltered, is the condition of lacking stable, safe, and functional housing. The general category includes disparate situations, such as living on the streets, moving between temporary accommodation such as family or friends, living in boarding houses with no security of tenure, and people who leave their domiciles because of civil conflict and are refugees within their country.

<span class="mw-page-title-main">Homes for Heroes Act of 2013</span>

The Homes for Heroes Act of 2013 is a bill that was introduced into the United States House of Representatives in the 113th United States Congress on January 23, 2013. The bill would create a Special Assistant for Veterans Affairs in the Department of Housing and Urban Development (HUD) with responsibilities related to making sure United States military veterans get fair access to housing and homeless assistant programs.

<span class="mw-page-title-main">United States military veteran suicide</span> Suicide among veterans of the United States armed forces

United States military veteran suicide is an ongoing phenomenon regarding the high rate of suicide among U.S. military veterans in comparison to the general civilian public. A focus on preventing veteran suicide began in 1958 with the opening of the first suicide prevention center in the United States. During the mid-1990s, a paradigm shift in addressing veteran suicide occurred with the development of a national strategy which included several Congressional Resolutions. More advancements were made in 2007, when the Joshua Omvig Veterans Suicide Prevention Act created a comprehensive program including outreach at each Veterans Affairs Office (VA) and the implementation of a 24-hour crisis hotline. PTSD, depression, and combat-related guilt in veterans are often related to suicide as it can be difficult for veterans to transition to civilian life.

Homelessness and aging is a largely neglected topic in the literature. There is a widespread assumption that aged homeless people are rare, but this is not true. Japan, Australia and the United Kingdom show increases in their populations of aging homelessness. Increased Elderly adults who straddle the poverty line are at greater risk of falling into pathways of homelessness. When a homeless person enters their later years, or becomes homeless for the first time in older age, health issues can become difficult to address and compound as age progresses.

<span class="mw-page-title-main">Homelessness in Colorado</span>

Homelessness is a growing problem in Colorado and is considered the most important social determinants of health. Homelessness is very difficult for many Coloradoans to escape due to the continuous increase in costs for housing in Colorado, along with mental health treatments and other factors. When people are forced to live without stable shelter, they are then exposed to a number of risk factors that affect physical and mental health. Although it is difficult to pin point any one cause of homelessness, there is a complicated combination of societal and individual causes.

<span class="mw-page-title-main">Homelessness in California</span>

The United States Department of Housing and Urban Development estimated that more than 181,399 people were experiencing homelessness in California in January 2023. This is one of the highest per capita rates in the nation, with 0.46% of residents estimated as being homeless. More than two-thirds of homeless people in California are unsheltered, which is the highest percentage of any state in the United States. 49% of the unsheltered homeless people in the United States live in California. Even those who are sheltered are so insecurely, with 90% of homeless adults in California reporting that they spent at least one night unsheltered in the past six months.

<span class="mw-page-title-main">Homelessness in Oregon</span>

In 2016, a report from the Department of Housing and Urban Development (HUD) revealed that the U.S. state of Oregon had an estimated homeless population of 13,238 with about 60.5% of these people still unsheltered. In 2017, these numbers were even higher. As of January 2017, Oregon has an estimated 13,953 individuals experiencing homelessness. Of this homeless population, 1,083 are family households, 1,251 are veterans, 1,462 are unaccompanied young adults, and 3,387 are individuals experiencing chronic homelessness. As of 2022, 17,959 people total experienced homelessness in Oregon, with 2,157 individuals being youth under 18, 6,671 being female, 10,931 being male, and 131 being transgender. Also among the 17,959 total homeless in 2022, 15,876 were Non-Hispanic/Non-Latino, 2,083 were Hispanic/Latino, 13,960 were white, 1,172 were Black, African American, or African, 101 were Asian or Asian American, 880 were Native American, and those of multiple race were 1,619. Oregon has seen an increase in its total homeless population consistently every year since 2010. In last three years specifically Oregon has seen a 98.5% increase 2021-2022, 22.5% increase 2020-2021, and a 13.1% increase 2019-2020.

Rani A. Hoff is a professor of psychiatry and a director of a national center for Post-traumatic stress disorder (PTSD) at Yale University.

Supportive Services for Veteran Families (SSVF) was established by the United States Department of Veterans Affairs (VA) in 2011 to create public-private partnerships to rapidly re-house homeless Veteran families and prevent homelessness for very low-income Veterans at imminent risk due to a housing crisis. SSVF has been led since its inception by John Kuhn, the previous VA National Director of Homeless Evaluation.

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