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Homeless Veterans at Life’s End Produced by the

Veterans Advisory Council A taskforce of the National Hospice and Palliative Care Organization


Goals • This presentation provides an overview of a very serious concern facing our nation’s Veterans: homelessness. While this very important subject deserves far more attention than the slides can provide, its purpose is to raise awareness and provide sufficient resources for further exploration, continued education and skill building.


What is Homelessness • The Stewart B. McKinney Act (PL100-77) is the only major federal legislative response to homelessness. • Title I of the McKinney-Vento Act defines homelessness as: – A homeless person is one who lacks a fixed, regular and adequate nighttime residence; and – One who has a primary nighttime residence that is • a supervised publicly or privately operated shelter, • a temporary residence for individuals intended to be institutionalized, or • a public or private place not ordinarily used as a regular sleeping accommodation for human beings.


Estimates • Although the transient nature of homeless populations presents a major challenge in accurate counting, the VA estimates that 131,000 Veterans are homeless on any given night. • Furthermore, over the course of a year, approximately twice that many Veterans experience homelessness. http://www.mentalhealth.va.gov/homelessness.asp. Accessed 7/30/2012


Homeless Veterans Facts • Only eight percent of the general population in the United States can claim Veteran status but nearly one fifth (20%) of the homeless population are Veterans. • Nearly half of homeless Veterans served during the Vietnam era. • Two-thirds served our country for at least three years, and one third were stationed in a war zone. • 89% received an honorable discharge. Reference: http://www.nchv.org/background.cfm#facts 5


Additional Data • The U.S. Department of Veteran’s Affairs states that almost all homeless Veterans are male, with women representing only about 3% of the homeless population. • The vast majority are single, and most come from poor, disadvantaged backgrounds. • Homeless Veterans also tend to be older and more educated than non-Veteran homeless citizens. www.wehonorveterans.org. Accessed 07/30/2012


Service Demographics • America’s homeless Veterans have served in – – – –

World War II the Korean War The Cold War The Vietnam War

– – – –

Grenada Panama Lebanon Afghanistan and Iraq (OEF/OIF)

• And also in the military’s anti-drug cultivation efforts in South America


Homeless Demographics • Currently, the number of homeless male and female Vietnam-era Veterans is greater than the number of service persons who died during that war. • A small number of Desert Storm Veterans are also now appearing in the homeless population. www.wehonorveterans.org. Accessed 07/30/2012


Additional Details… • Roughly 56 percent of all homeless Veterans are African American or Hispanic, despite only accounting for 12.8 percent and 15.4 percent of the U.S. population respectively. • About 1.5 million other Veterans are considered at risk of homelessness due to poverty, lack of support networks, and poor living conditions in cheap hotels, overcrowded or inadequate housing.


Why Are Veteran’s Homeless? • There are a complex set of factors affecting homelessness. These include: – An extreme shortage of affordable housing, livable income, and access to health care – Lingering effects of Post Traumatic Stress Disorder (PTSD) – Substance abuse – Lack of family and social support networks


Causes of Veteran Homelessness • Although many homeless Veterans served in combat in Vietnam and suffer from PTSD, the VA states that epidemiological studies do not suggest that there is a connection between military service, service in Vietnam, or exposure to combat and homelessness among Veterans. • The VA believes that family background, access to support from family and friends, and various personal characteristics (rather than military service) seems to be the stronger indicators of risk of homelessness. www.wehonorveterans.org. Accessed 07/30/2012


Facts about Homeless Veterans • 45% of homeless Veterans suffer from mental illness • 70% suffer from substance abuse problems • 58% have health/physical problems, and • 46% are age 45 or older compared to 20% of non-Veteran homeless citizens

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Federal Homelessness Programs • While "most homeless people are single, unaffiliated men ‌ most housing money in existing federal homelessness programs, in contrast, is devoted to helping homeless families or homeless women with dependant children,� "Is Homelessness a Housing Problem?" in Understanding Homelessness: New Policy and Research Perspectives, published by Fannie Mae Foundation in 1997.


Federal Homelessness Programs (cont.) • A top priority of Federal Homelessness Programs is to provide secure, safe, clean housing that offers a supportive environment which is free of drugs and alcohol. • To this end, every VA medical center has a homeless Veteran services coordinator who is responsible for providing outreach and services for homeless or at-risk Veterans.


Homeless Coordinator Services • Services include outreach, case management, referrals to benefits counselors, linkage to health care, and housing assistance. • Each facility is unique and services vary among each medical center. • To download a list of VA Homeless Veteran Coordinator Offices by state go to: http://www1.va.gov/homeless/ and click on “Find a Homeless Coordinator”.


VA Homeless Programs • Numerous programs exist to help homeless Veterans and Veterans at risk of homelessness. These include: – – – – –

Prevention Services, Housing and Support Services, Treatment Services, Employment and Job Training, as well as Benefits and Other Services and Resources. www.va.gov/HOMELESS

• The slides that follow will describe each of these services in greater detail.


Prevention Services Prevention Services include: • National Call Center for Homeless Veterans • Healthcare for Reentry • Veteran Justice Outreach • Supportive Services for Veteran Families Program


National Call Center for Homeless Veterans • The VA has founded a National Call Center for Homeless Veterans or Veterans at-risk for homelessness that provides free, 24/7 access to trained counselors. • The hotline is intended to assist homeless Veterans and their families, VA Medical Centers, federal, state and local partners, community agencies, service providers and others in the community.


Healthcare for Reentry • The Health Care for Re-entry Veterans (HCRV) Program is designed to address the community reentry needs of incarcerated Veterans. • HCRV's goals are to prevent homelessness, reduce the impact of medical, psychiatric, and substance abuse problems upon community re-adjustment, and decrease the likelihood of re-incarceration for those leaving prison.


Veteran Justice Outreach • The Veteran Justice Outreach (VJO) initiative was created to assist eligible Veterans involved in the justice system to have timely access to VHA mental health and substance abuse services when clinically indicated. • The VJO’s purpose is to avoid the unnecessary criminalization of mental illness and extended incarceration among Veterans by offering these and other VA services and benefits as appropriate.


Supportive Services for Veteran Families Program • The Supportive Services for Veteran Families (SSVF) Program is a new VA program that will provide supportive services to very low-income Veterans and their families who are in or transitioning to permanent housing. • VA will award grants to private non-profit organizations and consumer cooperatives who will assist very low-income Veterans and their families by providing a range of supportive services designed to promote housing stability. http://www.va.gov/homeless/ssvf.asp


Housing and Support Services Housing and Support Services include: • HUD – VA Supported Housing Program (VASH) • Grant & Per Diem • Supported Housing


HUD-VA Supported Programs • The Department of Housing and Urban Development and VA Supported Housing (HUD-VASH) Program provides permanent housing and ongoing case management treatment services for homeless Veterans who require these supports to live independently. • HUD has allocated over 20,000 “Housing Choice” Section 8 vouchers to Public Housing Authorities (PHAs) throughout the country for eligible homeless Veterans.


HUD-VA Supported Programs, continued • This program provides for our most vulnerable Veterans, and is especially helpful to Veterans with families, women Veterans, recently returning Veterans and Veterans with disabilities. • Evaluation of an earlier, similar program demonstrated that most Veteran participants remained permanently housed.


Grant & Per Diem • The Grant and Per Diem (GPD) Program is offered annually (as funding permits) by the VA to fund community-based agencies providing transitional housing or service centers for homeless Veterans. • Under the Capital Grant Component, VA may fund up to 65% of the project for the construction, acquisition, or renovation of facilities; or to purchase van(s) to provide outreach and services to homeless Veterans. • Per Diem is available to grantees to help off-set operational expenses.


Supported Housing • Like the HUD program, staff in VA's Supported Housing Program provides ongoing case management services to homeless Veterans. • Emphasis is placed on helping Veterans find permanent housing and providing clinical support needed to keep Veterans in permanent housing. • Staff in these programs operate without benefit of the specially dedicated Section 8 housing vouchers available in the HUDVASH program. • However, they are often successful in locating transitional or permanent housing through local means, especially by collaborating with Veterans Service Organizations.


Treatment Several programs are available to assist homeless or at risk veterans. These are: • Healthcare for Homeless Veterans • Veteran Stand Downs • Homeless Veteran Dental Assistance • Domiciliary Care for Homeless Veterans • Drop-in Centers


Healthcare for Homeless Veterans • The Health Care for Homeless Veterans Program (HCHV) operates at 135 sites for extensive outreach • HCHV provides physical exams, psychiatric exams, supported housing, Drop-in-Centers, referrals, treatments, and ongoing case management.

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Healthcare for Homeless Veterans • The core mission of HCHV is primarily to perform outreach to identify homeless Veterans who are eligible for VA services and assist these Veterans in accessing appropriate healthcare and benefits. • In addition to its initial core mission, HCHV also works to contract with providers for communitybased residential treatment for homeless Veterans.


What is a Stand Down? • In times of war, exhausted combat units requiring time to rest and recover were removed from the battlefields to a place of relative security and safety. • At secure base camp areas, troops were able to take care of personal hygiene, get clean uniforms, enjoy warm meals, receive medical and dental care, mail and receive letters, and enjoy the camaraderie of friends in a safe environment.


Stand Down, continued • Today, Stand Down refers to a grassroots, community-based intervention program designed to help the nation’s estimated 200,000 homeless Veterans “combat” life on the streets. • The first Stand Down was organized in 1988 by a group of Vietnam Veterans in San Diego. Since then, Stand Downs have been used as an effective tool in reaching out to homeless Veterans. • Between 1994-2000, Stand Downs have reached more than 200,000 Veterans and their family members.


Stand Downs Provide Access to Community Resources • Through Stand Downs, homeless Veterans are provided access to the community resources needed to begin addressing their individual problems and rebuilding their lives. • Just as Stand Down afforded battle-weary soldiers the opportunity to renew their spirit, health and overall sense of well-being, today’s Stand Down affords the same opportunity to homeless Veterans.


Stand Down Events • Stand Downs are typically one to three day events that provide services to homeless Veterans. • These services provide food, shelter, clothing, health screenings and counseling. VA and Social Security benefits, and referrals to a variety of other necessary services, such as housing, employment and substance abuse treatment are also available. • Stand Downs for Homeless Veterans are coordinated among local VA Medical Centers, other government agencies and community agencies serving the homeless.


Homeless Veteran Dental Assistance • The Homeless Veteran Dental Program increases accessibility to quality dental care to homeless Veteran patients and to help assure success in VA-sponsored and VA partnership homeless rehabilitation programs throughout the United States.


Domiciliary Care for Homeless Veterans • The Domiciliary Care Program is designed to provide state-of-the-art, high-quality residential rehabilitation and treatment services for Veterans with multiple and severe medical conditions, mental illness, addiction, or psychosocial deficits.


Drop-in Centers • Drop-in Centers provide a daytime sanctuary where homeless Veterans can clean up, wash their clothes, and participate in a variety of therapeutic and rehabilitative activities. Linkages with longer-term assistance are also available.


Employment/Job Training • Employment and Job Training is provided by the Compensated Work Therapy/Transitional Residence (CWT/TR) Program, also known as Veterans Industries. • The CWT/TR Program has been established for disadvantaged, at-risk, and homeless Veterans.


Compensated Work Therapy/Transitional Residence Program • Veterans in the CWT/TR program work about 33 hours per week, with approximate earnings of $732 per month. • Veterans live in community-based supervised group homes , and pay an average of $186 per month toward maintenance and up-keep of the residence.

• The average length of stay is about 174 days.


Compensated Work Therapy/Transitional Residence Program, continued • The VA contracts with private industry and the public sector for work performed by these Veterans, who learn new job skills, relearn successful work habits, and regain a sense of self-esteem and self-worth.


Benefits and Other Services Benefits and Other Services provided by the VA include: • Homeless Veteran Benefit Assistance • Property Sales for Homeless Providers • Excess Property for Homeless Veterans • Project CHALENG


Homeless Veteran Benefit Assistance • Twelve Veterans Benefit Assistance (VBA) Counselors have been specially funded to provide dedicated outreach, benefits counseling, referral, and additional assistance to eligible Veterans applying for VA benefits. • To reach more homeless Veterans, homeless Veterans coordinators have been designated at VBA’s 58 regional offices.


Homeless Veteran’s Benefits, cont. • These coordinators make over 4,700 visits annually to homeless facilities and over 9,000 contacts with nonVA agencies working with the homeless. • In addition, they provide over 24,000 homeless Veterans with benefits counseling and referrals to other VA programs. • VBA is also working to reduce the processing times for homeless Veterans' benefits claims.


Property Sales for Homeless Providers • This program makes all the properties the VA obtains through foreclosures on VA-insured mortgages available for sale to homeless provider organizations at a discount of 20 to 50 percent, depending on time of the market.


Excess Property for Homeless Veterans • This initiative provides for the distribution of excess federal personal property, such as hats, parkas, footwear, socks, sleeping bags, and other items to homeless Veterans and homeless Veteran programs. • A CWT Program employing formerly homeless Veterans has been established at the Medical Center in Lyons, NJ to receive, warehouse, and ship these goods to VA homeless programs across the country.


What is PROJECT CHALENG? • Project CHALENG stands for Community Homelessness Assessment, Local Education and Networking Groups • It was launched in 1994 by the VA and was designed to enhance the overall care provided by the local VA and its surrounding community service agencies Ref: www.va.gov/homeless/chaleng.asp


PROJECT CHALENG • The guiding principle behind Project CHALENG is that no single agency can provide the full spectrum of services required to help homeless Veterans become productive members of society. • Project CHALENG enhances coordinated services by bringing the VA together with community agencies and other federal, state, and local governments who provide services to the homeless to raise awareness of homeless Veterans' needs and to plan to meet those needs. Reference: /www1.va.gov/HOMELESS/chaleng.asp


PROJECT CHALENG continued • At the local level, VA medical centers and regional offices designate CHALENG Points of Contact (POCs) who are responsible for meeting the Project requirements. • These CHALENG Points of Contact (usually local VA homeless center/project coordinators) work with local agencies throughout the year to coordinate services for homeless Veterans.


Where to find help • National Coalition for Homeless Veterans – Phone: 1-800-VET-HELP – Email: nchv@nchv.org – Website: www.nchv.org

• VA Medical Centers – – – –

Homeless Coordinator www.va.gov/homeless homelessvet@va.gov Phone 1-877-222-VETS


Where to Find Help • State Director of Veterans Affairs – Website: www.va.gov/statedva.htm

• National Call Center for Homeless Veterans – 1-877-4AID-VET (1-877-424-3838)

• Homeless Veterans Chat links to Veterans Suicide Prevention Hotline – www.suicidepreventionlifeline.org/Veterans/Default.aspx

• For locations of Stand Downs – www.va.gov/HOMELESS/StandDown.asp – Homeless Veterans Programs Office: 202-461-7401


Where to Find Help • Veterans Service Organizations and Auxiliary Organizations (VSOs) • AMVETS www.amvets.org • Blinded Veterans Association www.bva.org • Disabled American Veterans www.dav.org • Veterans of Foreign Wars www.vfw.org • Vietnam Veterans of America www.vva.org


Where to Find Help • Veteran Homestead Hospice, Fitchburg, MA – a unique program providing hospice care to homeless Veterans in a residential, homelike setting • Website: http://Veteranhomestead.org • To view video: http://Veteranhomestead.org/video/LiveDieDignity.html


A Parting Word-Please Remember • All VA enrolled Veterans are entitled to VA payment of hospice care across all settings regardless of their service connection. • VA and hospice partnerships can improve Veterans’ access to the care and services they need at the end of life.


Homeless Veterans Self-Study