24
Dec
08

188. Home for The Brave Part II

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This is the second in the series of the essay by a “concerned citizen” addressing homeless veterans. Part I can be found here.

Home For The Brave:Part II

The Causes of Veteran Homelessness
While it is easy to lay the problem of veteran homelessness solely on inadequate public policy failing to provide sufficient services to veterans reintegrating into society, it is also important to understand the underlying causes of veteran homelessness. A case can be made that, like non-veteran homelessness, even with adequate resources in place, communities would continue to experience some veteran homelessness due simply to the medical and mental health conditions experienced by the veteran’s themselves, either due to pre-existing conditions or to conditions developed during service. The VA has begun to assess potential service-members prior to military service regarding pre-existing risk factors like pre-existing medical and personality disorders, substance abuse, anti-social conduct, criminal history, low levels of education, and domestic issues. However, evidence shows that some policy changes exacerbated veteran homelessness by affecting the quality of the persons entering service.

First, the All Volunteer Force (AVF) is pointed to by some researchers as a partial answer to veteran homelessness. Instituted in 1973, the AVF prevented the military from having a representative sample of the male population. Instead, the practice attracted men who had weak family ties, a lack of social support, substance abuse and mental health problems, and disadvantaged childhoods. Age cohort studies have supported this argument: in 1987, there was a disproportionate risk of homelessness among veterans aged 20-34 (veterans of early AVF) and in 1996 the same cohorts, now aged 35-44 were still disproportionally represented among the homeless12. In Maine, the same cohort continues to be chronically homeless: almost half of the homeless veterans in the HMIS in 2007 were aged 45 – 5413. This is an astonishing fact: it indicates that this same group of veterans has been experiencing homelessness for the last 35 years! This is also evidenced by anecdotal data from local emergency shelters, particularly in Cumberland County, where some of residents have been homeless and residing in the same emergency shelter for more than 20 years. Regardless, the implementation of a public policy that moved from selective draft to volunteerism pre-disposed the military service membership to risks for post-service reintegration and stability issues.

Second, the recent (4 years or less) deployment of National Guard and Reserves to Iraq and Afghanistan is increasing the number of veterans. Although the benefit of these “stand-by” reserves to protect the homeland is irreplaceable, the continued policy of volunteerism coupled with the unexpected experience with active combat duty also exacerbates the problem of post-service reintegration and stability issues as these reserves experience combat duty. Although many reservists and guards are ex-military, many of them had not previously experienced active military duty. Therefore, these reservists were unexpectedly exposed to active combat that placed them at risk for development or exacerbation of medical and mental health issues – bringing both an increase in at risk veterans and a new dimension of issues to the post-service traumatized veteran cohort that had not been previously anticipated.

Third, a woman in combat is also a new phenomenon. Research shows that this military demographic brings with it children and a high incidence of trauma. Sexual trauma – pre-service, during service, and post-service are common denominators for women exiting military service and entering homelessness. Research indicates that women with these and other home-based traumas are significantly more likely to enter military service as an escape and more likely to enter homelessness post-service as a means to not re-enter abusive situations.

Another interesting factor of post-military homelessness is the factor of age of entry into service. Younger persons who enter military service without first having to maintain housing on their own (i.e., renting apartments, houses, or college dormitory settings), provide services through the military and then return home – only to find that this housing is not open nor a long-term solution – and find themselves in unfamiliar housing territory and unable to cope with the activities associated with maintaining self-sufficient housing. As an adjunct to this problem, the stress associated with instability of housing exacerbates other post-military issues like mental illness and substance abuse. There is research undergoing to assess the connection between age and pre-service circumstance and post-service needs.

Still, not to be under stressed, evidence shows that the Department of Defense and the Department of Veterans Affairs both drastically underestimated the need for services and did not plan appropriately to alleviate risk factors both pre- and post-deployment. Lack of pre-service evaluation resulted in missed opportunities to identify and alleviate potential high risk service-members and lack of services post-service cannot accommodate even a fraction of those homeless or considered at risk.

Another reason for veteran homelessness is the barrier of discharge status and its link to eligibility for VA pensions and benefits. Less-than-honorable discharges keep veterans with income, physical/mental health, and social connection support needs from receiving those services. Although less-than-honorable veterans can apply to the VA for a discharge status change, the VA admits that the process for doing so is in itself a long, complicated, barrier-ridden journey – a journey that many veterans already experiencing instability don’t have the strength to pursue.

                         Addressing Veteran Homelessness
There are three primary domains of activities that will alleviate homelessness, including veteran homelessness: access to housing, access to income, and access to treatment and supportive services. Given these three domains, there are a number of recommended activities that will advance a solution to ending and preventing veteran homelessness.

Access to Housing
Increase transitional housing opportunities for veterans at reintegration. The purpose of transitional housing is to provide, for a 2 year time frame, stable housing coupled with support services. The goal is for the veteran to obtain self-sufficiency at program end. Currently, the median length of stay in transitional housing is 89 to 95 days for individuals (appr. 3 months) and 151 days for families14 (appr. 5 months); Maine’s Rental Assistance Coupon+ transitional housing voucher program reports an average stay in the program of 9 ½ months to one year15. Because of the inclusion of support services aimed at self-sufficiency, transitional housing programs are well suited to the intent of reintegration services – particularly for veterans who were inexperienced with maintaining self-sufficiency pre-service.
Increase permanent housing opportunities for veterans.
Rental Assistance: While many veterans reintegrating will eventually return to homes, families and a normal lifestyle, many others will have developed physical and mental disabilities that will be challenging to overcome, if it is possible at all. Permanent housing solutions for this subset of veterans would include availability of housing near services coupled with ongoing rental support.
Homeownership Opportunities: Since research shows that veterans are more likely to obtain and retain homeownership than their non-veteran counterparts, a permanent housing program targeted to veterans that leverages this tendency would be an excellent solution for long-term permanent housing. Coupled with personal finance management and homeownership education, homeownership opportunities for reintegrating veterans are likely to decrease their risk of homelessness through stabilization of housing, a sense of ownership, and responsibility.
Homes for the Brave – Habitat for Humanity Veteran Housing and Repair Program: The success of the Habitat for Humanity program is undeniable. Developing a like program that targets veteran housing needs would be advantageous and cost effective. An expansion of this program to include home repair or upgrades to accommodate physical disabilities (wheelchair ramps, accessibility issues, etc.) would support long-term housing solutions. Many building material suppliers have both the means to provide materials for this good cause as well as the ability and resources to organize skilled builders and carpenters.

Access to Income
Increase job and career related activities:
Job/Career Training: A major barrier to reintegration for veterans is the non-transfer of military skills to civilian job skills. As part of reintegration activities, job and career training programs for marketable skill development should be mandatory. Veterans should have ongoing access to marketable skill development resources.
Educational Opportunities: As a companion to job and career training, reintegrating veterans should be quickly introduced to the educational system as a means to develop marketable skills.
Back to Work programs: As a companion to job/career training and educational opportunities, Back to Work programs should be implemented to support veterans as they join the work force. These programs should include support on appropriate employee/employer relations, appropriate personal hygiene in the workplace, and conflict resolution.
Provide short-term/temporary income supports: As veterans reintegrate into civilian life, they will lose the monthly income provided by the military. Short-term income supports should be put in place to stabilize veterans as they transition to the workforce or are connected to mainstream incomes supports (SSI, SSDI, etc.).
Increase accessibility of long-term income supports: Due to physical and mental health conditions mentioned above, some veterans will not be able to transition into the workforce. These veterans will need to be introduced to and quickly absorbed into mainstream income support programs, including VA disability income programs, to lessen the risk of both homelessness and exacerbation of health problems. Direct assistance in applying for and retaining these benefits should be part of their treatment programs, and veteran applicants should be favored with expedited application processing, approval, and appeals processes.

Access to Treatment and Supportive Services
Increase access to healthcare benefits: The primary barrier to assessing treatment for physical, mental, and substance abuse problems is access to healthcare benefits and/or medical insurance.
Potential Combat Related Conditions: Veterans are unique in that, provided they have an eligible discharge status, they are immediately eligible for free healthcare through the VA for conditions possibly related to combat. This eligibility extends for 2 years from discharge date. Because there is usually a delay in the onset of PTSD, it is recommended by experts that this eligibility timeframe be increased to 5 years. Additionally, for chronic homeless veterans diagnosed with a combat related condition who become engaged after the eligibility time frame as expired, the time frame condition for eligibility should be waived. This one recommendation would provide healthcare for the group of chronic homeless veterans who were first identified as AVF veterans in 1973, greatly enhancing chances of engagement, stabilization, and self-sufficiency of this group.
Loosen eligibility guidelines: VA guidelines are very strict regarding those serving in the military and those who actually quality for services and pensions. These guidelines should be reviewed and updated to reflect the reality of the nature of today’s veteran characteristics and medical trends.
Conduct pre- and post- deployment evaluations: Evaluations of and pro-active mediation of pre-existing circumstances and conditions of service-members would:
Pro-actively address conditions that could be exacerbated during service.
Decrease the number of less-than-honorable discharges caused by exacerbation of pre-existing conditions during active service.
Change policy regarding medical holds for PTSD: Veterans routinely inaccurately answer the Post Deployment Health Assessment (PDHA). Veterans have indicated that they do this to avoid the stigma associated with mental health needs: fear of the impact to their military or civilian careers and because they are told if they admit need they will be placed on medical hold and not allowed to return home after deployment. This policy change is particularly critical for veterans returning from Iraq and Afghanistan, where the nature of the deployment predisposes them to PTSD.
Increase access to ongoing case management services:
Increasing VA case management staff to adequately address the volumes of veterans seeking and needing services is essential. The current case load in Maine for VA homeless case managers is currently 35 veterans to 1 case manager.

                                                        Conclusion
These recommendations for addressing veteran homelessness will require policy and system change that will not easily be achieved. Achieving these recommendations will require a change in mindset about what solutions work as well as a willingness to change both funding policy and system design. The lack of specific goals and objectives to address veteran homelessness in Maine’s Plan to End & Prevent Homelessness is a clear indication how great these barriers will be.

Of all of the social programs run by the government, those targeted to veterans should be the best funded and most supported. Veterans have put their lives on the line and lost pieces of themselves – their lives, bodies, and minds – to protect our ideals and property from harm. They have paid a price far higher than the rest of us when it comes to preserving our way of life, and they deserve better than a life of untreated physical and mental illness and a home that is the street. Implementation of programs that achieve permanent housing for veterans while treating physical and mental illness will achieve something Maine veterans deserve – a home for the brave.

1 WikiAnswers, 10/01/2008, http://wiki.answers.com/Q/How_many_people_in_US_Army_as_of_2007
2, Vital Mission: Ending Homelessness Among Veterans, November 2007, National Alliance to End Homelessness
3 Ibid
4 “New Numbers of Homeless Vets Announced”, National Coalition for Homeless Veterans, 3/6/2008, http://www.nchv.org/news_article.cfm?id=353
5 VFW Washington Weekly, Oct 10, 2008, http://www.vfw.org/washingtonweekly/2008/ww10102008.pdf
6 In compliance with the HMIS Data and Technical Standards, veteran status is self-reported by victims accessing homeless services. Status is not verified through the VA and cross pollination of data sets to accurately identify mutual clients does not currently occur. It is a known data collection problem that veterans, in particular women, do not accurately identify themselves as veterans when presenting themselves for serves, for a variety of reasons stemming from eligibility for services fears.
7 Count of unique IDs of homeless persons identifying as veterans in the Maine Statewide Homeless Management Information System (HMIS), Maine Housing, Division of Community Development and Planning, October 2008
8 HUD- VASH program allocation numbers, 2007, Maine’s allocation of the national funds at an expected housing cost rate would create 35 HUD vouchers for permanent housing rent coupled with VA supportive services and case management. http://www.HUD.gov
9 Maine’s Plan to End & Prevent Homelessness, March 2008, http://www.mainehousing.org/Documents/HousingReports/MainePlanToEndAndPreventHomelessness.pdf
10 Homelessness in Maine – 2007, http://www.mainehousing.org/Documents/Homeless/Homeless-2007HomelessnessAnnualReport.pdf
11 Based on housing cost analysis of all homeless, Cost of Homelessness, Cost Analysis of Permanent Supportive Housing, State of Maine – Greater Portland, Sept 2007. Maine State Housing Authority (MaineHousing)
12 Vital Mission: Ending Homelessness Among Veterans, November 2007, National Alliance of Homelessness
13 Analysis of homeless persons identifying as veterans in the Maine Statewide Homeless Management Information System (HMIS), Maine Housing, Division of Community Development and Planning, October 2008
14 The Third Annual Homeless Assessment Report to Congress, July 2008, http://www.hudhre.info/documents/3rdHomelessAssessmentReport.pdf
15 http://www.mainehousing.org/Documents/Homeless/Homeless-2007HomelessnessAnnualReport.pdf

 

**Wanderingvets thanks this author for sharing her work through Wanderingvets.

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