A Housing First evaluation project for homeless Veterans in Canada: Quantitative findings

LAY SUMMARY This study sought to evaluate a Housing First program for Veterans experiencing homelessness. Housing First is an approach made up of many different aspects of care including peer support and greater access to care resources within the home. These aspects of care are offered in order to address underlying issues and maintain housing stability. The program was implemented across four cities in Canada including London, Toronto, Calgary, and Victoria. To assess the program, interviews with Veterans were conducted at time of enrollment, 3, 9, and 15 months. The Veterans in this study demonstrated a significant reduction in homelessness. As well, a significant reduction in emergency room visits was reported. Other health care interactions and quality-of-life scores remained stable. These findings could, therefore, lead to potential future cost savings in the health care sector. This study demonstrates why this approach to housing for Veterans can be a highly effective and useful way to ensure housing stability.

Predictors of COVID-19 Vaccination among Veterans Experiencing Homelessness

Sufficient uptake of the COVID-19 vaccine is key to slowing the spread of the coronavirus among the most vulnerable in society, including individuals experiencing homelessness. However, COVID-19 vaccination rates among the Veteran homeless population are currently unknown. This study examines the COVID-19 vaccination rate among homeless Veterans who receive care at the U.S. Department of Veterans Affairs (VA), and the factors that are associated with vaccine uptake. Using VA administrative and clinical data, bivariate and multivariate analyses were conducted to identify the sociodemographic, health-related, and healthcare and housing services utilization factors that influenced COVID-19 vaccine uptake during the first eight months of the vaccine rollout (December 2020–August 2021). Of the 83,528 Veterans experiencing homelessness included in the study, 45.8% were vaccinated for COVID-19. Non-white, older Veterans (65+), females, those who received the seasonal flu vaccine, and Veterans with multiple comorbidities and mental health conditions were more likely to be vaccinated. There was a strong association between COVID-19 vaccination and Veterans who utilized VA healthcare and housing services. VA healthcare and homeless service providers are particularly well-positioned to provide trusted information and overcome access barriers for homeless Veterans to receive the COVID-19 vaccine.

Qualitative findings from a Housing First evaluation project for homeless Veterans in Canada

LAY SUMMARY This two-year study implemented a Housing First approach among homelessness services for Veterans in four cities across Canada (Victoria, Calgary, London, and Toronto). This approach included peer support and harm reduction resources for Veterans. To obtain a detailed evaluation of personal experiences and opinions, focus groups were held with Veterans, housing staff, and stakeholders at three time points during the study: July-September 2012, May-June 2013, and January 2014. Harm reduction and peer support were regarded as positive aspects of this new approach to housing and homelessness. It was suggested that greater mental health support, support from peers with military experience, and issues regarding roommates should be considered in future implementations of housing services for Veterans. It was also noted that to support personal stabilization, permanent housing is preferred over transitional or temporary housing. Future housing programs serving Veterans experiencing homelessness should consider the addition of harm reduction and peer support to further enhance services and help maintain housing stability.

Differences in disease prevalence among homeless and non-homeless veterans at an urban VA hospital

Objectives Approximately 10% of homeless adults in the US are veterans and that number is increasing. Veterans who experience homelessness tend to do so for longer periods compared to non-veterans; and homelessness is associated with more chronic disease complications. We compared the prevalence of five chronic, ambulatory-care sensitive conditions in homeless and domiciled individuals who received primary care at an urban VA hospital. Methods Data were obtained from the Veteran’s Hospital Administration clinical data warehouse. Differences in disease prevalence were compared between the two groups using chi-square analyses and then adjusted for age, gender, race/ethnicity, BMI, and other risk factors where appropriate, using logistic regression. All analyses were conducted using SAS version 9.4. Results Homeless individuals were 46% more likely to have asthma (OR 1.46, 95% CI 1.16–1.84) and 40% more likely to have COPD (OR 1.40, 95% CI 1.14–1.73) after adjustment for age, gender, race/ethnicity, BMI, and tobacco use status. After adjustment for covariates, there was no difference between homeless and domiciled veterans in the prevalence of diabetes, hypertension, or congestive heart failure. Discussion Future quality improvement projects should identify social-environmental risk factors like employment characteristics, and housing quality that can impact chronic respiratory illness prevalence and associated complications.