Veterans who have experienced homelessness value the option to receive health care in the community, found a study by VA researchers. The majority of Veterans surveyed had positive views of community care they received. However, coordination challenges exist when Veterans receive health care both in the community and from VA.

“Nights without shelter, current homelessness, and chronic homelessness did not appear to limit Veterans’ access to community care,” conclude the researchers. “The findings imply that VHA’s evolution from a direct provider to a payer of health services has not impeded health care access for highly vulnerable Veterans.”

The results appeared in the April 6, 2021, issue of the journal Medical Care.

In 2014, the Veterans Choice Program made it possible for eligible Veterans to receive health care from private health care organizations in the community. The program uses a network of providers to expand care for VA patients who lived far away from VA facilities or faced long wait times for appointments. The program was expanded by the MISSION Act in 2018.

Homeless Veterans have complex medical needs

While helping Veterans receive care outside VA increases their access to health care services, it could also lead to coordination problems. Some concern exists that Veterans receiving care from more than one source could result in fragmented care and poor clinical outcomes.

This may be especially true in vulnerable populations such as homeless Veterans. Homeless Veterans often have complex health care needs, with high rates of chronic medical, mental health and substance use conditions. They also often have difficulty accessing services. Because VA focuses on care coordination to manage the often-complex medical needs of homeless Veterans, there is some worry that moving care outside of the centralized VA system could cause problems.

To explore how the Veterans Choice Program affected this population, researchers surveyed nearly 5,000 Veterans in a 2018 mail survey. The survey was conducted before the MISSION Act was implemented in 2019. The survey recruited Veterans with recent experiences of homelessness from 26 VA medical centers. Fourteen percent of those surveyed were currently homeless, 15% had lacked shelter in the past six months, and 19% experienced chronic homelessness.

More than 80% satisfied with their community care

About 27% of those surveyed used community care. Of those, 83% said they were satisfied with the community care they received. In addition, 75% were satisfied with how quickly they were able to receive community care.

Older Veterans, female Veterans, and those managed in a homeless patient-aligned care team (H-PACT) were more likely to be satisfied with community care. Results also showed that Veterans with psychological distress and financial hardship were more likely to use community care, a finding unique to this study.

While most Veterans surveyed were satisfied with their care, care coordination did suffer somewhat, as the researchers expected. Veterans who used both VA health care and community care reported poorer care coordination than those who only used VA. Satisfaction with community care was also lower for Veterans with fewer personal resources (i.e., travel difficulties, financial hardship, and limited social support).

Favorable perceptions of VA care coordination

According to study first author Dr. Audrey L. Jones of the VA Salt Lake City Health Care System, one place to look for lessons to improve care coordination for homeless Veterans is in the H-PACT system. H-PACT is a coordination effort that is geared specifically to the needs of Veterans experiencing homelessness. “We found homeless-experienced Veterans managed in H-PACT, compared to other PACTs, were more satisfied with their time to receive community care,” explains Jones. “They also had more favorable perceptions of VA care coordination. Taking a closer look at what works in H-PACT might help VA improve care coordination for vulnerable Veterans managed in traditional VA primary care environments.”

Although more work is needed to improve care coordination, the results show that a community care option can be valuable for homeless Veterans, according to the researchers. “Initiatives to improve the coordination of health care across VA and community care settings will continue to be important as more Veterans choose community care option,” says Jones.

The findings are part of a larger VA Health Service Research and Development (HSR&D) study to determine which factors of H-PACT matter most. The researchers, led by Dr. Stefan Kertesz of the Birmingham VA Medical Center and the University of Alabama, Birmingham, hope to identify specific components of H-PACT – such as on-site services, staffing, and team culture – that promote positive care experiences for homeless Veterans.

More Information

Click here to learn more about VA research.

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Published on May. 4, 2021

Estimated reading time is 3.7 min.

Views to date: 252


  1. Raymond L. Edwords Jr. May 10, 2021 at 4:03 pm

    Even responding on this site is a joke I’m done it twice and it’s been deleted. The idea that 80% of homeless veterans are happy with their Healthcare is a joke. They cherry-pick the result. I don’t know one veteran homeless or otherwise that thinks the VA is great or even average. We see the billions and billions of dollars going to a system that doesn’t equate to better care. And the people are the same. When I was a kid and people went to the VA we felt sorry for them. Now I’m one of those people and I’m sorry too! It might be free but you get what you pay for. the politicians get free healthcare too. It’s not the same free health care we get! Thanks VA we know you care

  2. Raymond L. Edwords Jr. May 10, 2021 at 3:58 pm

    Notice how the VA markets and sells everything, your data, they market businesses on their site those businesses get tremendous advertising for low input the corruption of business and the VA is a shame and a sin. I’m embarrassed that I’m homeless and only have the Va. YOU have to fight for everything. The homeless that really need the help can’t access it because the system is too complex and hard to maneuver even for educated people it is astounded ignorant.. the whole system is just too hard to maneuver and there’s too many va people that are just punching a ticket they turn everything around on you. you ask for help they tell you where to go get it but you have to work for it, the runaround. It’s so complex and self-destructive most give up. I’ve had my data used against Me by VA employees. I’ve been denied help. I’ve been denied glasses $5 glasses that’s what the VA gives you $5 glasses oh, why aren’t they American glasses. I’ve been denied housing by a corrupt VA person. I’ve been lectured for an hour and a half on homelessness buy a sleep doctor who was self important at my expense. I was given nose drops for a chronic nasal infection. It’s a klusterfk

  3. Thomas Whittingham May 6, 2021 at 12:05 pm

    They need to fix the payment / billing problem. I have used ccn two times first time I had to pay close to $2,000 in not covered by VA charges. Second time I’m more than assured that the VA will cover everything. I got three bills so far from the ER they sent me to with an Authorization number. It seems to be a question of which pocket they reach into (hospital) to get paid . VA says not covered because it was authorized by CCN (wait didn’t I call the VA for authorization?) Hospital says they billed VA, I ask why when I told them it was CCN thru VA? I was skeptical to use the CCN again but was assured by VA that It would be paid for. Never again.

  4. August May 4, 2021 at 11:51 am

    The VA considers “Any Drinking” by by a homeless veterans as Full-Blown Street-Gutter Alcoholism; it is not.

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