Running Head: HOMELESS VETERANS AS A VULNERABLE POPULATION 1

Homeless Veterans as a Vulnerable Population

Mikayla Crookshanks

Professor Kathy S. Faw RN, MSN

Bon Secours Memorial College of Nursing

NUR 3113

April 6, 2017

Honor Code “I pledge...”

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Homeless Veterans as a Vulnerable Population

According to Flaskerud and Winslow, vulnerable populations are “social groups who

experience limited resources and consequent high relative risk for morbidity and premature

mortality” (Anderson & McFarlane, 2011, p. 313). Examples of vulnerable populations can

include people of different races, ethnicities, or religions, those experiencing poverty, individuals

alienated for their sexual preferences, and immigrants or refugees from foreign countries. Due to

their lack of resources and social determinants, these groups are at a higher risk for poor

physical, mental, and social health leading to disease and illness. One group that is

unquestionably underserved from not only a community standpoint but also from a global

perspective, is homeless veterans. These brave men and women risk their lives fighting for our

freedom but yet on any given night, between 130,000 and 200,000 of them are left without

homes. Those numbers add up to around 23% of all homeless individuals being United States

veterans. Of that 23%, 67% served our country for three or more years and 89% of them received

honorable discharge from the military (“Homeless Veterans,” 2009). Many factors can lead to

veterans becoming homeless such as poor transition to civilian life, lack of resources for support,

decreases in job opportunities, and development of mental illnesses secondary to war.

Social Determinants of Health

Social determinants of health are defined as the factors within an environment that

influence the health of the individuals living in that community (Faw, 2017, Slide 12). The

Centers for Disease Control and Prevention (CDC) developed a report which confirms that yes a

majority of all health determinants are a direct result of a community’s social and physical

environment but also their lifestyle. According to the CDC, “factors such as income, education,

physical activity levels, housing, and eating habits collectively affect health in a more significant
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way than factors related to the access to, and quality of, health care services” (Brunt, 2017, p.

407). Many of these factors just listed can contribute to veterans experiencing poverty and

homelessness. The transition from military life to civilian life is a rough path for many veterans.

Finding jobs with only basic levels of education, adjusting to the lack of order and discipline of

civilian life, and possibly dealing with mental illnesses such as post-traumatic stress disorder all

present major complications during the transition. These things can greatly impact the income

factor for veterans, which in turn impacts healthcare and housing.

Evidence-based Interventions Addressing Health Needs

In 2011, the Veterans Health Administration (VHA) founded the Homeless Patient

Aligned Care Team (H-PACT) program with the initiative to end homelessness among veterans.

The intent of the program is to “integrate and coordinate health and social services care for

homeless veterans with a focus on the highest-risk, highest-need veterans unable or unwilling to

access traditional health care” (O’Toole, Johnson, Aiello, Kane, & Pape, 2016, p. 2). The

programs overall goals are to find the participants access to resources such as healthcare, social

services, help programs, and opportunities for housing. After performing an analysis of the 32

sites and 58 medical facilities of the H-PACT program, an overall decrease in ED visits (19.0 %

reduction) and hospitalizations (34.7% reduction) was seen between when the participating

homeless veterans started the program and the 6 months after that. These numbers were achieved

through the services the H-PACT sites provided which included hygiene support, transportation

assistance, on-site clothes pantries, and meals/food through pantries, food stamps, and cooking

classes. The facilities also offered vocational programs and mentors who helped with the need

for benefits, disability claims, and legal aid (O’Toole et al., 2016, p. 5).
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Another intervention program that targets the needs of homeless veterans is the

Supportive Services for Veteran Families (SSVF) initiative. This program provides financial

grants to community agencies who then use the money to provide support and aid to those

veterans and their families who are at risk of becoming homeless or are already homeless.

Between October, 2014 and September, 2015, the program provided housing assistance to over

122,000 people which included more than 14,000 veteran households. VA Health Care for

Homeless Veterans also holds community outreach events on weekends which give veterans the

opportunity to get involved in an abundance of programs that make access to care, services, and

other resources easier. Other programs that make it their initiative to decrease homelessness

among veterans are the Housing and Urban Development Veterans Affairs Supportive Housing

(HUD-VASH) program and the VA Domiciliary Care Program (O’Toole & Pape, 2015, p. 311-

312).

In September of 2000, 189 UN member states sent their representatives to meet in New

York, where they strategized and developed the Millennium Declaration. According to Anderson

and McFarlane, the Millennium Declaration is “a set of eight goals and specific targets under

each goal designed to reduce poverty, reduce global inequities, and promote health and social

welfare of the world’s citizens (2011, p. 8-9). One of the UN Millennium Development Goals

(MDGs) is to eradicate extreme poverty and hunger. This goal closely relates to homeless

veterans because it is specifically aimed at people who live off of an income of less than $1 per

day and those who suffer from hunger, both of which homeless individuals experience

(Anderson & McFarlane, 2011, p. 9). Increasing job opportunities would in turn decrease

poverty and with better income, people would have an easier time putting food on the table.

Meeting this goal would give homeless veterans a better chance of achieving stable income and
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successfully transferring to civilian life. It would also decrease the amount of newly retired

veterans who “fall through the cracks” of our society and eventually find themselves homeless.

Global Approach in Addressing “Health for All”

There are numerous barriers to global health such as access to and affordability of health

care services, being able to maintain a stable income, lack of housing, food shortages, and

inadequate transportation. One global approach to eradicating these health barriers is through the

World Food Programme (WFP), which is “the leading humanitarian organization fighting hunger

worldwide, delivering food assistance in emergencies and working with communities to improve

nutrition and build resilience” (“World Food Programme: Overview”, 2017). This organization

supports and assists an astonishing number of more than 80 million people in over 80 different

countries every year. Proper nutrition is crucial to our health and wellbeing because nutrients are

needed by our bodies to continue functioning properly. By helping to provide adequate nutrition

and eradicate world hunger, WFP is directly improving the overall health of these countries.

The International Development Association (IDA), of the World Bank, is another

approach to eradicating barriers of health. The mission of the IDA is “to reduce poverty by

providing loans (called “credits”) and grants for programs that boost economic growth, reduce

inequalities, and improve people’s living conditions” (“What Is IDA?”, 2016). As one of the

world’s largest community assistance programs, it delivers assistance and resources to the

world’s 77 most poverty stricken countries. The IDA’s grants and loans also go towards

improving primary education, job opportunities, higher incomes, basic health services, clean

water and sanitation, and agriculture of underserved countries and communities (“What Is

IDA?”, 2016).
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Conclusion

In conclusion, homeless veterans are a vulnerable population because they lack the

resources needed for adequate nutrition, housing, and health care services. However, there are

many programs working to make the transition to civilian life easier for veterans by providing

housing, job opportunities, health services and other resources. Just a few of these organizations

or programs are the Veterans Health Administration (VHA), Homeless Patient Aligned Care

Team (H-PACT) program, Supportive Services for Veteran Families (SSVF) initiative, Housing

and Urban Development Veterans Affairs Supportive Housing (HUD-VASH) program, VA

Domiciliary Care Program, and the VA Health Care for Homeless Veterans. These programs all

make it their initiative in some shape or form to eradicate the barriers of health that homeless

veterans encounter. Day in and day out, military personnel of all branches and types risk their

lives to protect the American dream of safety and freedom and they should be able to experience

the same opportunities upon returning home.

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References

Anderson, E. T. & McFarlane, J. (2015). Community as partner: Theory and practice in nursing

(7th ed.). Philadelphia, PA: Lippincott Williams & Wilkins.

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2857_1&content_id=_145260_1

International Development Association. (2016). What is IDA. Retrieved from:

http://ida.worldbank.org/about/what-ida

National Coalition for the Homeless. (2009). Homeless Veterans. Retrieved from:

http://nationalhomeless.org/factsheets/veterans.html

O’Toole, T. P., Johnson, E. E., Aiello, R., Kane, V., & Pape, L. (2016). Tailoring care to

vulnerable populations by incorporating social determinants of health: The Veterans

Health Administration’s “Homeless Patient Aligned Care Team” program. Preventing

Chronic Disease, 13(E44), 1-12. doi:10.5888/pcd13.150567

O’Toole, T. P., & Pape, L. (2015). Innovative efforts to address homelessness among veterans.

North Carolina Medical Journal, 76(5), 311-314.

Van Brunt, D. (2017). Community health records: Establishing a systematic approach to

improving social and physical determinants of health. American Journal of Public

Health, 107(3), 407-412. doi:10.2105/AJPH.2016.303602

World Food Programme. (2017). Overview. Retrieved from: http://www1.wfp.org/overview