Trends and Challenges in Rural Homeless Veterans in the United States

Authors

  • Celena Derderian MD, Creighton University School of Medicine, Omaha, NE, Unites States
  • Anthony Easterday MD, Creighton University School of Medicine, Omaha, NE, Unites States
  • David Driscoll PhD, VA Nebraska-Western Iowa Health Care System, Omaha, NE, Unites States
  • Sriram Ramaswamy MD, Creighton University School of Medicine, Omaha, NE, USA. VA Nebraska-Western Iowa Health Care System, Omaha, NE, Unites States.

DOI:

https://doi.org/10.5195/ijms.2021.694

Keywords:

Homeless Persons, Veterans, Rural Health

Abstract

Background: Homelessness is a significant public health issue in the United States. Living in rural locations has been associated with an increase in poverty. Additionally, it has been found that veterans are at greater risk for homelessness than the general population. The aim of this research was to characterize rural homeless veterans and non-veterans living in Nebraska, United States.

Methods: A cross-sectional study was conducted comprising 50 veterans and 64 non-veterans recruited from rural locations in Nebraska. Fully structured interviews were conducted by the research staff that consisted of questions regarding participant sociodemographics, housing, clinical characteristics, psychosocial factors, and utilization of health care and social services.

Results: In comparison to non-veterans, rural homeless veterans were found to be older, more qualified, and more likely to have ever been married. Veterans spent fewer nights in a shelter and more nights in a halfway house. Regarding clinical features, veterans were more likely to report posttraumatic stress disorder and alcohol misuse. Veterans also reported shorter travel times to reach health care services and used them more often compared to non-veterans.

Conclusion: These findings suggest that homeless veterans and non-veterans within rural settings have unique needs to be addressed when it comes to providing health care and social services, as well as in attempts to eliminating homelessness. Further research will help in the development of improved methods to support rural veterans and non-veterans.

Metrics

Metrics Loading ...

References

U.S. Department of Housing and Urban Development. The 2018 Annual Homeless Assessment Report (AHAR) to Congress: Part 1: Point-in-time estimates of homelessness. Washington, DC: U.S. Department of Housing and Urban Development; 2018. Available at https://files.hudexchange.info/resources/documents/2018-AHAR-Part-1.pdf. Cited Feb 20, 2020.

National Health Care for the Homeless Council. Rural homelessness: identifying and understanding the ‘hidden homeless’. In Focus: A Quarterly Research Review of the National HCH Council. 2013 Jun;1(4):1-4.

U.S. Health Resources and Services Administration. Defining rural population. Available from: https://www.hrsa.gov/rural-health/about-us/definition/index.html. Last reviewed July 2020; cited Feb 18, 2020.

Weber B, Jensen L, Miller K, Mosley J, Fisher M. A critical review of rural poverty literature: is there truly a rural effect? Int Reg Sci Rev. 2005;28(4):381-414.

Eberhardt MS, Pamuk ER. The importance of place of residence: examining health in rural and nonrural areas. Am J Public Health. 2004 Oct;94(10):1682-6.

Meit M, Knudson A, Gilbert T. The 2014 Update of the Rural–Urban Chartbook. Bethesda, MD: Rural Health Reform Policy Research Center; 2014.

Hartley D. Rural health disparities, population health, and rural culture. Am J Public Health. 2004 Oct;94(10):1675-8.

Fargo J, Metraux S, Byrne T, Munley E, Montgomery AE, Jones H, et al. Prevalence and risk of homelessness among U.S. veterans. Prev Chronic Dis. 2012;9:E45.

Veterans Affairs Canada. New Veterans Charter Evaluation – Phase I: 4.4 Comparison to Other Countries; 2009. Available at https://www.veterans.gc.ca/eng/about-vac/publications-reports/reports/departmental-audit-evaluation/2009-12-nvc/4-4. Cited Dec 16, 2020.

O’Toole TP, Conde-Martel A, Gibbon JL, Hanusa BH, Fine MJ. Health care of homeless veterans: why are some individuals falling through the safety net? J Gen Intern Med. 2003 Nov;18(11),929-33.

Ramaswamy S, Driscoll D, Tsai J, Rose J, Smith LM, Rosenheck RA. Characteristics of urban male homeless veterans and non-veterans in Omaha, Nebraska. J Soc Distress Homeless. 2017;26(1),51-7.

U.S. Census Bureau. Population and Housing Unit Estimates Datasets. Available from: https://www.census.gov/programs-surveys/popest/data/data-sets.html. Last updated July 1, 2019; cited Feb 18, 2020.

Rosenheck R, Koegel P. Characteristics of veterans and nonveterans in three samples of homeless men. Hosp Community Psychiatry. 1993 Sep;44(9),858-63.

Tessler R, Rosenheck R, Gamache G. Comparison of homeless veterans with other homeless men in a large clinical outreach program. Psychiatr Q. Summer 2002;73(2),109-19.

Tsai J, Mares AS, Rosenheck RA. Do homeless veterans have the same needs and outcomes as non-veterans? Mil Med. 2012 Jan;177(1),27-31.

VHA Office of Rural Health. Fact Sheet: Information about the VHA Office of Rural Health and Rural Veterans. Washington, DC: VHA Office of Rural Health; 2014. Available at https://www.ruralhealth.va.gov/docs/factsheets/ORH_General_FactSheet_2014.pdf. Cited Feb 18, 2020.

U.S. Census Bureau. QuickFacts: Hastings, Nebraska. Washington, DC: U.S. Census Bureau; 2015a. Available from: https://www.census.gov/quickfacts/hastingscitynebraska. Last updated July 1, 2019; cited Feb 18, 2020.

U.S. Census Bureau. QuickFacts: North Platte, Nebraska. Washington, DC: U.S. Census Bureau; 2015b. Available from: https://www.census.gov/quickfacts/northplattecitynebraska. Last updated July 1, 2019; cited Feb 18, 2020.

U.S. Census Bureau. QuickFacts: Kearney, Nebraska. Washington, DC: U.S. Census Bureau; 2015c. Available from: https://www.census.gov/quickfacts/kearneycitynebraska. Last updated July 1, 2019; cited Feb 18, 2020.

Tsai J, Ramaswamy S, Bhatia SC, Rosenheck RA. A comparison of homeless male veterans in metropolitan and micropolitan areas in Nebraska: a methodological caveat. Am J Community Psychol. 2015 Dec;56(3-4),357-67.

Tsai J, Mares AS, Rosenheck RA. A geographic analysis of chronically homeless adults before and after enrollment in a multi-site supported housing initiative: community characteristics and migration. Am J Community Psychol. 2011 Dec;48(3-4),341-51.

Parker RD, Dykema S. The reality of homeless mobility and implications for improving care. J Community Health. 2013 Aug;38(4),685-9.

Jackson A, Shannon L. Examining social support in a rural homeless population. J Rural Soc Sci. 2014;29(1),48-74.

Dunne EM, Burrell LE 2nd, Diggins AD, Whitehead NE, Latimer WW. Increased risk for substance use and health-related problems among homeless veterans. Am J Addict. 2015 Oct;24(7),676-80.

Kessler RC, Chiu WT, Demler O, Merikangas KR, Walters EE. Prevalence, severity, and comorbidity of 12-month DSM-IV disorders in the National Comorbidity Survey Replication. Arch Gen Psychiatry. 2005 Jun;62(6),617-27.

Richardson LK, Frueh BC, Acierno R. Prevalence estimates of combat-related post-traumatic stress disorder: critical review. Aust N Z J Psychiatry. 2010 Jan;44(1):4-19.

O’Connell MJ, Kasprow W, Rosenheck R. Direct placement versus multistage models of supported housing in a population of veterans who are homeless. Psychol Serv. 2009;6(3),190-201.

Doran KM, Raven MC, Rosenheck RA. What drives frequent emergency department use in an integrated health system? National data from the Veterans Health Administration. Ann Emerg Med. 2013 Aug;62(2),151-9.

Tsai J, Link B, Rosenheck RA, Pietrzak RH. Homelessness among a nationally representative sample of US veterans: prevalence, service utilization, and correlates. Soc Psychiatry Psychiatr Epidemiol. 2016 Jun;51(6),907-16.

Gabrielian S, Yuan A, Andersen RM, McGuire J, Rubenstein L, Sapir N, et al. Chronic disease management for recently homeless veterans: a clinical practice improvement program to apply home telehealth technology to a vulnerable population. Med Care. 2013 Mar;51(3 Suppl 1):S44-51.

Jones AL, Hausmann LRM, Kertesz SG, Suo Y, Cashy JP, Mor MK, et al. Providing positive primary care experiences for homeless veterans through tailored medical homes: The Veterans Health Administration's Homeless Patient Aligned Care Teams. Med Care. 2019 Apr;57(4),270-8.

Polillo A, Gran-Ruaz S, Sylvestre J, Kerman N. The use of eHealth interventions among persons experiencing homelessness: A systematic review. Digit Health. 2021 Feb 2;7:2055207620987066.

Published

2021-05-18

How to Cite

Derderian, C., Easterday, A., Driscoll, D., & Ramaswamy, S. (2021). Trends and Challenges in Rural Homeless Veterans in the United States. International Journal of Medical Students, 9(2), 117–123. https://doi.org/10.5195/ijms.2021.694