Homeless Veterans Programs
Improved Communications and Follow-up Could Further Enhance the Grant and Per Diem Program Gao ID: GAO-06-859 September 11, 2006About one-third of the nation's adult homeless population are veterans, according to the Department of Veterans Affairs (VA). Many of these veterans have experienced substance abuse, mental illness, or both. The VA's Homeless Providers Grant and Per Diem (GPD) program, which is up for reauthorization, provides transitional housing to help veterans prepare for permanent housing. As requested, GAO reviewed (1) VA homeless veterans estimates and the number of transitional housing beds, (2) the extent of collaboration involved in the provision of GPD and related services, and (3) VA's assessment of GPD program performance. GAO analyzed VA data and methods used for the homeless estimates and performance assessment, and visited selected GPD providers in four states to observe the extent of collaboration.
VA estimates that on a given night about 194,000 veterans were homeless in 2005. The estimate, generally lower than the numbers reported prior to 2004, is considered by VA officials to be the best available. VA officials believe that its new estimation process and use of better local data have improved the estimate. While VA has increased the capacity of the GPD program over the past several years, VA reports that an additional 9,600 transitional housing beds from various sources are needed to meet current demand. VA has plans to make 2,200 additional GPD beds available. GPD providers collaborate with other agencies to help veterans regain their health and obtain housing, jobs, and various services to enable them to live independently. However, resource and communications gaps may stand in the way of VA and provider efforts to meet these goals. Limited availability of affordable permanent housing, for example, may make it difficult to move veterans out of homelessness, according to GPD providers. We also identified instances of misunderstandings of program policies related to eligibility and program stay limits that could prevent homeless veterans from being admitted into the GPD program. VA assesses overall program performance by the success of veterans in attaining stable housing, income, and self-determination at the time they leave the program. VA data show that the percentage of veterans achieving these goals has generally increased or held steady over time. In 2006, VA also stepped up its assessment of the performance of GPD providers. While these assessments do not indicate how veterans fare after they leave the program, preliminary results of a onetime VA study indicate positive housing outcomes were maintained 1 year later. However, VA does not routinely collect follow-up data and may not be able to determine how veterans who were not included in the study are faring after they leave the program.
RecommendationsOur recommendations from this work are listed below with a Contact for more information. Status will change from "In process" to "Open," "Closed - implemented," or "Closed - not implemented" based on our follow up work.
Director: Team: Phone:GAO-06-859, Homeless Veterans Programs: Improved Communications and Follow-up Could Further Enhance the Grant and Per Diem Program
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Report to the Chairman, Committee on Veterans' Affairs, House of
Representatives:
United States Government Accountability Office:
GAO:
September 2006:
Homeless Veterans Programs:
Improved Communications and Follow-up Could Further Enhance the Grant
and Per Diem Program:
Homeless Veterans Program:
GAO-06-859:
GAO Highlights:
Highlights of GAO-06-859, a report to the Chairman, Committee on
Veterans‘ Affairs, House of Representatives
Why GAO Did This Study:
About one-third of the nation‘s adult homeless population are veterans,
according to the Department of Veterans Affairs (VA). Many of these
veterans have experienced substance abuse, mental illness, or both. The
VA‘s Homeless Providers Grant and Per Diem (GPD) program, which is up
for reauthorization, provides transitional housing to help veterans
prepare for permanent housing. As requested, GAO reviewed (1) VA
homeless veterans estimates and the number of transitional housing
beds, (2) the extent of collaboration involved in the provision of GPD
and related services, and (3) VA‘s assessment of GPD program
performance.
GAO analyzed VA data and methods used for the homeless estimates and
performance assessment, and visited selected GPD providers in four
states to observe the extent of collaboration.
What GAO Found:
VA estimates that on a given night about 194,000 veterans were homeless
in 2005. The estimate, generally lower than the numbers reported prior
to 2004, is considered by VA officials to be the best available. VA
officials believe that its new estimation process and use of better
local data have improved the estimate. While VA has increased the
capacity of the GPD program over the past several years, VA reports
that an additional 9,600 transitional housing beds from various sources
are needed to meet current demand. VA has plans to make 2,200
additional GPD beds available.
Figure: Number of GPD Beds and Admissions from Fiscal Year 200 through
2005:
[See PDF for Image]
Source: GAO analysis of VA data rounded to the nearest 100th.
[End of Figure]
GPD providers collaborate with other agencies to help veterans regain
their health and obtain housing, jobs, and various services to enable
them to live independently. However, resource and communications gaps
may stand in the way of VA and provider efforts to meet these goals.
Limited availability of affordable permanent housing, for example, may
make it difficult to move veterans out of homelessness, according to
GPD providers. We also identified instances of misunderstandings of
program policies related to eligibility and program stay limits that
could prevent homeless veterans from being admitted into the GPD
program.
VA assesses overall program performance by the success of veterans in
attaining stable housing, income, and self-determination at the time
they leave the program. VA data show that the percentage of veterans
achieving these goals has generally increased or held steady over time.
In 2006, VA also stepped up its assessment of the performance of GPD
providers. While these assessments do not indicate how veterans fare
after they leave the program, preliminary results of a onetime VA study
indicate positive housing outcomes were maintained 1 year later.
However, VA does not routinely collect follow-up data and may not be
able to determine how veterans who were not included in the study are
faring after they leave the program.
What GAO Recommends:
To further strengthen VA‘s ability to help homeless veterans, GAO is
recommending that VA take steps to ensure policies are understood by
providers and staff who implement them. GAO also recommends that VA
explore feasible and cost-effective means of obtaining information on
long-term outcomes for veterans who leave the GPD programs. VA
generally agreed with our findings and recommendations.
[Hyperlink, http://www.gao.gov/cgi-bin/getrpt?GAO-06-859].
To view the full product, including the scope and methodology, click on
the link above. For more information, contact Cristina T. Chaplain at
(202) 512-7215 or chaplainc@gao.gov.
[End of Section]
Contents:
Letter:
Results in Brief:
Background:
VA Estimates about 194,000 Veterans Are Homeless and Has Increased Its
Capacity to Provide Transitional Housing:
GPD Providers Collaborate to Offer a Range of Services but Still Face
Challenges in Helping Veterans:
VA Data Show That the GPD Program Helps Veterans Get Housing and
Income, but Data Are Limited on Veterans' Circumstances after They
Leave the Program:
Conclusions:
Recommendations for Executive Action:
Agency Comments and Our Evaluation:
Appendix I: Scope and Methodology:
Appendix II: VA's Programs for Homeless Veterans Other than the GPD
Program:
Appendix III: Range of Services Offered by GPD Programs Nationwide:
Appendix IV: Participant Outcomes for the Grant and Per Diem Program:
Appendix V: Comments from the Department of Veterans Affairs:
Appendix VI: GAO Contact and Staff Acknowledgments:
Related GAO Products:
Tables:
Table 1: Available and Needed Transitional Beds for Homeless Veterans,
Fiscal Year 2005:
Table 2: Examples of Services and Partners That Worked with GPD
Providers We Visited:
Table 3: Numbers and Percentages of Veterans Leaving the GPD Program
with Employment or Benefit Income, Fiscal Years 2000 through 2005:
Table 4: Number of Veterans Leaving GPD Program and Percentage with
Specific Problems at Entry, Fiscal Years 2000 and 2005:
Table 5: Features of GPD Programs That GAO Visited:
Table 6: Percentage of GPD Facilities Reporting They Provided Selected
Services by Method:
Table 7: Number Served by VA's Health Care for Homeless Veterans and
Grant and Per Diem Program and Veterans' Outcomes, Fiscal years 2000
through 2005:
Figures:
Figure 1: VA Services and Programs for Homeless Veterans:
Figure 2: Interiors and Exteriors of Selected GPD Buildings That GAO
Toured:
Figure 3: VA Estimates of Homeless Veterans Nationwide, Fiscal Years
2000 through 2005:
Figure 4: Number of GPD Beds Compared to Admissions of Homeless
Veterans, Fiscal Years 2000 through 2005:
Figure 5: Distribution of the Beds Available under the GPD Program in
May 2006:
Figure 6: Flow of Policy and Program Information from VA to GPD
Providers:
Figure 7: Percentage of Veterans with Independent or Secured Housing
upon Leaving GPD Program, Fiscal Years 2000 through 2005:
Figure 8: Percentage of Veterans Leaving the GPD Program with Greater
Self-Determination, Fiscal Years 2000 through 2005:
Abbreviations:
CHALENG: Community Homelessness Assessment, Local Education and
Networking Group for Veterans:
DOL: Department of Labor:
GPD: Homeless Providers Grant and Per Diem:
HCHV: Health Care for Homeless Veterans:
HHS: Department of Health and Human Services:
HUD: Department of Housing and Urban Development:
NEPEC: Northeast Program Evaluation Center:
OIG: Office of Inspector General:
VA: Department of Veterans Affairs:
United States Government Accountability Office:
Washington, DC 20548:
September 11, 2006:
The Honorable Steve Buyer:
Chairman:
Committee on Veterans' Affairs:
House of Representatives:
Dear Chairman Buyer:
On any given night in the United States, an estimated 700,000 people,
including veterans, are homeless and sleep on the streets or in
shelters. Veterans constitute about one-third of the adult homeless
population, according to the Department of Veterans Affairs (VA). Many
veterans who are not homeless may be at risk of homelessness as a
result of poverty, lack of support from family and friends, or
precarious living conditions in overcrowded or substandard housing.
To help address the needs of homeless veterans, VA operates several
programs, the largest of which is the Homeless Providers Grant and Per
Diem (GPD) program. Scheduled for reauthorization in 2007, this program
provides a transitional setting to help veterans prepare for permanent
housing. The program is not intended to serve all homeless veterans but
is focused instead on serving those who are most in need, including
veterans whose circumstances make them likely to remain homeless unless
they receive assistance, such as those who have had problems with
mental illness, substance abuse, or both. Through a network of local
nonprofit or public agencies, the program provides beds to homeless
veterans in settings free of drugs and alcohol that are supervised 24
hours a day, 7 days a week. Program rules generally allow veterans to
stay with a single GPD provider for 2 years, but providers have the
flexibility to set shorter time frames. In addition, veterans are
generally limited to a total of three stays in the program over their
lifetime. The program's goals are to help homeless veterans achieve
residential stability, increase their skill levels or income, and
attain greater self-determination.
As Congress considers the reauthorization of the GPD program, you asked
us to review (1) VA estimates of the total number of homeless veterans
and the number of transitional beds available, (2) the extent of
collaboration involved in the provision of GPD and related services,
and (3) VA's assessment of GPD program performance.
In examining VA's estimates of the number of homeless veterans, we
reviewed relevant reports and interviewed outside experts as well as
officials with the Bureau of the Census, the Department of Housing and
Urban Development (HUD), and VA's Community Homelessness Assessment,
Local Education and Networking Group for Veterans (CHALENG). To assess
the extent of coordination among community partners serving homeless
veterans, we visited 13 GPD providers located in California, Florida,
Massachusetts, and Wisconsin, including some in rural areas as well as
large cities. In addition, we analyzed data from a survey of GPD
providers conducted by VA's Northeast Program Evaluation Center (NEPEC)
and attended a meeting of VA's Advisory Committee on Homeless Veterans.
We focused our review on those GPD providers serving homeless veterans
in general rather than special subgroups, such as the chronically
mentally ill. In each of these locations, we interviewed local VA
officials, GPD staff, community partners, and, where possible, current
and former program participants. To develop information on GPD
performance, we interviewed officials and analyzed data from NEPEC and
VA's national program office. Data obtained were considered
sufficiently reliable for our purposes. We coordinated with VA's Office
of Inspector General so that our review complemented but did not
duplicate its recent review related to GPD financial management and
oversight issues.[Footnote 1] We conducted our work between August 2005
and July 2006 in accordance with generally accepted government auditing
standards. For more information on our scope and methodology, see
appendix I.
Results in Brief:
VA reports that about 194,000 veterans were homeless nationwide on a
given night in fiscal year 2005--an estimate that VA officials consider
the best available. VA changed its estimation process in 2004 to
provide a snapshot of the number of homeless veterans at a given point
in time, as opposed to an aggregate total of veterans who were homeless
over the course of the year. Earlier estimates combined these aggregate
totals with the snapshot data. While VA officials consider the current
estimate to be more reliable than those for earlier years, the agency
believes the estimate to be on the low side because some veterans
cannot be located at the time the counts are taken. To accommodate
veterans ready and willing to assume the responsibilities involved in
transitional housing, VA reports that a total of 45,000 transitional
beds are needed. VA has identified 35,400 beds that are available from
various sources, including the GPD program, resulting in a shortfall of
about 9,600 beds. In fiscal year 2005, the GPD program had about 8,000
beds available for homeless veterans. Because veterans only stayed in
GPD beds on average about 4 months, the GPD program was able to admit
over 16,000 veterans over this same period. VA officials told us that
they have plans to expand the GPD program by 2,200 beds in the near
future. As the GPD program continues to grow, VA also recognizes that
it will have to accommodate the needs of the changing homeless veteran
population, including increasing numbers of women and veterans with
dependents.
The GPD providers that we visited often collaborated with public and
nonprofit agencies in helping veterans to recover from substance abuse
or mental illness and obtain permanent housing, employment, financial
stability, and services needed to enhance their ability to live
independently. While GPD providers were generally able to build
successful partnerships, most of them identified resource and
communications gaps that presented challenges to delivering certain
services. For example, providers reported difficulties in locating
affordable permanent housing for veterans ready to leave the program
because of shortages in their communities. In addition we found that
those responsible for program implementation did not always understand
the policies. Some GPD providers believed that homeless veterans were
eligible for the GPD program only if they were eligible for VA health
care. This assumption was incorrect and may have had the effect of
erroneously turning away veterans seeking to enter the GPD program.
There were also instances in which GPD providers did not understand
that veterans may be able to exceed the 3-stay lifetime limit under
certain conditions. This assumption, also incorrect, could keep
veterans from obtaining needed care.
VA assesses performance in two ways--the veterans' circumstances at the
time they leave the program and the ability of individual GPD providers
to meet their own objectives--but VA generally does not know how
veterans are faring months or years later. When veterans leave the
program for any reason, VA collects information on their immediate
success in obtaining housing, income, and greater self-determination--
the primary measures of overall GPD program performance. VA reports
that of all veterans leaving the program in fiscal year 2005, half had
successfully arranged independent housing, one-third had jobs, over one-
third were receiving public benefits, and 57 to 69 percent showed
progress with substance abuse, mental health or medical problems or
demonstrated greater self-determination in other ways. In addition, in
2006 VA took steps to ensure that its local staff conduct annual
reviews to determine if the GPD providers are meeting their objectives.
VA does not require providers to collect data from veterans months or
years after they leave the program, although many providers attempt to
maintain contact with former participants. Some indication of how
veterans are faring after they leave the program should be available
from VA's recent follow-up study of 520 program participants.
Preliminary results of this study indicate that veterans maintained
positive housing outcomes 1 year after leaving the GPD program.
To further strengthen VA's ability to help homeless veterans, we are
recommending that VA take steps to ensure that GPD policies and
procedures are consistently understood and to explore feasible means of
obtaining information about the circumstances of veterans after they
leave the GPD program. In its comments on a draft of this report, VA
concurred with our recommendations and described several initiatives
planned or under way to address some issues raised in our report as
well as other challenges the GPD program faces.
Background:
The GPD program is one of nine VA programs that specialize in serving
homeless veterans. Six of these programs fall under the responsibility
of the Veterans Health Administration, which obligated about $224
million in fiscal year 2006 for these programs as well as $1.2 billion
for outreach and treatment of homeless veterans. Outreach is considered
particularly important to locate and serve veterans living on the
street and in temporary shelters who otherwise would not seek
assistance. Treatment involves primary and specialty medical care,
mental health care, and alcohol and drug abuse services for eligible
homeless veterans. Three of the nine programs are run jointly or solely
by the Veterans Benefits Administration that also serves homeless
veterans as part of its broader mission to provide disability
compensation and pensions to eligible veterans. Figure 1 illustrates
some of the key programs and services for homeless veterans--including
the GPD program that is the focus of this report--provided by VA. (App.
II provides a general description of the eight programs not otherwise
covered in this report.)
Figure 1: VA Services and Programs for Homeless Veterans:
[See PDF for image]
Source: GAO analysis of VA data.
[A] This program is a joint initiative with VHA.
[B] HUD provides the housing subsidy; VA provides case management
services.
[End of figure]
GPD Transitional Housing Program for Homeless Veterans:
The GPD program---VA's major transitional housing program for homeless
veterans---spent about $67 million in fiscal year 2005. It became VA's
largest program for homeless veterans after fiscal year 2002, when VA
began to increase GPD program capacity and phase out national funding
for the more costly contracted residential treatment--another of VA's
transitional housing programs.[Footnote 2] To operate the GPD program
at the local level, nonprofit and public agencies compete for grants.
The program provides two basic types of grants--capital grants to pay
for the buildings that house homeless veterans and per diem grants for
the day-to-day operational expenses.
* Capital grants cover up to 65 percent of housing acquisition,
construction, or renovation costs and require that agencies receiving
the grants cover the remaining costs through other funding sources.
Generally, agencies that have received capital grants are considered
for subsequent per diem grants, so that the VA investment can be
realized and the buildings can provide operational beds.
* Per diem grants support the operations of about 300 GPD
providers[Footnote 3] nationwide. The per diem grants pay a fixed
dollar amount for each day an authorized bed is occupied by an eligible
veteran up to the maximum number of beds allowed by the grant.
Generally under this grant, VA does not pay for empty beds. VA makes
payments after an agency has housed the veteran, on a cost
reimbursement basis, and the agency may use the payments to offset
operating costs, such as staff salaries and utilities. By law, the per
diem reimbursement cannot exceed a fixed rate, which was $29.31 per
person per day in 2006. Reimbursement may be lower for providers
receiving funds for the same purpose from other sources.
On a limited basis, special needs grants are available to cover the
additional costs of serving women, frail elderly, terminally ill, or
chronically mentally ill veterans. Although the primary focus of the
GPD program is housing, grants may also be used for transport or to
operate daytime service centers that do not provide overnight
accommodations. According to VA, in fiscal year 2005, GPD grants
supported about 75 vans that were used to conduct outreach and
transport homeless veterans to medical and other appointments. Also, 23
service centers were operating with GPD support.
Most GPD providers have 50 or fewer beds available for homeless
veterans, with the majority of providers having 25 or fewer.
Accommodations vary and may range from rooms in multistory buildings in
the inner city to rooms in detached homes in suburban residential
neighborhoods. Veterans may sleep in barracks-style bunk beds in a room
shared by several other participants or may have their own rooms.
Figure 2 shows the exteriors and interiors of selected GPD buildings we
visited.
Figure 2: Interiors and Exteriors of Selected GPD Buildings That GAO
Toured:
[See PDF for image]
Sources: GAO (bottom two); Maryland Center for Veterans Education and
Training (top left); and Veterans Hospice Homestead, Inc. (top right).
[End of figure]
Generally housing is either male only or has separate sleeping areas
for males and females. Multipurpose rooms may be available for
television, games, and conversation, as well as communal kitchen
facilities where meals can be purchased or made by the participants
themselves. Not all GPD providers supply food. Some may assist the
participants in obtaining items from community food banks. GPD
providers may require veterans to pay rent, but the rent cannot exceed
30 percent of a veteran's income, after deducting the costs of medical,
child care, and court-ordered payments. In addition, veterans may be
charged fees for other services not supported by the GPD grant, such as
cable television. According to VA rules, veterans may stay with a
single GPD provider for 24 months or longer under certain
conditions.[Footnote 4] GPD providers may specify shorter limits such
as 3, 6, or 12 months. In fiscal year 2005, the average stay for
veterans was about 4 months with a single GPD provider.
Veteran Eligibility for the GPD Program:
To meet VA's minimum eligibility requirements for the program,
individuals must be veterans and must be homeless. A veteran is defined
as an individual who has been discharged or released from active
military service and includes members of the Reserves and National
Guard with active federal service. Although the GPD program definition
excludes individuals who have received a dishonorable discharge, it is
less restrictive in terms of length of service requirements. As a
result, some homeless veterans may be eligible for the GPD program and
not eligible for VA health care.[Footnote 5] VA does not pay for
spouses and children of veterans who are not themselves veterans, but
they may be served by GPD providers using other funds.[Footnote 6]
Consistent with the definition used in many other federal programs, VA
defines a homeless individual as a person who lacks a fixed, regular,
adequate nighttime residence and instead stays at night in a shelter,
institution, or public or private place not designed for regular
sleeping accommodations.[Footnote 7] Prison inmates are not deemed
homeless, but may be at risk of homelessness and may be eligible for
the program upon their release. GPD providers determine if potential
participants are homeless, but VA officials determine if potential
participants meet the program's definition of veteran. VA officials are
also responsible for determining whether veterans have exceeded their
lifetime limit of three stays in a GPD program and for issuing a waiver
to that rule when appropriate.
Prospective GPD providers may identify additional eligibility
requirements in their grant documents. Because the providers are
responsible for providing a clean and sober environment that is free of
illicit drugs, about two-thirds of providers require that veterans
entering the program be sober and free from alcohol and drug use for a
given length of time. The time frames set by many providers range from
1 to 30 days of sobriety. Many providers also conduct drug tests of
veterans after they enter the program to ensure their continued
sobriety. Most providers will not accept veterans considered to be a
danger to themselves or others, in need of detoxification, or under the
influence of drugs or alcohol. About one-fifth of providers also
exclude veterans who are considered seriously mentally ill, because the
providers may not be able to provide adequate care.
Characteristics of Veterans Eligible for the GPD Program:
The GPD program is focused primarily on helping those most in need--
veterans who might remain homeless for long periods of time if no
intervention occurs--and is not intended to serve all homeless
veterans. About two-thirds of homeless veterans in the program in
fiscal year 2005 had struggled with alcohol, drug, medical, or mental
health problems. About 40 percent of homeless veterans seen by VA had
served during the Vietnam era, and most of the remaining homeless
veterans served after that war, including over 2,500 who served in
military operations in the Persian Gulf, Afghanistan, and Iraq. Almost
all homeless veterans seen by VA are males; about half are between 45
and 54 years old, one-quarter are older, and one-quarter are younger.
African-Americans are disproportionately represented, constituting the
largest racial group at 47 percent; whites are the next largest group
at 45 percent. About 75 percent of veterans are either divorced or
never married.
Roles of Various Agencies Serving Homeless Veterans:
The complex problems faced by homeless veterans require a system of
comprehensive, integrated services that often involves multiple
organizations. Key federal agencies with programs specifically targeted
to the homeless, including veterans, are HUD, the Department of Health
and Human Services (HHS), and the Department of Labor (DOL). HUD makes
funds available to bring together community organizations to plan and
coordinate service delivery through local or regional networks
designated as the "Continuums of Care." In their planning role, the
Continuums arrange for counts of the homeless in their area, and since
2003, are required to report the number for a given point in time and
to do so at least every 2 years.[Footnote 8] Further, as part of their
coordination role, the Continuums review agency applications for
certain HUD grants. HUD also funds emergency shelters that are open
seasonally or year-round for temporary, overnight accommodations. In
addition, HUD is the only federal agency that is authorized to provide
permanent subsidized housing for the homeless. HHS specializes in
funding health care and researching the needs of homeless with
substance abuse and mental health issues. DOL, like VA, has programs
targeted specifically to veterans within the homeless population, with
DOL's emphasis on helping veterans obtain employment. Charities,
businesses, and state and local governments are also involved in
meeting the needs of homeless veterans and, in some cases, providing
funding to GPD providers.
At the federal level, VA works with these and other federal agencies
through two key committees. VA's Advisory Committee on Homeless
Veterans is responsible for assessing the needs of homeless veterans
and determining if VA and others are meeting these needs. The committee
comprises homeless veterans, experts and advocates, community-based
service providers, state and federal government officials, and
representatives of veterans' service organizations. The committee has
made several recommendations on improvements to homeless veterans'
programs, including the GPD program, some of which have been
implemented. In 2004 the committee urged VA to fund GPD providers
serving veterans with special needs, especially female veterans; in
fiscal year 2005 there were 29 programs of this kind, including 8 for
female veterans.[Footnote 9]
VA is also a participant on the Interagency Council on Homelessness,
which coordinates the federal response to homelessness and works with
state and local governments to develop plans for ending chronic
homelessness among individuals, including veterans, in 10
years.[Footnote 10] Although the chronic homeless represent only 10 to
20 percent of all homeless adults, they take up roughly half of all
shelter beds and also use a disproportionate share of resources for the
homeless.
At the local level, VA works with various agencies through the
Community Homelessness Assessment, Local Education and Networking
Groups for Veterans, referred to as Project CHALENG. An arrangement of
this kind is needed, according to VA, because no single agency can
provide the full range of services required to help homeless veterans
become more productive members of society. Through CHALENG, a
designated VA official in each medical center, usually VA's homeless
coordinator, reaches out to community agencies that provide services to
the homeless to raise awareness of homeless veterans' particular needs
and to plan to meet those needs. Specific needs to be addressed include
outreach, counseling, health care, education and training, employment,
and housing. Every year these VA officials prepare estimates of the
total number of homeless veterans in their area, based on input from
various sources. In addition, the officials meet with community
representatives to complete a survey of available resources, additional
resources needed, priorities for service, and an action plan.[Footnote
11]
VA Estimates about 194,000 Veterans Are Homeless and Has Increased Its
Capacity to Provide Transitional Housing:
VA estimates that on a given night in fiscal year 2005 about 194,000
veterans were homeless.[Footnote 12] The estimate, generally lower than
the numbers reported prior to 2004, is considered by VA officials to be
the best estimate available. VA officials believe that a new
methodology and use of local HUD data has improved the estimate,
although some homeless veterans may not have been included because they
could not be found when the estimate was developed. While VA has
increased its capacity to provide transitional housing for homeless
veterans in recent years, its program planning efforts indicate that an
additional 9,600 transitional housing beds from various sources are
needed to meet current demand. VA officials report that they are
working to operationalize an additional 2,200 beds for the GPD program.
VA Considers Its Homeless Veterans Estimate to Be the Best Available:
VA bases its national estimate of homeless veterans on the summation of
local estimates developed by VA officials for the areas served by VA
medical facilities. This process is part of the annual CHALENG planning
effort, which involved 135 local VA officials in 2005. Local VA
officials are not responsible for conducting their own counts of
homeless veterans, but are expected to rely on data from other groups
that have collected these data. More than 75 percent of VA officials
use multiple data sources, in part because the areas covered by VA
medical facilities often comprise several cities, counties, or even
states, while local data sources may cover one or more of these
jurisdictions, but rarely cover the full area served by the medical
facility. Most often, local VA officials rely on data collected by the
HUD-funded Continuums of Care, local governments, university
researchers, or other groups along with information from local homeless
providers. The estimates reported by local VA officials are compared to
the previous year's and if they have significantly changed, the local
VA officials are asked to explain the differences before their
estimates are incorporated into the national figure.
Prior to 2004, local VA officials used a methodology to develop their
estimates that was the equivalent of mixing apples with oranges and, as
a result, yielded less consistent, reliable counts of the homeless
veteran population. This mixed methodology combined cumulative numbers
such as the total who were homeless over the course of a year with
point-in-time numbers involving the number homeless on any given day or
night. The numbers were not comparable because over the course of a
year some individuals who were not homeless when the counts were
conducted later became homeless. Generally, the number of veterans who
are homeless sometime over the course of a year is larger than the
number who are homeless on any given night. Since 2004, local VA
officials have been directed to use point-in-time data exclusively in
developing their estimates to reflect the number of homeless veterans
on any given day of the year. VA reports that this standardized method
yields more reliable estimates than were developed for earlier years,
although there may be some veterans who cannot be located. Figure 3
shows VA's estimates of the homeless veteran population from fiscal
years 2000-2005.
Figure 3: VA Estimates of Homeless Veterans Nationwide, Fiscal Years
2000 through 2005:
[See PDF for image]
Source: GAO analysis of VA data from CHALENG reports.
[End of figure]
Recent estimates are also likely to be more reliable, according to VA,
because local VA officials increasingly use homeless data from counts
funded by HUD's Continuum of Care, which are believed to be more
accurate. In 2005, more than twice as many local VA officials used HUD
counts as was the case in 2003. HUD-funded counts in many communities
are gradually improving as the census takers increasingly seek out the
"hidden" homeless who do not contact service providers as well as the
homeless who congregate at soup kitchens and shelters. In both Atlanta
and Los Angeles, homeless individuals were hired in 2005 to assist the
census takers in locating areas where homeless individuals could be
found. As a result, the local counts that were conducted in these two
communities were more accurate than the counts conducted in earlier
years, according to VA officials.
Although VA officials believe that the number is likely an
underestimate, VA officials consider their 2005 year estimate of
194,000 homeless veterans on any given night to be the best available.
Counting the homeless is a challenge for several reasons, as VA and
other agencies have acknowledged,[Footnote 13] since the homeless are
hard to locate and some may not be included in the current estimate.
Also, the number may change in relation to social and economic factors,
such as job layoffs or a tighter housing market. In addition, veterans
who are doubled up and sharing crowded living quarters with others are
considered at risk of becoming homeless but are not included in the
counts because they do not meet VA's definition of homeless.
VA Expanded GPD Program Capacity and Plans Further Expansion to Help
Meet Homeless Veterans' Needs:
Since fiscal year 2000, VA has almost quadrupled the number of
available beds and the number of admissions of homeless veterans to the
GPD program in order to address some of the needs identified through
the CHALENG survey. In fiscal year 2005, VA had the capacity to house
about 8,000 veterans on any given night. However, over the course of
the year, because some veterans completed the program in a matter of
months and others left before completion, VA was able to admit about
16,600 veterans into the program. Figure 4 illustrates the growth in
GPD program capacity from fiscal years 2000 through 2005.
Figure 4: Number of GPD Beds Compared to Admissions of Homeless
Veterans, Fiscal Years 2000 through 2005:
[See PDF for image]
Source: GAO analysis of VA data rounded to the nearest 100th.
Note: Not all beds shown were in operation for the full year; for
example, only 7,800 beds were in operation at the end of fiscal year
2005.
[End of figure]
VA has pursued a policy of making GPD beds available in all states and
the District of Columbia, in line with the recommendation made by the
VA Advisory Committee on Homeless Veterans. As shown in figure 5, all
but three states had beds available in May 2006, and VA officials told
us that they were working with potential providers to develop the
capacity in these states. The greatest number of beds is in California
(1,867 beds); Florida and Massachusetts (430 and 378 beds,
respectively); and New York, Ohio and Pennsylvania (274, 261, and 332
beds respectively).
Figure 5: Distribution of the Beds Available under the GPD Program in
May 2006:
[See PDF for image]
Source: GAO analysis of VA data.
Note: VA reports that grants have been awarded to providers in Alaska,
Maine, and North Dakota to develop 20, 18 and 48 beds respectively in
those states.
[End of figure]
VA's CHALENG report found that about 45,000 transitional housing beds
were needed in fiscal year 2005 to help homeless veterans become more
socially and economically independent. As shown in table 1, the report
identified over 35,000 transitional housing beds that were available
through various sources for this purpose---including the GPD beds,
another 2,400 beds funded by VA through its other specialized homeless
programs, and additional beds funded by other sources. Still needed
were about 9,600 more transitional housing beds nationwide beyond the
number currently available to meet the demand in fiscal year 2005. To
begin to address the demand, VA officials told us that, as of May 2006,
they have negotiated an additional 2,200 beds for the GPD program that
are expected to be available in the near future.
Table 1: Available and Needed Transitional Beds for Homeless Veterans,
Fiscal Year 2005:
Transitional beds needed;
45,000.
VA transitional beds available;
10,400.
* GPD program;
(8,000).
* Non-GPD programs[A];
(2,400).
* Other transitional beds available;
25,100.
Total transitional beds available[B];
35,400.
Additional beds still needed[B];
9,600.
Source: GAO analysis of VA data.
[A] Beds for VA's contracted residential treatment are not included,
but VA officials estimate about 304 beds are available.
[B] Numbers are CHALENG estimates rounded to nearest 100; subtotals
included in these numbers may not add to numbers shown due to rounding.
[End of table]
Although VA reports the need for transitional housing beds is greater
than the capacity, the demand varies throughout the year and by
location. Some GPD programs we visited had vacancies and others had
waiting lists at the time of our visit. GPD providers and VA officials
identified several reasons that beds may go unfilled at any given time.
Some beds are held for veterans who are receiving medical treatment,
while others may be unfilled as a result of the normal transition when
one veteran has left the program and another veteran will soon be
entering the program.
VA officials and GPD providers also told us they expect a change in the
demographics of homeless veterans that may require them to reconsider
the type of housing and services that they are providing with GPD
funds. Specifically, VA officials expect to see more homeless women
veterans and more veterans with dependents who are in need of
transitional housing. GPD providers told us that women veterans have
sought transitional housing; some recent admissions had dependents; and
a few of their beds were occupied by the children of veterans, for whom
VA could not provide reimbursement. To meet the needs of homeless women
veterans, VA has provided additional funding in the form of special
needs grants to a few GPD programs.
GPD Providers Collaborate to Offer a Range of Services but Still Face
Challenges in Helping Veterans:
GPD providers often worked with public and nonprofit agencies to offer
a spectrum of services that may help veterans meet individual and GPD
program goals. While GPD providers were generally able to build
successful partnerships, most of them identified resource gaps that
presented challenges to helping veterans, particularly affordable
permanent housing. We also found that communication issues related to
program policies could prevent veterans from being offered care.
Providers did not always understand eligibility requirements such as
which veterans may be eligible for the program and the allowable number
and length of program stays. Further, providers were not always aware
of policy changes.
GPD Providers Create Partnerships to Help Veterans Meet Program Goals,
but Resource Gaps Remain:
GPD providers generally created partnerships to help prepare veterans
to obtain permanent housing and, ultimately, to live independently.
VA's grant process encourages such collaboration by awarding points to
GPD program applicants that demonstrate they have relationships with
other organizations. GPD providers are to identify how they will
provide services to meet the program's goals--residential stability,
increased skill level or income, and greater self-determination. For
example, providers may identify services such as substance abuse and
mental health treatment, financial counseling, employment assistance
and training, transportation to appointments and job interviews, and
related services. We found variation in the agencies that provided
these services. According to a VA survey, most GPD providers used their
own on-site staff to offer services like case management and
transportation assistance. In contrast, mental health assessments were
mostly handled indirectly, with 79 percent of the GPD providers using
the staff of other agencies, often the VA. (More information from the
survey can be found in app. III.)
The GPD providers that we visited established partnerships with state
and local government agencies, other federal agencies, and local
community organizations. Further, several of the providers that we
visited participated in the local Continuum of Care funded by HUD or in
other community coalitions, taking advantage of community networks that
serve homeless individuals. While most providers offered a range of
services, not all veterans received each service. To identify the
specific services a veteran may need, providers typically worked with
veterans to develop individual treatment plans that identified the
veteran's needs on entering the program. Table 2 lists examples of
services and partners of GPD providers we visited.
Table 2: Examples of Services and Partners That Worked with GPD
Providers We Visited:
Veterans' needs: Case management and individual treatment plan;
Partners that provided services[A]:
* VA liaison with GPD provider.
Veterans' needs: Health Care;
Select services: Mental health treatment;
Partners that provided services[A]:
* VA;
* Local area hospitals;
* Local organizations.
Veterans' needs: Health Care;
Select services: Substance abuse treatment;
Partners that provided services[A]:
* VA;
* Local area hospitals;
* Local organizations.
Veterans' needs: Health Care;
Select services: Counseling (family, nutritional, etc.);
Partners that provided services[A]:
* VA;
* Local organizations.
Veterans' needs: Health Care;
Select services: Medical services;
Partners that provided services[A]:
* VA;
* Local area hospitals.
Veterans' needs: Employment and Income;
Select services: Financial counseling;
Partners that provided services[A]:
* Local organizations.
Veterans' needs: Employment and Income;
Select services: Employment assistance and training;
Partners that provided services[A]:
* Department of Labor;
* Disabled Veterans' Outreach Program[B];
* Homeless Veterans Reintegration Program[C];
* VA;
* Compensative Work Therapy;
* Incentive Therapy[D];
* State and local training programs;
* Local organizations and colleges.
Veterans' needs: Employment and Income;
Select services: Assistance with getting benefits;
Partners that provided services[A]:
* VA;
* Social Security Administration representative;
* State/county benefits counselors;
* Veterans service organizations.
Veterans' needs: After leaving GPD program;
Select services: Stable housing;
Partners that provided services[A]:
* State and local programs;
* HUD.
Veterans' needs: After leaving GPD program; Select services: Follow- up
care and supportive services[E];
Partners that provided services[A]:
* VA;
* Local organizations.
Veterans' needs: Other needs;
Select services: Legal assistance;
Partners that provided services[A]:
* Local organizations and law offices;
* Local colleges;
* Outreach to local jails.
Veterans' needs: Other needs;
Select services: Transportation;
Partners that provided services[A]: Partners that provided services[A]:
* VA GPD van grants;
* Relationship with local transit authority.
Source: GAO analysis of GPD provider partnerships.
[A] GPD provider staff also may have been directly involved in
providing services in any of these partnership examples.
[B] Program provides funding through state employment security agencies
to support dedicated staff positions to develop and provide employment
and job training opportunities for disabled and other qualified
veterans.
[C] Program provides services to assist in reintegrating homeless
veterans into meaningful employment within the labor force.
[D] Program helps veterans regain work habits and skills by
participating in various work situations within VA as part of their
treatment or rehabilitative programs.
[E] Supportive services for veterans who leave the GPD program may
include health care services rendered during a veteran's GPD program
stay, as well as other services to help veterans maintain housing.
[End of table]
GPD programs often collaborated with VA and others to provide health
care-related services--such as mental health and substance abuse
treatment, and family and nutritional counseling--to help veterans
become more self-sufficient in their day-to-day activities. Several
programs hosted Alcoholics Anonymous meetings and other counseling
services, while some GPD programs expected veterans to attend regular
meetings elsewhere in the community. At least two GPD providers we
visited provided their own substance abuse treatment and did not rely
on community partners to provide such services. At least two other
providers that referred veterans to VA for substance abuse treatment
expressed concerns about waiting lists for that service, making it hard
for veterans to access care immediately. Typically, a VA local medical
center provided veterans with primary and specialized health care.
However, GPD providers sometimes expressed concerns about difficulties
obtaining dental care.[Footnote 14] To meet the needs of veterans who
were not eligible for VA health care, GPD providers made other
arrangements. For example, a program in the Boston area partnered with
the local hospital which provided free health care to homeless veterans
who were in the GPD program but were ineligible for VA health care. We
also found that many providers either used their own staff or used
partners' staff to provide mental health services and family and
nutritional counseling services.
All providers we visited tried to help veterans obtain financial
benefits or employment. Some had staff who assessed a veteran's
potential eligibility for public benefits such as food stamps,
Supplemental Security Income, or Social Security Disability Insurance.
Other providers relied on relationships with local or state officials
to provide this assessment. For example, a Wisconsin GPD provider
worked with a county veterans' service officer who reviewed veterans'
eligibility for state and federal benefits. The provider also had a
relationship with a county employment representative who came to the
GPD facility to discuss job searches, training, and other employment
issues with veterans. Several providers were receiving DOL grants to
provide employment training services, worked with local colleges, or
relied on other local programs to help veterans to increase
skills.[Footnote 15] However, a lack of available jobs in an area may
sometimes pose problems to finding employment for veterans.
Most of the GPD providers in the areas that we visited worked with
community partners to obtain permanent housing for veterans ready to
leave the GPD program, but indicated this was sometimes difficult
because of limited affordable permanent housing. Some providers had
established extensive partnerships with organizations that provide or
find affordable permanent housing. For instance, several of the
providers worked with the local HUD-funded Continuum of Care network to
identify permanent housing resources. Some providers had or were
applying for HUD funds to build single room occupancy housing units
that could serve as a transition to more permanent long-term
housing.[Footnote 16] As at least one provider mentioned, veterans
sometimes become resourceful and agree to share apartments. In some
instances, providers have asked for an extension to allow veterans to
stay until housing becomes available.
GPD providers and VA staff coordinated with community resources to help
address other issues that they identified that might also present
obstacles for transitioning veterans out of homelessness. For example,
staff in some locations indicated that such legal issues as criminal
records or credit problems may preclude veterans from obtaining
employment and housing. To help overcome these issues, some GPD
providers worked with lawyers who provided services at no cost or other
volunteer organizations. Staff in some of the locations also reported
that transportation issues made it difficult for veterans to get to
medical appointments or employment-related activities. To help address
potential transportation difficulties, some providers received GPD
grants to purchase vans. One provider that we visited partnered with
the local transit company that provided subsidies to homeless veterans.
This option is not always available, however, and transportation
remained an issue in areas not near a medical center.
Communication of Program Polices May Affect Providers' Ability to Serve
Veterans:
VA has five staff in the national program office who administer the GPD
program through a network of 21 regional homeless coordinators and 136
local VA liaisons. While program policies are developed at the national
level by the GPD program staff, the local VA liaisons designated by VA
medical centers have primary responsibility for communicating with GPD
providers in their area. Figure 6 depicts the flow of information about
the GPD program.
Figure 6: Flow of Policy and Program Information from VA to GPD
Providers:
[See PDF for image]
Source: GAO analysis of VA data.
[End of figure]
The VA liaisons may serve in a full-time or part-time capacity, in part
depending on the number of GPD beds in the area served by the VA
medical centers and the number of admissions per year. In fiscal year
2006, there were 60 full-time liaisons and another 76 individuals
serving as part-time liaisons in addition to their other VA duties.
Liaisons sometimes found it hard to readily assist providers, according
to some staff we met, because of the liaisons' large caseloads and
multiple GPD responsibilities--including eligibility determination,
verification of intake and discharge information, case management,
fiscal oversight, monitoring program compliance and inspections of GPD
facilities, among other duties. To help address this issue, VA has set
aside additional funding for more full-time liaisons.[Footnote 17]
The program office communicates with GPD providers and VA liaisons
through written guidance and teleconferences. VA provides liaisons with
a guidebook about their responsibilities and the program rules as well
as a manual prepared by NEPEC on the forms to be completed for all
program participants. To stay up-to-date on GPD program policies,
liaisons participated in monthly conference calls and also had the
opportunity to attend a conference conducted by the GPD program office
in 2004. The program office recently held a training seminar for new
liaisons and also offers training via phone. VA also gives GPD
providers program handbooks and holds monthly conference calls to
discuss program rules. In addition, some of the VA medical centers we
visited held meetings with local GPD program providers in their areas
to share information.
Despite VA's efforts, we found that some providers did not understand
all of the GPD program policies. Some misunderstandings could affect a
veteran's ability to get--and a GPD provider's ability to offer--care.
For instance, two providers said that VA staff told them that veterans
eligible to participate in the GPD program were also required to be
eligible for VA health care, but this is not the case. Similarly, in
another location, the local VA liaison and a provider both told us that
they had received information from the GPD program office indicating
that the total lifetime length of stay was 2 years, but the GPD program
officials told us this interpretation of the information that they
provided is incorrect. Elsewhere several providers understood the
lifetime limit of three GPD stays but may not have known or believed
that waivers to this rule could be granted. They argued that the limit
could hinder a veteran's ability to participate in the GPD program if
participation involved phased care offered by separate GPD providers,
each specializing in certain phases of treatment, such as
detoxification or job preparation. Since each phase of treatment is
counted as one GPD stay, veterans may exhaust their 3-stay limit before
they have received services vital to their improved functioning.
Although VA has the authority to waive the 3-stay limit in such cases,
these providers did not seem to understand that this option was
available to them.[Footnote 18] In addition, providers were not always
aware of changes in the GPD program in a timely fashion; sometimes not
at all. For example, not all GPD providers knew in 2006 that their
program's inspections would include a review of whether they were
meeting the objectives described in their GPD grant documents.
VA recognizes that communication to providers and liaisons needs to be
improved. In its fiscal year 2005 report, the VA Advisory Committee on
Homeless Veterans recommended that VA hold an annual conference and
that each GPD provider have an opportunity to attend at least one such
conference. The purpose of the conference would be to improve
communications, program compliance, and treatment strategies. In the
spring of 2006 when the committee reconvened, VA had not yet accepted
the committee's recommendation.
VA Data Show That the GPD Program Helps Veterans Get Housing and
Income, but Data Are Limited on Veterans' Circumstances after They
Leave the Program:
VA data show that in fiscal years 2000-2005 a steady or increasing
percentage of veterans had stable housing, income, and greater self-
determination at the time they left the GPD program. These national
performance results are derived from standard forms filled out by VA
staff or by provider staff with VA's review and sign-off for every
veteran who leaves the program for any reason. While the veterans'
success is VA's primary measure of program performance, in 2006 VA took
steps to ensure that the performance of individual GPD providers would
also be reviewed, in line with a recommendation of VA's Office of
Inspector General (OIG). Some GPD providers we visited had stated in
their grant documents that a certain percentage of veterans they served
would have permanent housing or employment a year after they left the
program. Also, VA recently completed a onetime study looking at longer-
term outcomes for homeless veterans, including 520 who participated in
the GPD program, and preliminary results show that positive housing
outcomes were maintained 1 year after veterans left the GPD program.
However, VA does not routinely collect follow-up information to
determine the status of participants at specified times after they
leave the program and may not be able to rely on the results of its
study to determine the success of future program participants.
Many Veterans Attain Stable Housing, Income, and Greater Self-
Determination Immediately upon Leaving the Program, According to VA
Data:
The following sections compare VA's GPD performance data from fiscal
year 2005 with data from fiscal years 2000 through 2004.
Stability in Independent and Secured Housing:
VA reports that about 81 percent of veterans had arranged some form of
housing at the time they left the GPD program in fiscal year 2005, a
significant improvement over the 56 percent with housing in fiscal year
2000. VA considers the program successful if veterans have obtained
either independent or secured housing.[Footnote 19] Independent housing
comprises apartments, rooms, or houses, while secured housing includes
transitional housing programs, halfway houses, hospitals, nursing
homes, or similar facilities. Most of the improvement in housing
outcomes has occurred in independent housing. While independent housing
may be a more desirable outcome, for some veterans, including those
with severe disabilities, secured housing may be more appropriate.
Figure 7 shows the percentages of veterans who had arranged housing
when they left the GPD program in fiscal years 2000 through 2005.
Figure 7: Percentage of Veterans with Independent or Secured Housing
upon Leaving GPD Program, Fiscal Years 2000 through 2005:
[See PDF for image]
Source: GAO analysis of NEPEC data.
[End of figure]
In its annual reports, VA compares the housing arrangements of veterans
who successfully met provider requirements with those who did not. As
might be expected, proportionately more veterans who met requirements
had obtained independent housing in fiscal year 2005---nearly 70
percent--compared to the 40 percent with independent housing who had
not met provider requirements. In terms of numbers, about half of the
15,000 veterans who left the program in fiscal year 2005 were
considered by the GPD providers to have met program requirements, an
improvement over earlier years. Of the approximately 7,500 veterans
remaining, about half dropped out and the other half violated program
rules, such as rules on maintaining sobriety, or they left for other
reasons. VA derives this information from discharge forms completed by
VA or GPD staff for all veterans at the time they leave the program.
VA's evaluation center NEPEC aggregates this data and prepares annual
reports on overall GPD program performance. For more on this process,
see appendix IV.
Income from Employment or Financial Benefits:
The program goal of increased income can be achieved through
maintaining or obtaining employment or financial benefits such as VA
disability compensation or pensions, Supplemental Security Income, or
food stamps. From fiscal years 2000 to 2005, about one-third of
veterans had jobs, mostly on a full-time basis, when they left the GPD
program. The number of veterans with jobs more than tripled over the
period, with about 4,900 employed in fiscal year 2005 at the time they
left the program. The number of veterans receiving VA benefits when
they left the GPD program was about 3,800, while another 2,200 veterans
had applied or planned to apply for VA benefits. Table 3 shows the
percentages and numbers of those employed or receiving benefits for
fiscal years 2000 through 2005, but VA did not have data on receipt of
benefits until 2003.
Table 3: Numbers and Percentages of Veterans Leaving the GPD Program
with Employment or Benefit Income, Fiscal Years 2000 through 2005:
Number and percentage of discharges from GPD program with:
* Total full-and part-time employment;
Fiscal year 2000: 1,404 (37%);
Fiscal year 2001: 2,803 (33%);
Fiscal year 2002: 3,579 (33%);
Fiscal year 2003: 3,735 (33%);
Fiscal year 2004: 4,108 (34%);
Fiscal year 2005: 4,920 (33%).
Number and percentage of discharges from GPD program with:
* full-time;
Fiscal year 2000: 1,163 (30%);
Fiscal year 2001: 2,178 (26%);
Fiscal year 2002: 2,852 (26%);
Fiscal year 2003: 2,995 (26%);
Fiscal year 2004: 3,311 (27%);
Fiscal year 2005: 3,927 (26%).
Number and percentage of discharges from GPD program with:
* part-time;
Fiscal year 2000: 241 (6%);
Fiscal year 2001: 625 (7%);
Fiscal year 2002: 727 (7%);
Fiscal year 2003: 740 (7%);
Fiscal year 2004: 797 (7%);
Fiscal year 2005: 993 (7%).
Number and percentage of discharges from GPD program with:
* Total with any benefits;
Fiscal year 2000: [Empty];
Fiscal year 2001: [Empty];
Fiscal year 2002: [Empty];
Fiscal year 2003: 3,594 (31%);
Fiscal year 2004: 4,400 (36%);
Fiscal year 2005: 5,840 (38%).
Number and percentage of discharges from GPD program with:
* VA benefits only;
Fiscal year 2000: NA;
Fiscal year 2001: NA;
Fiscal year 2002: NA;
Fiscal year 2003: 1,530 (13%);
Fiscal year 2004: 2,091 (17%);
Fiscal year 2005: 2,924 (19%).
Number and percentage of discharges from GPD program with:
* other benefits only;
Fiscal year 2000: NA;
Fiscal year 2001: NA;
Fiscal year 2002: NA;
Fiscal year 2003: 1,494 (13%);
Fiscal year 2004: 1,699 (14%);
Fiscal year 2005: 2,089 (14%).
Number and percentage of discharges from GPD program with:
* both VA and other benefits;
Fiscal year 2000: NA;
Fiscal year 2001: NA;
Fiscal year 2002: NA;
Fiscal year 2003: 570 (5%);
Fiscal year 2004: 610 (5%);
Fiscal year 2005: 827 (5%).
Source: GAO analysis of VA data.
Notes: Percentages may not add up to total shown due to rounding. NA =
Data on receipt of VA and other benefits were not available for fiscal
years 2000 through 2002.
[End of table]
Greater Self-Determination in Terms of Improved Functioning in Several
Areas:
To track greater self-determination, VA examines such goals as
veterans' progress in handling of alcohol, drug, mental health, and
medical problems and overcoming deficits in social or vocational
skills.[Footnote 20] A greater proportion of veterans leaving the
program each year have met these goals, with 57 to 69 percent showing
improved functioning in fiscal year 2005, as shown in figure 8.
Figure 8: Percentage of Veterans Leaving the GPD Program with Greater
Self-Determination, Fiscal Years 2000 through 2005:
[See PDF for image]
Source: GAO analysis of VA data.
Note: The percentage calculations are based on the number of veterans
who showed the problem at admission.
[End of figure]
These improvements have occurred while the proportion of veterans who
entered the GPD program with a history of such problems remained
constant or increased. Specifically, the proportion entering with
substance abuse problems who left the program in fiscal years 2000
through 2005 remained relatively constant, while the proportion of
veterans with a history of mental or medical illness more than doubled,
according to VA data. See table 4.
Table 4: Number of Veterans Leaving GPD Program and Percentage with
Specific Problems at Entry, Fiscal Years 2000 and 2005:
Number of discharges from GPD program;
Fiscal Year 2000: 4,020;
Fiscal year 2005: 15,403.
Number of discharges for whom data are available;
Fiscal year 2000: 3,826;
Fiscal year 2005: 15,048.
Problems that discharged veterans showed on entering the program:
* Alcohol;
Fiscal year 2000: 2,789 (73%);
Fiscal year 2005: 11,180 (74%).
Problems that discharged veterans showed on entering the program:
* Drugs;
Fiscal year 2000: 2,579 (67%);
Fiscal year 2005: 10,307 (68%).
Problems that discharged veterans showed on entering the program:
* Mental illness;
Fiscal year 2000: 1,205 (32%);
Fiscal year 2005: 9,736 (65%).
Problems that discharged veterans showed on entering the program:
* Medical illness;
Fiscal year 2000: 1,255 (33%);
Fiscal year 2005: 10,488 (70%).
Problems that discharged veterans showed on entering the program:
* Social or vocational;
Fiscal year 2000: 2,276 (60%);
Fiscal year 2005: 10,864 (72%).
Source: GAO analysis of data from NEPEC annual reports.
[End of table]
In 2006 VA Took Steps to Help Ensure That VA Liaisons Conduct Required
Reviews of GPD Provider Performance:
In addition to assessing the program through the success of its
veterans, VA policy calls for all VA liaisons to review the performance
of individual GPD providers in meeting objectives that are identified
in their grant documents. Providers are required to establish specific
measurable objectives for each of the three program goals. To reach the
housing goal, for example, some providers we visited established
savings objectives, requiring veterans to set aside a portion of any
income they receive so that they can accumulate sufficient cash
reserves to cover costs of renting a room or apartment when they leave
the program. Most providers we visited also set outcome objectives for
the percentage of veterans expected to obtain independent housing when
they left the program. For the income goal, some providers set
objectives requiring that a certain percentage of veterans be offered
or enrolled in vocational training, develop résumés, interview for
jobs, or apply for entitlement benefits. Most providers also set
objectives that a certain percentage of veterans would find work. For
the self-determination goal, some providers required that a certain
percentage of veterans maintain sobriety or attend weekly Alcoholics or
Narcotics Anonymous meetings.
In its 2006 examination of the GPD program, VA's OIG found, however,
that many providers had not tracked their performance in achieving
these objectives and some VA liaisons had not reviewed the providers'
performance. The OIG recommended that VA liaisons ensure that the
providers' performance be monitored. The GPD program office has since
moved to enforce the requirement that VA liaisons review GPD providers'
performance when the VA team comes on-site each year to inspect the GPD
facility.[Footnote 21] The VA liaison will have the flexibility to
determine the method for reviewing and recording the providers'
performance, so long as the results are documented. GPD providers who
do not meet performance objectives will be required to work with their
local VA staff to create a corrective action plan or resubmit their
applications with new objectives.
VA Does Not Routinely Collect Data on Veterans' Long-Term Success, but
Recent Study May Provide Insights on How Veterans Fare a Year after
Leaving the Program:
VA does not require that veterans be contacted for purposes of program
evaluation after they leave the GPD program. With a view to the long-
term health of veterans, however, VA attempts to have its clinicians
provide GPD participants with a substance abuse or mental health
assessment within 2 months of leaving the program. In addition, the
forms completed when veterans leave the GPD program identify any follow-
up that may have been arranged to help them continue to cope with
problems that they have experienced. While follow-up is not required,
about 80 percent of GPD providers reported that they conduct some sort
of follow-up with veterans after they leave the GPD program. Providers
may call veterans who have left, obtain data on those who return for
additional support services, or arrange reunions or other gatherings.
Some grant documents also indicate that the providers planned to
measure their performance, in part by following up with veterans from 3
to 12 months after they left the program. Some providers follow up to
meet the requirements of non-VA funding they receive. Several providers
we interviewed had DOL grants requiring them to report the employment
status of veterans 3 and 6 months after they left the DOL program.
These providers were able to report results for the veterans deemed
employable who participated in both the GPD and DOL programs. However,
GPD participants who were deemed unemployable because of their
disabilities may not have been included in the DOL program. While many
providers attempt to follow up with veterans, several told us that it
is sometimes difficult to maintain contact, especially with veterans
lacking telephones or reliable mailing addresses and with veterans who
have moved away from the area.
While VA considers it important for veterans to achieve immediate
success on leaving the GPD program, homeless veterans may experience
setbacks later on that may negatively affect their housing
arrangements, employment and financial benefits, and self-
determination. Furthermore, veterans who were not immediately
successful on leaving the program nevertheless may have benefited from
participating and may be able to achieve success at a later time. To
explore the long-term outcomes of program participants, VA funded a
onetime follow-up study in May 2001 to examine the outcomes for a
randomly selected sample of about 1,300 veterans spread across five
geographic locations who were participating in the GPD program and two
other VA-sponsored homeless programs. According to a VA official, the
cost of the study was about $1.5 million.[Footnote 22] Included in the
sample were 520 veterans housed with 19 GPD providers. Proportionately
more veterans in the GPD programs were chronically homeless, while
veterans in one of the other programs had higher levels of serious
medical and psychiatric problems and greater impairments. At the time
of selection, the veterans had various lengths of stays in these
programs.
For the study, university and RAND Corporation researchers interviewed
veterans to determine their status at 1, 3, 6, and 12 months after they
left the programs, with the last interviews conducted in October 2005.
About 360 of the former GPD participants responded to the last
interviews. VA officials do not expect to release final results of the
study until 2007, but preliminary results show that just over 80
percent of the GPD participants had housing 12 months after they left
the program. Other outcomes that are expected to be included in the
report are the number of days that the veterans have either been housed
or homeless, their income and employment situation, their use of drugs
and alcohol, their physical and mental health status, and quality of
life.
Conclusions:
Addressing homelessness is a daunting challenge, given the difficulties
associated with identifying those who need help and the broad spectrum
of services that need to be successfully tailored, coordinated, and
delivered in order to enable individuals and even families to secure
permanent housing and to live more independently. Limited resources--
particularly the availability of affordable permanent housing--make
this job even more difficult. Moreover, the physical and emotional
conditions including substance abuse, and mental illness, prevalent in
the homeless veteran population further increase the difficulty.
VA has taken a number of steps to tackle this challenge by enhancing
its ability to estimate how many veterans need assistance, increasing
the number of GPD beds, instituting measures that help gauge the
program's effectiveness, and through the GPD program, working
proactively with local and federal government agencies and nonprofits
to provide the assistance needed. However, more could be done to
optimize VA's investment, particularly with respect to ensuring
policies and criteria are clearly understood and consistently applied
and assessing longer-term outcomes. In enhancing communications, VA
will need to identify effective ways of sharing information with the
more than 100 agency liaisons in addition to the 300 local GPD program
providers--each with a potentially different means of operating. In
assessing longer-term outcomes, VA will need to weigh the costs,
benefits, and feasibility of implementing a variety of analytical
approaches. Clearly, these endeavors will not be easy, but they are
critical to better equipping VA to help homeless veterans.
Recommendations for Executive Action:
We recommend that the Secretary of Veterans Affairs take the following
two steps to improve and evaluate the GPD program:
1. To aid GPD providers in better understanding the GPD policies and
procedures, we recommend that VA take steps to ensure that its policies
are understood by the staff and providers who are to implement them.
For example, VA could make more information, such as issues discussed
during conference calls, available in writing or online, hold an annual
conference, or provide training that may also include local VA staff.
2. To better understand the circumstances of veterans after they leave
the GPD program, we recommend that VA explore feasible and cost-
effective ways to obtain such information, where possible using data
from GPD providers and other VA sources. For example, VA could review
ways to use the data from its own follow-up health assessments and from
GPD providers who collect follow-up information on the circumstances of
veterans whom they have served.
Agency Comments and Our Evaluation:
We provided a draft of this report to VA for review and comment. VA
agreed with our findings and concurred with our recommendations and
provided information on initiatives it has under way or planned that
will address issues raised in our report as well as other challenges
the GPD program faces.
VA concurred that there is an apparent lack of consistency in GPD
program implementation and stressed its commitment to further enhance
communications with VA liaisons and GPD providers, including providers
whose operations are still in the developmental stage. For example, VA
plans to develop a comprehensive GPD implementation plan that will
address several operational issues, including training and
certification requirements. As well, for the first time, the VA's
Veterans Health Administration plans to host a conference or series of
regional conferences for GPD providers and VA liaisons to review
program requirements and expectations. VA estimates these conferences
will take place in spring 2007.
VA also concurred with the need to better understand the circumstances
of veterans after they leave the GPD program and stated that it has
plans in place to address optional approaches for long-term study in
this area after it completes an analysis of its longitudinal outcome
studies of VA's homeless program. In the interim, VA said it would
continue to explore options for using existing data to evaluate program
effectiveness.
However, the agency disagreed with the statement in our draft report
that VA officials attribute the decrease in the estimates of homeless
veterans to VA's estimation process and better local data. VA believes
that the recent decrease in the estimates is a direct result of its
progress in treating these veterans through the GPD program.
Several factors may have contributed to the decrease in the estimates
of homeless veterans. We did not intend to imply that the decrease was
solely attributable to changes in VA's estimation process and better
local data, nor did we intend to downplay VA's program successes. We
have revised the language in this report accordingly.
VA's written comments appear in appendix V. VA also provided technical
comments, which have been incorporated into the report as appropriate.
We are sending copies of this report to the Secretary of Veterans
Affairs. We will also make copies available to others on request. In
addition, the report will be available at no charge on GAO's Web site
at http://www.gao.gov. If you or your staff have any questions about
this report, please contact me at (202) 512-7215 or chaplainc@gao.gov.
Contact points for our Offices of Congressional Relations and Public
Affairs can be found on the last page of this report. GAO staff who
made major contributions to this report are listed in appendix VI.
Sincerely yours,
Signed by:
Cristina T. Chaplain:
Acting Director:
Education, Workforce, and Income Security Issues:
[End of section]
Appendix I: Scope and Methodology:
The objectives of this report were to review (1) Department of Veterans
Affairs (VA) estimates of the total number of homeless veterans and the
number of transitional beds available, (2) the extent of collaboration
involved in the provision of Homeless Providers Grant and Per Diem
(GPD) program and related services, and (3) VA's assessment of GPD
program performance.
In conducting our review, we focused on the GPD providers that serve
the general homeless veteran population rather than those serving
veterans with special needs, although we visited some special needs
grantees. We interviewed officials at VA headquarters, the GPD program
office, the regional Veterans Integrated Service Networks, VA's
Northeast Program Evaluation Center (NEPEC), and organizations
knowledgeable about homeless veterans' issues, including the National
Coalition for Homeless Veterans. To gain an initial understanding of
the GPD program in operation, we spoke with staff and toured GPD
facilities in Baltimore, Maryland; Denver, Colorado; and Washington,
D.C. To develop greater in-depth material for this report, we made more
extensive visits to 13 GPD providers that fall under the responsibility
of VA's medical centers in Boston, Massachusetts; Los Angeles,
California; Tampa, Florida; and Tomah and Madison, Wisconsin. We
selected these GPD providers to obtain a range of geographic locations,
size of programs, and proximity to VA medical centers. (See table 5 for
a listing of sites we visited and their characteristics.) During our
visits, we toured GPD facilities, interviewed GPD providers, medical
center staff, community agencies that partner with the GPD providers,
and current and former GPD program participants. Additionally, we
interviewed staff but did not tour facilities of 16 other GPD providers
in the areas we visited. We also met with GPD and other service
providers at conferences sponsored by the Departments of Labor and
Health and Human Services.
Table 5: Features of GPD Programs That GAO Visited:
Massachusetts--Boston, Fitchburg, Leominster Veterans Integrated
Service Network 1: New England Shelter for Homeless Veterans, Post-
Detox Program (Boston);
Number of GPD beds: 30;
Fiscal Year '05 Admits: 149;
Fiscal Year '05 Discharges: 137;
Location Type[A]: urban.
Massachusetts--Boston, Fitchburg, Leominster Veterans Integrated
Service Network 1: Veteran Hospice Homestead (Fitchburg);
Number of GPD beds: 12;
Fiscal Year '05 Admits: 19;
Fiscal Year '05 Discharges: 21;
Location Type[A]: rural.
Massachusetts--Boston, Fitchburg, Leominster Veterans Integrated
Service Network 1: The Armistice Homestead[B] (Leominster);
Number of GPD beds: 15;
Fiscal Year '05 Admits: NA;
Fiscal Year '05 Discharges: NA;
Location Type[A]: rural.
Florida- Tampa, Melbourne, Cocoa: Veterans Integrated Service Network
8: Agency for Community Treatment Services, (Tampa);
Number of GPD beds: 60;
Fiscal Year '05 Admits: 64;
Fiscal Year '05 Discharges: 53;
Location Type[A]: urban.
Florida- Tampa, Melbourne, Cocoa: Veterans Integrated Service Network
8: Vietnam Veterans of Brevard (Melbourne);
Number of GPD beds: 19;
Fiscal Year '05 Admits: 70;
Fiscal Year '05 Discharges: 53;
Location Type[A]: urban.
Florida- Tampa, Melbourne, Cocoa: Veterans Integrated Service Network
8: Volunteers of America--Florida (Cocoa)[C];
Number of GPD beds: 80;
Fiscal Year '05 Admits: 100;
Fiscal Year '05 Discharges: 100;
Location Type[A]: urban.
Wisconsin- Tomah, Madison, Fort McCoy: Veterans Integrated Network 12:
Veterans Assistance Foundation (Tomah)[D];
Number of GPD beds: 60;
Fiscal Year '05 Admits: 162;
Fiscal Year '05 Discharges: 167;
Location Type[A]: rural.
Wisconsin- Tomah, Madison, Fort McCoy: Veterans Integrated Network 12:
Veterans Assistance Foundation, Step Up Program(Madison);
Number of GPD beds: 7;
Fiscal Year '05 Admits: 9;
Fiscal Year '05 Discharges: 10;
Location Type[A]: urban.
Wisconsin- Tomah, Madison, Fort McCoy: Veterans Integrated Network 12:
Wisconsin Department of Veterans Affairs (Fort McCoy);
Number of GPD beds: 14;
Fiscal Year '05 Admits: 23;
Fiscal Year '05 Discharges: 18;
Location Type[A]: rural.
California - Los Angeles: Veterans Integrated Service Network 22:
P.A.T.H.[C];
Number of GPD beds: 10;
Fiscal Year '05 Admits: 28;
Fiscal Year '05 Discharges: 23;
Location Type[A]: urban.
California - Los Angeles: Veterans Integrated Service Network 22: The
Salvation Army, The Haven[ D];
Number of GPD beds: 95;
Fiscal Year '05 Admits: 193;
Fiscal Year '05 Discharges: 200;
Location Type[A]: urban.
California - Los Angeles: Veterans Integrated Service Network 22:
Volunteers of America--LA[C];
Number of GPD beds: 102;
Fiscal Year '05 Admits: 106;
Fiscal Year '05 Discharges: 98;
Location Type[A]: urban.
California - Los Angeles: Veterans Integrated Service Network 22:
Weingart Center Association;
Number of GPD beds: 100;
Fiscal Year '05 Admits: 107;
Fiscal Year '05 Discharges: 113;
Location Type[A]: urban.
Source: GAO review of VA data.
[A] VA does not classify grantees as rural; however, we included this
type of information for site selection purposes.
[B] The Armistice Homestead is part of a collaborative grant under
Massachusetts Veterans Inc. The entire grant funds 43 beds, 15 of which
are located at the Armistice. Specific admission and discharge data
were not available for the Armistice program.
[C] Program also has funding for a service center.
[D] Program is located on VA medical center grounds.
[End of table]
Throughout our review, we worked with the VA's Office of Inspector
General (OIG) to ensure that we complemented but did not duplicate a
review it was conducting on GPD program management. The OIG's review
was designed to determine if records demonstrate that (1) homeless
veterans receive appropriate assessment and treatment, (2) GPD provider
performance is evaluated and actions are taken to improve conditions,
(3) GPD providers achieve their stated goals, (4) VA's guidelines for
the inspection of GPD facilities are followed, (5) GPD operations are
properly monitored by VA, and (6) fiscal controls are adequate.
Although the OIG's report was not available at the time we prepared our
report, we were briefed on results that were relevant to our work and
incorporated the information as appropriate. In addition, we discussed
with the OIG's team our selection of sites to visit and chose sites
that were not included in the team's review.
In reviewing VA estimates of the number of homeless veterans, we
reviewed the literature, read relevant reports, and interviewed VA
officials, particularly those involved in the federally mandated
Community Homelessness Assessment, Local Education and Networking Group
for Veterans (CHALENG). We interviewed experts in the subject area and
officials with the Bureau of the Census and the Department of Housing
and Urban Development (HUD). We used information from our site visits
to supplement our discussion on how local entities conduct counts of
homeless individuals. We did not review the validity of VA's estimates.
To identify GPD program capacity, location, and number of admissions,
we analyzed data from a series of annual reports prepared by NEPEC,
updated where appropriate by information from the GPD program office in
May 2006.
To assess the overall extent to which GPD providers collaborated with
other agencies to offer services to homeless veterans, we analyzed
NEPEC survey data. The survey included responses from all GPD providers
in 2003, when NEPEC first conducted the survey, and all programs that
became operational or were funded in subsequent years through November
2005. For more information on the survey data, see appendix III. We
performed basic reasonableness tests on the survey data and contacted
NEPEC for any clarifications or discrepancies. We determined these data
to be sufficiently reliable for the purposes of this report. To get an
understanding of how collaboration was actually occurring at the local
level, we conducted site visits. During these visits we gathered
information on the types of services GPD providers offer, how providers
partnered with local agencies (including VA) to offer services, and how
these partnerships were working. To review how VA coordinates with
other federal agencies, we attended a meeting of VA's Advisory
Committee on Homeless Veterans, talked with a representative from the
Interagency Council on Homelessness, and contacted other prominent
federal partners.
To identify how VA assesses the performance of the GPD program, we
reviewed GPD program goals, interviewed VA officials, including a team
with the OIG, and analyzed data obtained from VA's national program
office and NEPEC. We reviewed the Grant and Per Diem Program Evaluation
Procedures Manual that NEPEC sends to each VA liaison that describes
the responsibilities of liaisons and GPD providers in completing,
reviewing, and submitting intake and discharge forms on individual
participants. We extracted data on outcomes from tables included in
NEPEC's series of annual reports on the program and discussed the
reliability of these data with NEPEC officials. This information is
briefly summarized in appendix IV along with relevant findings from the
OIG's review. We did not independently verify the NEPEC data. We
reviewed how VA collects and analyzes outcome data and found these data
to be sufficiently reliable for our purposes. Additionally, we reviewed
grant documents for the sites we visited to identify the specific
objectives they set to meet program goals and asked VA officials and
providers about various aspects of performance measurement during our
site visits. We did not conduct our own review of outcomes for homeless
veterans served by the GPD providers we visited.
At the time we conducted our analysis, VA's follow-up study had not
been released; therefore, our discussion of the study is based on our
review of preliminary results that identified the numbers and
characteristics of the participants, the timetable and roles of the
universities and researchers involved, and the housing outcomes at the
end of the year. Conducted from 2001 through 2005, the study followed a
total of 1,294 participants, with approximately 260 participants from
each of five medical center areas serving California, the District of
Columbia, Florida, Maryland, Ohio, Pennsylvania, and West Virginia.
Veterans were randomly selected from lists of active participants that
included recent admissions as well as participants with longer stays in
the program. Participants were drawn from programs operated by 6
domiciliary care providers, 16 contracted residential treatment
providers, and 19 GPD providers. The study had an overall response rate
of 72 percent for all participants in the three transitional housing
programs, with a response rate of 69 percent for the GPD participants,
for the interviews conducted a year after they left the program. Of the
520 GPD participants studied, 359 were interviewed a year after leaving
the program. Of those interviewed, 60 percent were in their own
independent housing, 23 percent were sharing with friends or family,
and 15 percent were in temporary housing, including shelters or in an
institution other than a jail.
We conducted our work between August 2005 and July 2006 in accordance
with generally accepted government auditing standards.
[End of section]
Appendix II: VA's Programs for Homeless Veterans Other than the GPD
Program:
Veterans Health Administration Programs for Homeless Veterans:
Health Care for Homeless Veterans (HCHV) including Contracted
Residential Treatment:
Under the HCHV umbrella program, VA provides outreach, health and
mental health assessments, treatment, and referrals for homeless
veterans with mental health and substance abuse problems. Veterans with
limited length of service or with other than a dishonorable discharge
are eligible for the HCHV program but may not necessarily be eligible
for VA health care, where the criteria are more restrictive. A veteran
needing transitional housing while undergoing treatment may be placed
in one of the approximately 300 contracted residential treatment beds
that are funded from the budgets of individual medical centers. In
fiscal year 2005, there were about 1,700 admissions for an average stay
of 2 months at $36 per day; the recommended maximum stay is 6 months.
Where contracted residential treatment is not available, veterans in
need of transitional housing may be referred to the more widely
available GPD program or domiciliary care. In fiscal year 2005, VA's
HCHV program provided outreach, treatment, and referral services to
about 61,000 homeless veterans, with obligations of about $40 million.
Homeless Domiciliary Residential Rehabilitation and Treatment Program:
This transitional housing program is designed for homeless veterans who
do not need hospital or nursing home services while their clinical
status is being stabilized. In this program, veterans receive various
services, including medical and mental health evaluations, treatment,
and community support. Domiciliary programs are generally located on
the grounds of VA medical centers, and unlike the GPD programs, they
are usually managed and staffed by the local VA medical center. In
fiscal year 2005 about 5,000 homeless veterans stayed an average of 4
months in this program. About 1,800 beds were available exclusively for
homeless veterans, with obligations of about $58 million. Additional
funding was awarded in 2005 to increase the number of beds available to
about 2,200 in fiscal year 2007, bringing total obligations up to a
projected $73 million.
Homeless Compensated Work Therapy/Transitional Residence:
This work therapy program provides veterans with job skills and income.
Through the program veterans produce items for sale or provide services
such as temporary staffing to a company. While participating in this
program, veterans may receive individual or group therapy and follow-up
medical care on an outpatient basis. At some locations, program
participants can stay in one of the about 500 beds available in
transitional, community-based group homes. Veterans participating in
this program are required to use a portion of their income from the
work program to pay for rent, utilities, and food. Obligations for this
program in fiscal year 2005 were about $10 million.
Loan Guarantee for Multifamily Transitional Housing:
This transitional housing program provides guaranteed loans to
nonprofit organizations to construct or rehabilitate multifamily
transitional housing for homeless veterans, including single room
occupancy units. Supportive services and counseling, including job
counseling, must be provided with the goal of encouraging self-
determination among participating veterans. Veterans must maintain
sobriety, seek and maintain employment, and pay a fee in order to live
in these transitional units. Not more than 15 loans with an aggregate
total of $100 million may be guaranteed under this program. In fiscal
year 2005, the Vietnam Veterans of San Diego housing project was under
construction. Other programs have been conditionally selected and are
expected to be approved in fiscal years 2006 and 2007. For information
on the challenges encountered in implementing this initiative, see
Related GAO Products for GAO's report on this program.
Housing and Urban Development-VA Supported Housing:
This permanent, subsidized housing program provides HUD rental
assistance (Section 8) vouchers for use by homeless veterans with
chronic mental health or substance abuse disorders. Veterans are
required to pay a portion of their income for rent; those without
income receive fully subsidized housing. In general, veterans who do
not exceed the maximum allowable income can remain in the housing
permanently, but must agree to intensive case management services from
VA staff and make a long-term commitment to treatment and
rehabilitation. Local housing authorities control access to the
vouchers. Many of the 1,780 vouchers allocated by HUD remain in use but
no new vouchers have been made available. As a result, in fiscal year
2005, only 142 veterans were admitted to the program. VA's obligations
in support of this program in fiscal year 2005 were about $3 million.
Veterans Benefits Administration Programs for Homeless Veterans:
Veterans Benefits Administration Outreach:
According to VA, in 20 of its 57 regional offices VA has designated
full-time homeless veterans coordinators who work with HCHV and other
VA staff to conduct joint outreach, provide counseling, and offer other
services to homeless veterans, such as helping them apply for veterans
benefits. In the remaining regions, staff may be assigned collateral
responsibility to work with homeless veterans. One of the goals of this
program is to expedite the processing of benefit claims made by
homeless veterans. According to VA, in fiscal year 2005, VA received
approximately 4,400 claims from homeless veterans. Of these claims, 56
percent were for disability compensation and 44 percent were for
pensions. Of the compensation claims, 26 percent were granted, 33
percent denied, and 41 percent pending an average of about 4 months. Of
the pension claims, 62 percent were granted, 18 percent denied, and 21
percent pending an average of about 3 months.
Acquired Property Sales for Homeless Providers:
VA properties that are obtained through foreclosures on VA-insured
mortgages are available for sale at below fair market value to
nonprofit and public agencies that use the properties to shelter or
house homeless veterans. Since the inception of this program, more than
200 properties have been sold or leased.
Labor-VA Incarcerated Veterans' Transition Program:
Under this demonstration program, the Department of Labor (DOL) funds
community agencies to provide training and support services, and VA
contributes its services, to help veterans who are incarcerated and at
risk of homelessness make a successful transition back into the
workforce. According to DOL, services provided include career
counseling, employment training, job-search and job-placement
assistance, life-skills development, and follow-up. Local staff from
both VA's Health Administration and Benefits Administration provide
information about available VA benefits and services. Grantees must
report the number of veterans who are still employed 6 months after job
placement, whether they are in the same or similar jobs, and the
reasons why veterans who were placed are no longer employed. DOL
provided $2 million to seven community agencies in 2006 for this
purpose.
[End of section]
Appendix III: Range of Services Offered by GPD Programs Nationwide:
We analyzed NEPEC's Facility Survey data to identify the types of
services that programs provide and how they are provided. NEPEC
conducted the survey to capture information on the types of GPD
programs funded. According to NEPEC officials, the survey was used to
capture information such as program location, admissions criteria,
services available, and licensing. Because the survey was not intended
to be used as a tool to review how programs were performing, NEPEC does
not conduct rigorous internal reviews of the data collected. We
conducted basic reasonableness tests and contacted NEPEC for any
clarifications or discrepancies. We found the survey data sufficiently
reliable for the purposes of this report.
The survey was first deployed in 2003 to all agencies that were
receiving funding that year. In subsequent years, NEPEC had newly
funded agencies complete this onetime survey. A total of 281
transitional housing facilities were included in the survey data we
analyzed--148 of the facilities were surveyed in 2003, 94 in 2004, and
39 in 2005. According to NEPEC, this represents all operational
programs as of November 2005. While there were about 300 agencies with
GPD grants, some of the agencies have multiple grants for one facility,
resulting in one survey being completed for that facility. The surveys
were completed by the VA liaisons in consultation with GPD provider
staff. NEPEC officials were confident they have achieved a 100 percent
response rate. While we did not independently verify the response rate
for the survey, we concluded that it would be at least 90 percent.
Table 6 shows the percentage of facilities that reportedly provide the
selected services and how the services were provided. Survey
respondents were asked to identify how, if at all, services were
provided and were directed to choose only one method. It may be the
case, however, that as in some locations we visited, services were
provided by more than one method. As can be seen, the majority of GPD
programs provided a spectrum of services for veterans. However, these
programs varied in how services were provided, with some services more
likely to be provided through partnerships and others more likely to be
provided in-house directly by staff. Some of the services that were
more likely to be provided through partnerships include those that
require counseling or medical-related treatment. Services primarily
provided directly by GPD providers tended to be more related to case
management type activities.
Table 6: Percentage of GPD Facilities Reporting They Provided Selected
Services by Method:
Services (ordered by prevalence of service being offered): Vocational/
educational counseling;
How services were provided by programs: Indirectly through linkages[A]:
48.0;
How services were provided by programs: Indirectly by staff[B]: 11.5;
How services were provided by programs: Directly by staff[C]: 39.8;
How services were provided by programs: Total percentage of facilities
providing service: 99.3.
Services (ordered by prevalence of service being offered): Discharge
planning;
How services were provided by programs: Indirectly through linkages[A]:
8.2;
How services were provided by programs: Indirectly by staff[B]: 2.5;
How services were provided by programs: Directly by staff[C]: 88.6;
How services were provided by programs: Total percentage of facilities
providing service: 99.3.
Services (ordered by prevalence of service being offered): Assistance
with obtaining social services (e.g., Medicaid, Supplemental Security
Income, Social Security Disability Insurance);
How services were provided by programs: Indirectly through linkages[A]:
25.7;
How services were provided by programs: Indirectly by staff[B]: 5.4;
How services were provided by programs: Directly by staff[C]: 67.5;
How services were provided by programs: Total percentage of facilities
providing service: 98.6.
Services (ordered by prevalence of service being offered): Case
management services;
How services were provided by programs: Indirectly through linkages[A]:
10.0;
How services were provided by programs: Indirectly by staff[B]: 3.2;
How services were provided by programs: Directly by staff[C]: 85.4;
How services were provided by programs: Total percentage of facilities
providing service: 98.6.
Services (ordered by prevalence of service being offered): Housing
assistance;
How services were provided by programs: Indirectly through linkages[A]:
20.8;
How services were provided by programs: Indirectly by staff[B]: 4.3;
How services were provided by programs: Directly by staff[C]: 73.1;
How services were provided by programs: Total percentage of facilities
providing service: 98.2.
Services (ordered by prevalence of service being offered): Assistance
with spending money, banking or other financial matters;
How services were provided by programs: Indirectly through linkages[A]:
18.6;
How services were provided by programs: Indirectly by staff[B]: 8.2;
How services were provided by programs: Directly by staff[C]: 70.0;
How services were provided by programs: Total percentage of facilities
providing service: 96.8.
Services (ordered by prevalence of service being offered):
Transportation or assistance using public transportation;
How services were provided by programs: Indirectly through linkages[A]:
20.0;
How services were provided by programs: Indirectly by staff[B]: 7.1;
How services were provided by programs: Directly by staff[C]: 69.3;
How services were provided by programs: Total percentage of facilities
providing service: 96.4.
Services (ordered by prevalence of service being offered): Relapse
prevention groups;
How services were provided by programs: Indirectly through linkages[A]:
48.8;
How services were provided by programs: Indirectly by staff[B]: 5.4;
How services were provided by programs: Directly by staff[C]: 41.9;
How services were provided by programs: Total percentage of facilities
providing service: 96.1.
Services (ordered by prevalence of service being offered):
Comprehensive mental health assessment/diagnosis;
How services were provided by programs: Indirectly through linkages[A]:
70.4;
How services were provided by programs: Indirectly by staff[B]: 8.6;
How services were provided by programs: Directly by staff[C]: 16.8;
How services were provided by programs: Total percentage of facilities
providing service: 95.7.
Services (ordered by prevalence of service being offered): Individual
therapy;
How services were provided by programs: Indirectly through linkages[A]:
47.9;
How services were provided by programs: Indirectly by staff[B]: 5.4;
How services were provided by programs: Directly by staff[C]: 42.5;
How services were provided by programs: Total percentage of facilities
providing service: 95.7.
Services (ordered by prevalence of service being offered): Referral to
other transitional services;
How services were provided by programs: Indirectly through linkages[A]:
13.9;
How services were provided by programs: Indirectly by staff[B]: 3.2;
How services were provided by programs: Directly by staff[C]: 78.2;
How services were provided by programs: Total percentage of facilities
providing service: 95.4.
Services (ordered by prevalence of service being offered):
Comprehensive substance abuse assessment/diagnosis;
How services were provided by programs: Indirectly through linkages[A]:
47.7;
How services were provided by programs: Indirectly by staff[B]: 8.6;
How services were provided by programs: Directly by staff[C]: 38.7;
How services were provided by programs: Total percentage of facilities
providing service: 95.0.
Services (ordered by prevalence of service being offered): Group
therapy, not including relapse prevention;
How services were provided by programs: Indirectly through linkages[A]:
38.6;
How services were provided by programs: Indirectly by staff[B]: 5.7;
How services were provided by programs: Directly by staff[C]: 47.1;
How services were provided by programs: Total percentage of facilities
providing service: 91.4.
Services (ordered by prevalence of service being offered): Aftercare
counseling;
How services were provided by programs: Indirectly through linkages[A]:
48.2;
How services were provided by programs: Indirectly by staff[B]: 5.4;
How services were provided by programs: Directly by staff[C]: 37.5;
How services were provided by programs: Total percentage of facilities
providing service: 91.1.
Services (ordered by prevalence of service being offered): AIDS
screening and counseling;
How services were provided by programs: Indirectly through linkages[A]:
75.0;
How services were provided by programs: Indirectly by staff[B]: 7.5;
How services were provided by programs: Directly by staff[C]: 6.8;
How services were provided by programs: Total percentage of facilities
providing service: 89.3.
Services (ordered by prevalence of service being offered): Nutritional
counseling;
How services were provided by programs: Indirectly through linkages[A]:
54.6;
How services were provided by programs: Indirectly by staff[B]: 11.4;
How services were provided by programs: Directly by staff[C]: 23.2;
How services were provided by programs: Total percentage of facilities
providing service: 89.3.
Services (ordered by prevalence of service being offered): Legal advice
or counseling;
How services were provided by programs: Indirectly through linkages[A]:
76.1;
How services were provided by programs: Indirectly by staff[B]: 3.9;
How services were provided by programs: Directly by staff[C]: 5.7;
How services were provided by programs: Total percentage of facilities
providing service: 85.7.
Services (ordered by prevalence of service being offered): Outcome
follow-up (post discharge);
How services were provided by programs: Indirectly through linkages[A]:
18.6;
How services were provided by programs: Indirectly by staff[B]: 6.1;
How services were provided by programs: Directly by staff[C]: 56.3;
How services were provided by programs: Total percentage of facilities
providing service: 81.0.
Services (ordered by prevalence of service being offered): Family
counseling;
How services were provided by programs: Indirectly through linkages[A]:
44.3;
How services were provided by programs: Indirectly by staff[B]: 7.1;
How services were provided by programs: Directly by staff[C]: 28.6;
How services were provided by programs: Total percentage of facilities
providing service: 80.0.
Services (ordered by prevalence of service being offered): Religious or
spiritual counseling;
How services were provided by programs: Indirectly through linkages[A]:
51.1;
How services were provided by programs: Indirectly by staff[B]: 8.2;
How services were provided by programs: Directly by staff[C]: 17.5;
How services were provided by programs: Total percentage of facilities
providing service: 76.8.
Services (ordered by prevalence of service being offered): Domestic
violence--family/partner violence services;
How services were provided by programs: Indirectly through linkages[A]:
63.2;
How services were provided by programs: Indirectly by staff[B]: 4.3;
How services were provided by programs: Directly by staff[C]: 8.2;
How services were provided by programs: Total percentage of facilities
providing service: 75.7.
Services (ordered by prevalence of service being offered):
Representative payee services[D];
How services were provided by programs: Indirectly through linkages[A]:
51.4;
How services were provided by programs: Indirectly by staff[B]: 3.6;
How services were provided by programs: Directly by staff[C]: 8.6;
How services were provided by programs: Total percentage of facilities
providing service: 63.6.
Services (ordered by prevalence of service being offered): Child care;
How services were provided by programs: Indirectly through linkages[A]:
17.1;
How services were provided by programs: Indirectly by staff[B]: 3.2;
How services were provided by programs: Directly by staff[C]: 1.8;
How services were provided by programs: Total percentage of facilities
providing service: 22.1.
Source: GAO analysis of NEPEC GPD program facility survey.
Note: Percentages were calculated for facilities that completed the
survey question, either 279 or 280 facilities depending on the
question.
[A] Indirectly through linkages means treatment is provided indirectly
through links with other agencies, including VA.
[B] Indirectly by staff means treatment is provided indirectly by other
staff of the organization.
[C] Directly by staff means treatment is provided directly by staff at
this program.
[D] Representative payees handle an individual's benefits if the
individual is unable to. The benefits must be used to meet the needs of
the beneficiary.
[End of table]
[End of section]
Appendix IV Participant Outcomes for the Grant and Per Diem Program:
Outcomes are reported on a standard Northeast Program Evaluation Center
discharge form that must be filled out by VA staff or by GPD staff with
VA's review and sign-off when the participant leaves the program. The
form also captures information on the length and cost of stay in the
GPD, reasons the participant left the program, and any plans for follow-
up treatment for substance abuse or other problems. NEPEC officials
told us that they do not verify the data submitted to them, but they do
perform tests for completeness and internal consistency. VA's Office of
Inspector General (OIG) found that not all outcomes shown on the
discharge forms were supported by additional information in the sample
of case records that the OIG reviewed. For example, 76 percent of
records included information supporting the veterans' outcomes
indicated on the form, but about 24 percent of records lacked such
support.
Outcomes for housing and income are shown as a percentage of all
participants who left the program for any reason. However, outcomes for
self-determination in terms of improved functioning are shown as a
percentage of those veterans who had an identified problem when they
entered the program. The determination that a participant has or has
not improved may be considered somewhat subjective. The problems are
described by participants themselves to VA staff in response to a
series of questions on a standard NEPEC intake form that also includes
a section for the VA clinical staff to record their observations of the
substance abuse or mental health problems that the participants face.
The intake form also captures other characteristics of the
participants, such as their military, financial and living
circumstances. VA staff are expected to complete these forms when they
first contact homeless veterans but no later than the veterans' third
day with a GPD provider and to forward the forms to NEPEC. NEPEC
reports that it does not receive intake forms for about 10 percent of
participants in the GPD program each year.
Table 7: Number Served by VA's Health Care for Homeless Veterans and
Grant and Per Diem Program and Veterans' Outcomes, Fiscal years 2000
through 2005:
Participants served and outcomes: Number of: veterans treated by VA's
Health care for Homeless Veterans' (HCHV) staff;
Federal Fiscal year (October through September of year shown): 2000:
43,082;
Federal Fiscal year (October through September of year shown): 2001:
57,854;
Federal Fiscal year (October through September of year shown): 2002:
61,123;
Federal Fiscal year (October through September of year shown): 2003:
69,970;
Federal Fiscal year (October through September of year shown): 2004:
63,283;
Federal Fiscal year (October through September of year shown): 2005:
61,261.
Participants served and outcomes: Number of: intake assessments of
homeless veterans by HCHV staff[A];
Federal Fiscal year (October through September of year shown): 2000:
34,206;
Federal Fiscal year (October through September of year shown): 2001:
46,862;
Federal Fiscal year (October through September of year shown): 2002:
44,296;
Federal Fiscal year (October through September of year shown): 2003:
42,380;
Federal Fiscal year (October through September of year shown): 2004:
42,485;
Federal Fiscal year (October through September of year shown): 2005:
41,111.
Participants served and outcomes: Number of: admissions of veterans to
GPDs;
Federal Fiscal year (October through September of year shown): 2000:
4,841;
Federal Fiscal year (October through September of year shown): 2001:
10,137;
Federal Fiscal year (October through September of year shown): 2002:
11,913;
Federal Fiscal year (October through September of year shown): 2003:
12,396;
Federal Fiscal year (October through September of year shown): 2004:
13,509;
Federal Fiscal year (October through September of year shown): 2005:
16,597.
Participants served and outcomes: Number of: discharges from GPDs;
Federal Fiscal year (October through September of year shown): 2000:
4,020;
Federal Fiscal year (October through September of year shown): 2001:
8,706;
Federal Fiscal year (October through September of year shown): 2002:
11,098;
Federal Fiscal year (October through September of year shown): 2003:
11,427;
Federal Fiscal year (October through September of year shown): 2004:
12,454;
Federal Fiscal year (October through September of year shown): 2005:
15,403.
Participants served and outcomes: Days a veteran stays at a GPD, on
average;
Federal Fiscal year (October through September of year shown): 2000:
91;
Federal Fiscal year (October through September of year shown): 2001:
85;
Federal Fiscal year (October through September of year shown): 2002:
93;
Federal Fiscal year (October through September of year shown): 2003:
110;
Federal Fiscal year (October through September of year shown): 2004:
126;
Federal Fiscal year (October through September of year shown): 2005:
127.
Participants served and outcomes: Housing stability outcomes: Number of
Discharges from GPDs with: full-time or part-time employment;
Federal Fiscal year (October through September of year shown): 2000:
1,404;
Federal Fiscal year (October through September of year shown): 2001:
2,803;
Federal Fiscal year (October through September of year shown): 2002:
3,579;
Federal Fiscal year (October through September of year shown): 2003:
3,735;
Federal Fiscal year (October through September of year shown): 2004:
4,108;
Federal Fiscal year (October through September of year shown): 2005:
4,920.
Participants served and outcomes: Housing stability outcomes: Number of
Discharges from GPDs with: VA benefits[B];
Federal Fiscal year (October through September of year shown): 2000:
NA;
Federal Fiscal year (October through September of year shown): 2001:
NA;
Federal Fiscal year (October through September of year shown): 2002:
NA;
Federal Fiscal year (October through September of year shown): 2003:
2,100;
Federal Fiscal year (October through September of year shown): 2004:
2,701;
Federal Fiscal year (October through September of year shown): 2005:
3,751.
Participants served and outcomes: Housing stability outcomes: Number of
Discharges from GPDs with: Other public benefits[B];
Federal Fiscal year (October through September of year shown): 2000:
NA;
Federal Fiscal year (October through September of year shown): 2001:
NA;
Federal Fiscal year (October through September of year shown): 2002:
NA;
Federal Fiscal year (October through September of year shown): 2003:
2,064;
Federal Fiscal year (October through September of year shown): 2004:
2,309;
Federal Fiscal year (October through September of year shown): 2005:
2,916.
Participants served and outcomes: Greater self-determination outcomes:
Percentage of discharges from GPDs with: improved alcohol, drug, mental
health[C];
Federal Fiscal year (October through September of year shown): 2000: 38-
42;
Federal Fiscal year (October through September of year shown): 2001: 42-
49;
Federal Fiscal year (October through September of year shown): 2002: 43-
50;
Federal Fiscal year (October through September of year shown): 2003: 52-
62;
Federal Fiscal year (October through September of year shown): 2004: 60-
67;
Federal Fiscal year (October through September of year shown): 2005: 62-
69.
Participants served and outcomes: Greater self-determination outcomes:
Percentage of discharges from GPDs with: improved medical,
social/vocational condition[C];
Federal Fiscal year (October through September of year shown): 2000: 43-
46;
Federal Fiscal year (October through September of year shown): 2001: 40-
44;
Federal Fiscal year (October through September of year shown): 2002: 43-
46;
Federal Fiscal year (October through September of year shown): 2003: 50-
57;
Federal Fiscal year (October through September of year shown): 2004: 55-
63;
Federal Fiscal year (October through September of year shown): 2005: 57-
64.
Participants served and outcomes: Greater self-determination outcomes:
Percentage of discharges from GPDs with: success in program;
Federal Fiscal year (October through September of year shown): 2000:
30;
Federal Fiscal year (October through September of year shown): 2001:
32;
Federal Fiscal year (October through September of year shown): 2002:
38;
Federal Fiscal year (October through September of year shown): 2003:
43;
Federal Fiscal year (October through September of year shown): 2004:
49;
Federal Fiscal year (October through September of year shown): 2005:
50.
Source: VA data.
[A] Intake assessments are completed by HCHV staff when they first
encounter a homeless veteran, unless the contact is casual and no
services are offered or referrals made. After a year, new assessments
are required if VA care or services are provided and VA staff have not
been working with the veteran.
[B] Numbers shown here include veterans who receive both types of
benefits as well as those who receive only the designated benefits. For
this reason, they differ from the numbers shown in table 3.
[C] Percentages are ranges showing the highest and lowest of each of
two or three outcome measures.
[End of table]
[End of section]
Appendix V: Comments from the Department of Veterans Affairs:
The Secretary Of Veterans Affairs:
Washington:
August 25, 2006:
Ms. Cristina Chaplain:
Acting Director:
Education, Workforce, and Income Security Team:
U. S. Government Accountability Office:
441 G Street, NW:
Washington, DC 20548:
Dear Ms. Chaplain:
The Department of Veterans Affairs (VA) has reviewed the Government
Accountability Office's (GAO) draft report, Homeless Veterans Programs:
Improved Communications and Follow-up Could Further Enhance the Grant
and Per Diem Program (GAO-06-859) and agrees with the findings and
concurs with the recommendations. However, we disagree with the comment
attributed to VA officials that VA's new estimation process and better
local data are the reasons we are experiencing a decrease in the number
of homeless veterans. VA believes the decrease is a direct result of
our progress in treating these veterans through an effective needs-
focused GPD health care program.
The Department is proud of the wide array of services that its GPD
program provides to homeless veterans through our partnership with many
community provider organizations. GAO's findings favorably highlight
the accomplishments of this rapidly expanding program. Nevertheless, we
recognize opportunities for improvement exist. The Veterans Health
Administration (VHA) is pursuing initiatives that actually reach well
beyond issues GAO raises. As GAO reports, VA has almost quadrupled the
number of beds and admissions to the GPD program since fiscal 2000.
Such explosive growth has resulted in significant challenges. Although
program oversight by VA field facilities is crucial in ensuring program
effectiveness at the local level, it is also apparent that there is a
lack of consistency in implementation of the program, as well as in
national oversight. These have contributed to program gaps that VA is
currently addressing. The Acting Under Secretary for Health has
directed the Deputy Chief Patient Care Services Officer for Mental
Health to convene a special field advisory group to develop a
comprehensive GPD implementation plan that will address such issues as
functional responsibilities at all organizational levels, staff roles
and responsibilities, training/certification requirements, data
collection, and standardization of reporting and oversight, including
uniform management controls. Because planning for this advisory group
is still in the early developmental stages, I am unable to provide
established timeframes; however, we look forward to sharing progress
with GAO in the coming months.
In addition, VHA is finalizing a statement of work for solicitation of
an expert consultant to evaluate the current GPD program/process-
especially as it relates to financial oversight. The solicitation will
include a requirement for the development of alternative options for
program management.
The enclosure details actions the Department has taken and has planned
to implement GAO's recommendations. Technical corrections were passed
separately. I appreciate the opportunity to comment on your draft
report.
Signed by: R. James Nicholson:
Enclosure:
Enclosure:
Department of Veterans Affairs (VA) Comments on Government
Accountability Office (GAO) Draft Report, Homeless Veterans Programs:
Improved Communications and Follow-up Could Further Enhance the Grant
and Per Diem Program (GAO-06-859):
To improve and evaluate the Grant Per Diem (GPD) program, GAO
recommends that the Secretary of Veterans Affairs take the following
two steps:
1. to help ensure that GPD providers' understand the GPD policies and
procedures, GAO recommends that VA take steps to help ensure its
policies are understood by the staff and providers who are to implement
them. For example, VA could make more information, such as issues
discussed during conference calls, available in writing or online, hold
an annual conference, or provide training that may also include local
VA staff.
Concur - During the past 9 months, the Veterans Health Administration's
(VHA) GPD program office has conducted regional face-to-face training
sessions for all newly hired and current liaison staff. These training
sessions will continue to be scheduled for all new staff as they come
onboard. The GPD program office has worked in close coordination with
VA's Employee Education Service (EES) to design the training sessions,
as well as an informative web-based training package that is widely
accessed by both VA staff and GPD providers. The EES has also
established a feedback mechanism whereby the liaison staff is contacted
to determine the extent to which training tools are actually being
implemented in practice.
Avenues of communication with GPD liaisons and providers will be
enhanced further. A recently-appointed national clinical manager serves
as a resource expert on issues regarding veteran care and program
design, as well as technical determinations involving eligibility,
length of stay, episodes of care, etc. This individual also facilitates
the regularly scheduled monthly conference calls for GPD liaisons,
network homeless coordinators, and providers and will be available for
consultative site visits as required. In addition, the new clinical
manager will conduct an annual assessment of problematic areas and
initiate follow-up corrective actions as indicated.
All relevant policies and procedures related to the GPD program,
including issues identified by GAO, are consolidated in the recently
published VHA GPD Handbook (1162.01, March 2006). This easily accessed
document is available on the GPD Intranet Web site. In addition, the
GPD program office will soon provide a personal copy to each GPD
liaison.
The GPD national program office is also actively pursuing more open
lines of communication with operational grantees and with those
grantees whose programs are still in the developmental stage. As noted,
the new national clinical manager will serve as a liaison for these
organizations. Monthly conference calls with the grantees are already
routinely scheduled, and minutes of these meetings are distributed to
the attendees as well as posted on the Intranet Web site. For the first
time, VHA is also planning to host a post-award conference or series of
regional conferences, possibly in the spring of 2007 for all FY 2006
grant awardees and their respective GPD liaisons. These face-to-face
meetings will provide an opportunity to review program requirements and
expectations and to gain valuable feedback from the providers about the
status of project initiatives.
2. To better understand the circumstances of veterans after they leave
the GPD program, GAO recommends that VA explore feasible and cost-
effective ways to obtain such information, where possible using data
from GPD providers and other VA sources. For example, VA could review
ways to use the data from its own follow-up health assessments and from
GPD providers who collect follow-up information on the circumstances of
veterans whom they have served.
Concur - Plans are in place to address optional approaches for long-
term study in this area. VA's first priority is to complete an analysis
of the data already generated from the nine longitudinal outcome
studies of VA's homeless programs that the Northeast Program Evaluation
Center (NEPEC) has conducted. We anticipate having the initial analyses
by the end of December 2006 from the four completed projects. At that
time, more information will be available to make evidence-based
decisions about future directions. In the interim, VA will continue to
explore the feasibility, limits, and utility of using existing health
care performance measures and quality indicators to evaluate program
effectiveness.
[End of section]
Appendix VI: GAO Contact and Staff Acknowledgments:
GAO Contact:
Cristina T. Chaplain, Acting Director, (202) 512-7215,
chaplainc@gao.gov:
Acknowledgments:
Shelia Drake, Assistant Director; Patricia L. Elston; David Forgosh;
and Nyree M. Ryder made significant contributions to this report. In
addition, Roger Thomas provided legal assistance; Walter Vance and Lynn
Milan analyzed and assessed the reliability of data; Lily Chin,
Jonathan McMurray, and Charles Willson assisted in report development;
and Amy Sheller supported the team during its Los Angeles site visit.
[End of section]
Related GAO Products:
Homeless Veterans: Job Retention Goal Under Development for DOL's
Homeless Veterans' Reintegration Program. GAO-05-654T. Washington,
D.C.: May 4, 2005.
Veterans Affairs Homeless Programs: Implementation of the Transitional
Housing Loan Guarantee Program. GAO-05-311R. Washington, D.C.: March
16, 2005.
VA Health Care: VA Should Expedite the Implementation of
Recommendations Needed to Improve Post-Traumatic Stress Disorder
Services. GAO-05-287. Washington, D.C.: February 14, 2005.
Decennial Census: Methods for Collecting and Reporting Data on the
Homeless and Others without Conventional Housing Need Refinement. GAO-
03-227. Washington, D.C.: January 17, 2003.
Homelessness: Improving Program Coordination and Client Access to
Programs. GAO-02-485T. Washington, D.C.: March 6, 2002.
Homeless Veterans: VA Expands Partnerships, but Effectiveness of
Homeless Programs Is Unclear. GAO/T-HEHS-99-150. Washington, D.C.: June
24, 1999.
Homeless Veterans: VA Expands Partnerships, but Homeless Program
Effectiveness Is Unclear. GAO/HEHS-99-53. Washington, D.C.: April 1,
1999.
Homelessness: Overview of Current Issues and GAO Studies. GAO/T-RCED-
99-125. Washington, D.C.: March 23, 1999.
Homelessness: Demand for Services to Homeless Veterans Exceeds VA
Program Capacity. GAO/HEHS-94-98. Washington, D.C.: February 23, 1994.
FOOTNOTES
[1] VA's Office of Inspector General reviewed the GPD program and
planned to issue a report in September 2006 titled Evaluation of the
Veterans Health Administration Homeless Grant and Per Diem Program that
will be available on the Internet.
[2] Some medical centers continue to fund contracted residential
treatment from their own budgets. For more on earlier VA programs
serving homeless veterans, see GAO, Homeless Veterans: VA Expands
Partnerships, but Homeless Program Effectiveness Is Unclear, GAO/ HEHS-
99-53 (Washington, D.C.: Apr. 1, 1999).
[3] Throughout this report, we use the term "GPD provider" to refer to
a locally run program. In some cases a single organization may have
several GPD grants for housing at different locations, and we generally
report this as multiple providers.
[4] VA granted extensions to about 1 percent of the veterans who left
the program in fiscal year 2005. The rules allow extensions when
permanent housing for the veteran has not been located or the veteran
requires additional time to prepare for independent living.
[5] In contrast to the GPD program, veterans must meet the minimum
length of service requirements of in 38 U.S.C. §5303A in order to be
eligible for VA health care. In certain cases veterans with
dishonorable discharges may obtain an upgrade to their discharge status
and thus become eligible for the GPD program or for VA medical care.
[6] Veterans must constitute at least 75 percent of participants in
facilities that have received GPD capital grants.
[7] The definitions appear at 42 U.S.C. § 11302 and 38 C.F.R. § 61.1.
[8] To assist Continuums in conducting counts of the homeless, HUD
issued A Guide to Counting Unsheltered Homeless People, which is
available on the Internet.
[9] For the committee's recommendations and VA's responses, see
Department of Veterans Affairs, 2005 Annual Report of the Advisory
Committee on Homeless Veterans: Reaching Out to Homeless Veterans
(Washington, D.C.: July 2005).
[10] The chronic homeless are unaccompanied individuals with disabling
conditions who have either been continuously homeless for a year or
have had at least four episodes of homelessness in the past 3 years. An
estimated 63,000 veterans were considered chronically homeless in 2005.
[11] For the fiscal year 2005 report, see VA, Community Homelessness
Assessment, Local Education and Networking Group (CHALENG) for
Veterans: The Twelfth Annual Progress Report on Public Law105-114,
Services for Homeless Veterans Assessment and Coordination,
(Washington, D.C.: Apr. 15, 2006).
[12] The estimate of homeless veterans is derived from the CHALENG
survey of designated local VA officials who are asked to provide the
highest number of homeless veterans estimated in their service area on
one day of the official's choosing in fiscal year 2005.
[13] The Bureau of the Census has had difficulty enumerating the
overall homeless population, as we reported in GAO, Decennial Census:
Methods for Collecting and Reporting Data on the Homeless and Others
without Conventional Housing Need Refinement, GAO-03-227 (Washington,
D.C.: Jan. 17, 2003). A Census official we interviewed cautioned that
the 2010 Census may not enumerate homeless veterans.
[14] VA issued a directive for a onetime dental care opportunity for
homeless veterans (VHA Directive 2002-080) in line with 38 U.S.C. § 101
note. VA officials told us that funding was provided in 2006 to
implement this directive.
[15] For more information on DOL programs, see GAO, Homeless Veterans:
Job Retention Goal Under Development for DOL's Homeless Veterans'
Reintegration Program, GAO-05-654T (Washington, D.C.: May 4, 2005).
[16] Through the Continuum of Care, HUD contracts with public housing
agencies for the rehabilitation of residential properties that provide
multiple single room dwelling units. These agencies make Section 8
rental assistance payments generally covering the difference between a
portion of the tenant's income (normally 30 percent) and the unit's
rent to participating owners (i.e., landlords) on behalf of homeless
individuals who rent the rehabilitated dwellings.
[17] According to VA, in fiscal years 2005 and 2006 it had allocated
funding for a total of 97 full-time liaisons. As of the time of our
review, some sites were still going through the recruitment and hiring
processes to fill these positions.
[18] VA may waive the episode requirement if the services offered are
different from those previously provided and may lead to a successful
outcome. The VA liaisons must review and approve or deny the waiver
based on their best clinical assessment of the individual case.
[19] Since fiscal year 2002, VA's strategic plan has included a
performance target to capture the housing status of veterans discharged
from three of its transitional housing programs, including the GPD
program. VA has gradually increased its target from 65 percent in
fiscal year 2002 to 79 percent in fiscal year 2005. VA estimates that
it exceeded this target in fiscal year 2005.
[20] VA also asks participants for their evaluations after they have
been in the program for 1 month. Nearly half of the participants
completed the surveys in fiscal year 2005. Most reported satisfaction
with the GPD, rating it at 3.2 on a scale where 4 is the highest
possible score, and with their VA case managers, rating them at 4.6 on
a scale where 6 is the highest possible score.
[21] This effort has been possible, according to VA, in part because
increased funds have made it possible for more liaisons to work with
the GPD program on a full-time rather than a part-time basis.
[22] VA has also conducted other follow-up studies designed to test
innovative approaches to serving homeless veterans, including ways to
improve employment outcomes, ensure the safety and serve the needs of
female veterans, and intervene on behalf of veterans dually diagnosed
with both mental health and substance abuse problems.
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