Among potential policy priorities, programs for veterans enjoy high levels of public support. While this mandate has often gone unfulfilled in the past, a recent series of federal efforts have substantially increased investments in programs addressing veteran homelessness. These programs, spanning the last decade, have resulted in notable successes along with some shortcomings. As a result, veterans have become an important microcosm within the housing policy ecosystem, generating useful lessons for researchers, practitioners, and policymakers alike.
Indeed, although relatively unheralded as a policy achievement, an expansion of innovative, targeted programs has reduced the number of veterans experiencing homelessness by half since 2010—down to less than 38,000 from over 73,000. Best practices gleaned from this effort can guide future initiatives on behalf of targeted subgroups, while diminishing returns in recent years also indicate the need for improvements. Furthermore, beyond the specific issue of veteran homelessness, there are hundreds of thousands of veterans who are heavily rent-burdened and struggling to keep up with rising housing costs. A complementary set of investments to increase supply of affordable housing and lower costs will greatly improve the quality of these veterans’ lives, along with millions of others.
Veterans and Homelessness: By the Numbers
There are currently around 18 million veterans living in the United States—roughly 9% of the US adult population. The largest proportion of veterans served in the ‘Gulf War’ Era (8.05M), followed by Vietnam (6.26M), Korea (1.1M), and World War II (326,000) cohorts. Given the historical context of these military engagements, many veterans are older, with a median age of 65 for male veterans and 51 for female veterans. At present, the veteran population is roughly 75% non-Hispanic white, with an even higher percentage for older cohorts. Veteran households also have, on average, more financial resources than the non-veterans; the median income for veteran households is $88,700, nearly ten thousand dollars more than for their non-veteran counterparts (Pew Research, 2019).
While the overall population of veterans skews older, whiter, and more financially secure than the non-veteran population, veteran demographics are in the midst of important shifts. Over the next twenty years, the total population of veterans is expected to decline to around thirteen million, a reduction of one-third. The proportion of female veterans, however, is growing over time, with anticipated growth from 10% today to 17% in 2040 (US Census Bureau, 2020). Similarly, the proportion of non-white veterans is also expected to rise from just one-quarter to over one-third during the same time frame (VA, 2020). The shift towards a younger, more diverse veteran population is accompanied by other changes, including a larger share of veteran households with children. In 2015, nearly over 6.3 million veterans lived in households with children under 18 (AEI, 2017)–a share of the overall veteran population that is also projected to rise in the near future.
Looking beyond the median veteran, a substantial share of veterans face significant quality of life challenges. Despite the fact that the average veteran is more financially secure than the average non-veteran, many veterans have extremely low incomes or are struggling with issues like substance abuse, mental health disorders, and homelessness. As of January 2020, there were approximately 37,252 homeless veterans in the United States (AHAR, 2020). Compared with non-veterans, veterans are overrepresented within the sheltered homeless population, making up 9% of the total population but 11.5% of those experiencing sheltered homelessness—even after steady declines over the last decade (Brignone et al, 2018).
This overrepresentation is even higher for specific subgroups of veterans. For example, female veterans are twice as likely to be homeless as non-veteran women. Additionally, more than half of homeless veterans have disabilities and nearly three-quarters struggle with substance abuse problems. Social isolation, sexual abuse (often occurring within the military), adverse childhood experiences, and incarceration are also associated with higher rates of veteran homelessness (O’ Connell & Rosenheck, 2019). Careful analysis of such risk factors also indicates an intersection of multiple aspects of disadvantage; while substance abuse and mental illness were the two most predictive risk factors–the relationship was much stronger for non-white veterans than for white veterans. Indeed, despite making up only one-fifth of the overall veteran population, non-white veterans account for 40% of the veteran population experiencing homelessness (Brignone et al, 2018).
Opening Doors for Homeless Veterans
There have been documented cases of veteran homelessness dating back to the Civil War era, but the issue first received widespread attention—largely due to increased prevalence—in the years following the Vietnam war (Brignone et al, 2019). Still, few formal steps were taken by policymakers until much more recently. The McKinney-Vento Act, passed in 1988, was the first large-scale federal response to homelessness, but there were relatively few programmatic efforts to curtail veteran homelessness specifically. Early efforts included residential programs for veterans struggling with chronic mental illness, but these initiatives did not provide pathways to permanent supportive housing.
Beginning in the early 2000s, as the wars in Afghanistan and Iraq generated a new cohort of veterans with many experiencing multiple deployments, the number of newly homeless veterans started rising, generating a new sense of urgency among policymakers. A particular cause for concern was that the onset of homelessness among Operation Enduring Freedom/Operation Iraqi Freedom/Operation New Dawn (OEF/OIF/OND) veterans began occurring much more quickly after deployment than it had for previous cohorts. Starting with Fiscal Year 2008, funding for veteran housing assistance programs increased dramatically. In the Spring of 2009, after nearly two years of discussion in Congress, a bipartisan contingent of legislators introduced The HEARTH Act, which amended McKinney-Vento and represented the first substantial homelessness policy update in two decades. Part of the bill was a mandate to create a national strategic plan to end homelessness.
In the fall, President Obama’s Secretary of Veteran Affairs, Eric Shinseki, unveiled a comprehensive plan to end veteran homelessness, developed jointly by the VA and the National Center for Homelessness Among Veterans. Shortly thereafter, the US Interagency Council on Homelessness (USICH) formally published the overarching federal strategy, Opening Doors. Opening Doors outlined a set of principles for combating homelessness on a national scale, largely adopting the VA’s approach for ending veteran homelessness. The result was a comprehensive, three-pronged strategy (O’Connell & Rosenheck, 2019):
- Awareness: Identify veterans who are homeless or at risk through universal screening.
- Prevention: Prevent homelessness via supportive, transitional services for veteran families.
- Support: Expand supportive housing programming that combines housing choice vouchers–a form of rental assistance–with extensive case management services provided by the VA.
For veterans experiencing chronic homelessness, the most impactful program has been the third prong, a substantial expansion of the Department of Housing and Urban Development – VA Supportive Housing Program (HUD-VASH). HUD-VASH programming is defined by four principles: direct and rapid placement into permanent housing (using housing vouchers), no formal requirements for sobriety before or after placement, veteran choice in the housing search, and the availability of supportive services for as long as needed (O’Connell & Rosenheck, 2019). These principles represent a departure from previous programs, lowering barriers that prevented veterans from accessing permanent housing and ongoing services.
HUD-VASH was first established as a pilot program in the early 1990s, and the VA’s robust data collection apparatus allowed for extensive research on its impact, which informed federal administrators’ decision to expand the program in 2008. Specifically, a randomized control trial and observational monitoring of HUD-VASH’s first decade demonstrated that the program was both cost-effective and more impactful than less comprehensive approaches, with 88% percent of participating veterans ultimately finding permanent housing (O’ Connell & Rosenheck, 2019).
In their twenty-five-year review of HUD-VASH, researchers Maria O’Connell and Robert Rosenheck summarize the research succinctly, “The evidence strongly supports the view that, on average, supportive housing was and is the most effective service model for assisting homeless Veterans and, more generally, homeless adults, although many individuals benefit from other interventions as well.” The HUD-VASH research was part of a broader literature that came to reveal the effectiveness of a “Housing First” approach, which emphasizes permanent housing as the first and most urgent priority of homeless prevention programs. HUD-VASH formally adopted Housing First principles in 2012.
Over the last 13 years, HUD-VASH has administered 104,666 new vouchers, along with the program’s case management services. Steady funding allowed the program to issue around 10,000 new vouchers annually from 2008 until 2016; under the Trump administration, that amount was reduced, resulting in smaller numbers of new vouchers. Historically, HUD-VASH vouchers have been targeted to chronically homeless veterans, but recently up to one-third of new vouchers have been allocated to other high priority groups including veterans with families, female veterans, and those who served in recent military engagements (OEF/OIF/OND). Over the course of ten years, 45,834 Veterans have exited HUD-VASH after becoming housed, and 85% of these veterans moved into permanent housing. Importantly, the most common reason for exit from the program is that it worked as intended and services are no longer needed (O’Connell & Rosenheck, 2019).
Beyond the successful transition to permanent housing, HUD-VASH has shown a variety of important benefits for users (O’Connell & Rosenheck, 2019). For example, HUD-VASH voucher users end up in better resourced neighborhoods than typical housing choice voucher users, an important outcome within housing mobility programs. Additionally, HUD-VASH participants report increased neighborhood satisfaction, more interactions with case managers than stand-alone case management or standard care programs and improved therapeutic relationships.
Importantly, HUD-VASH has been shown to work well for specific subpopulations of veterans (O’Connell & Rosenheck, 2019). For example, research suggests that the program disproportionately benefited Black participants, reducing their overrepresentation within the overall veteran homeless population. Similarly, individuals with co-occurring conditions such as both mental health and substance abuse issues have better outcomes than those without these conditions. Other indicators such as gender, age, and incarceration status do not undermine the effectiveness of HUD-VASH programming, showing null effects for men and women, older and younger veterans, and those who had and had not been incarcerated.
In addition to the HUD-VASH expansion, another key component of the federal strategy was the Supportive Services for Veteran Families Program (SSVF), which launched in 2012 and has grown rapidly in scale over time, receiving over $3 billion in funding in subsequent years. SSVF is a preventative, time-limited program designed for low-income veteran households facing the imminent or recent loss of housing. SSVF funding is channeled to nonprofit and community agencies, which offer case management and other services (including facilitating access to VA and other benefits such as educational aid and financial planning) to prevent the loss of housing, identify new housing options, or provide rapid rehousing for recently homeless veterans and their families. In recent years, roughly two-thirds of participants receive rapid-rehousing services, with the remaining third utilizing the homelessness prevention resources.
As a major component of USICH’s strategic plan, SSVF expanded from serving 20,000 veterans in FY 2012 to over 80,000 in FY 2018 with annual funding rising from $60 million to over $300 million during that time. As of 2019, SSVF had served over 572,000 veterans in total, with 80% of exited participants achieving permanent housing (VA, 2021). President Trump increased funding for SSVF in 2020, and President Biden had indicated his continued support for the program, advocating for its permanent authorization on the campaign trail.
For the universal screening part of the strategy, the VA National Center on Homelessness Among Veterans rolled out a two-question screener, the Homeless Screening Clinical Reminder, for use with veterans accessing healthcare services through the VA. The screener asks veterans if they are homeless or are at risk of losing their housing, with the possibility of referral for social services if the veteran answers in the affirmative. More than 5.8 million veterans responded to the survey in the first two years of implementation, between 2012 and 2014, with 1% at-risk of homelessness and 0.8% actively experiencing homelessness (Montgomery, 2021). Overall, the implementation process for the HSCR screener has been mixed, with an initial study finding that the screener increased provider attention to housing status (Chhabra et al, 2019), but later research indicating that administration was inconsistent, and the referral process was dependent on contextual factors such as provider location (Montgomery, 2021).
Though it is not widely mentioned as one of the Obama administration’s most significant or defining initiatives, dramatically reducing veteran homelessness is a substantial accomplishment that occurred almost entirely during his two terms in office. This progress was the result of clear goals and research-backed strategies, as well as consistent funding—with bipartisan support—from Congress.
Nor is the topline reduction–roughly 50%–the only part of the story. Many communities around the United States have not only reduced the number of homeless veterans; they have eliminated veteran homelessness altogether. As of the publication of this issue brief, three states (Virginia, Connecticut, and Delaware) and eighty-two communities across thirty four other states (including major cities such as New Orleans, Atlanta, and Houston) have announced an end to veteran homelessness (VA Homeless Programs).
As the editorial board of the New York Times pointed out, praising isolated successes and a national reduction (versus elimination) represents a narrowing of policy ambition, but the work left to be done should not entirely overshadow the material benefits provided to tens of thousands of homeless veterans that now have a safe, permanent home. In New York City alone, the number of homeless veterans dropped from 3,689 to 760 between 2010 and 2015—effectively ending chronic veteran homelessness—undeniable progress to an issue many regarded as intractable.
Finally, locally successful efforts to end veteran homelessness show that it is possible to do so, a proof point that should not be taken for granted. In the words of Dr. Claudia Solari, a Senior Research Associate at the Urban Institute, “When it comes to the value of ending homelessness for any population, I think the first value is that it shows it’s possible. I think that lesson itself can be extended to other populations…I think that is the largest value-add—people thinking it’s possible.” Nor is this a purely symbolic victory; for other communities around the country, replicating and broadening the targeted, well-resourced strategies that led to these accomplishments is a solid roadmap for success. For those that have been able to meet their ambitious targets, stakeholders can apply these lessons to other subgroups deserving of support.
The Importance of Quality Data
Substantive policy and programmatic improvements related to homelessness require access to quality data. Without an accurate understanding of the causes of homelessness, as well as the effectiveness of specific strategies, it is impossible to identify and implement potential improvements. Quality data related to homelessness, however, can be difficult to gather. Rather than existing as a static, unchanging population, populations experiencing homelessness are better thought of as a “moving target” when it comes to data collection (Lee et al, 2021). Consequently, a single methodology or data source is not sufficient for accurate estimation; a ‘family of studies’ approach, consisting of triangulating multiple sources and methods is more appropriate (Brignone et al, 2018).
Data Sources on Homeless Veterans
The most complete report on Veteran homelessness comes from the Annual Homeless Assessment Report (AHAR), which has been published by HUD annually since 2007. AHAR consists of multiple parts and reports both point-in-time prevalence, which measure the population experiencing homelessness on a given night, and period prevalence, which covers a broader time frame. AHAR data is drawn from Homeless Management Information Systems (HMIS), which aggregate data from homeless service providers in communities around the country. In addition, the VA has a notoriously comprehensive data management system, including an entire database dedicated to homelessness programs, Homeless Operations Management and Evaluation System (HOMES).
Both HOMES and HMIS represent important advances in data collection and homeless prevention. According to Dr. Claudia Solari, Senior Research Associate at the Urban Institute, “At first, most people didn’t even think you would be able to get data on such a mobile and diverse group of people who have various reasons that they may not want to be found or identified. The Homeless Management Information Systems proved them wrong…The critical role that data has played in shaping our homelessness response system cannot be overstated” (C. Solari, personal communication, 11/14/2021).
Coordination and Alignment
This multifaceted nature of housing insecurity and diverse needs of individuals experiencing homelessness has generated an equally complex organizational ecosystem; individuals interact with many organizations over the same period, many of which have their own personalized data systems. As a result, comparison across data sets is not a simple task. HMIS systems, for example, are organized around Continuums of Care, jurisdictions that can include single major metropolitan areas, vast swaths of rural areas, and many various geographic areas in between. HOMES data, on the other hand, are largely defined by the geographic reach of VA medical centers, resulting in different boundary lines being drawn.
This lack of common geography can result in translational difficulties. In the words of Dr. Solari, “You have two very large systems – The VA and the mainstream homelessness response system – that are trying to serve the same population in a given community with jurisdictions that don’t quite overlap; they are siloed enough that you don’t quite know what the left and right hand are doing,” (C. Solari, personal communication, 11/14/2021). While stakeholders have gone to great lengths to improve the quality of their data systems, aligning VA data with non-profit partners’ data is a work in progress. Recent progress has been made in aligning HMIS and HOMES systems, but more work needs to be done. Additionally, both HMIS and HOMES rely on program-specific data, but many homeless veterans don’t use VA homeless programs or other programs that would get them counted in these databases. For example, according to the National Health and Resilience in Veterans Survey, less than 20% of veterans who experienced homelessness at some point reported using VA Homeless programs (Brignone et al, 2018).
Qualitative Tools
Dr. Solari notes that an often-underutilized source of data is the perspectives of the homeless individuals themselves. “It is important to hear directly from people who are experiencing homelessness themselves. They know what is interfering with their ability to get out of homelessness and where they came from before that first night they found themselves without a space of their own; if you ask enough people, you will begin to see patterns emerge and be able to break down structural barriers,” (C. Solari, personal communication, 11/14/2021). In other words, when it comes to identifying the specific drivers of homelessness, the potential prevention points that could have been leveraged, or the programmatic components that did or didn’t work, there is no replacement for first-hand experience. By investing in data-collection efforts that go beyond binary outcome variables to gather in-depth knowledge of participants’ backgrounds and perspectives, researchers and practitioners can dramatically improve the quality of their data and thus the effectiveness of these programs. For example, in her research on veteran inflow, Dr. Solari and her colleagues heard from several communities that had used qualitative data to identify homelessness inflow points, such as substance use treatment programs, that wouldn’t have shown up in their quantitative data collection efforts (C. Solari, personal communication, 11/14/2021).
Diminishing Returns for Downstream Solutions
The slowdown of progress after 2015, however, suggests that further reducing veteran homelessness remains a pressing policy issue. For example, the Mayors Challenge to End Veteran Homelessness initiative, rolled out in 2014 with a focus on state and local contributions and public-private partnerships, has shown little improvement over and above the gains driven by the earlier expansion of federal programs like HUD-VASH and SSVF. In fact, veteran homelessness—and chronic homelessness more broadly—has ticked up recently after nearly a decade of decline, a trend that was noticeable even prior to the COVID-19 pandemic and the associated shocks to the housing market.
In other words, after significant advances in addressing veteran homelessness, progress has stalled. Even after distributing more than 100,000 vouchers, and spending billions of dollars, more than 30,000 veterans are chronically homeless. Why? It is possible that the current level of resource provision for HUD-VASH, SSVF, and other federal programs—while substantial—is simply not enough. Others call for more specific programmatic improvements. For example, some experts also suggest that the expansion of HUD-VASH vouchers requires complementary investments in the accompanying supportive services, which have not occurred on the same scale. Other potential adjustments include improving communication with key stakeholders such as landlords, providing additional assistance during the search for and transition to independent housing, increasing project-based vouchers to streamline the complementary care, and increasing collaboration across programs such as HUD-VASH and SSVF.
Other experts identify the rising cost of housing as a primary cause. Four states with high veteran populations and high costs of living—California, Florida, Texas, and Washington—make up 70% of the country’s homeless veteran population, with California making up nearly one-third of the total of homeless veterans on its own. In cities where median rent increases have outstripped wage growth for lower income households, such as San Francisco, Los Angeles, Seattle, and Austin, financial precarity and housing insecurity are dominant themes. Matthew Doherty, the former executive director of USICH, noted the connection between veteran homelessness and the high cost of housing, “The housing market is definitely a huge impact on the ability of people to retain stable housing and avoid the experience of homelessness. It’s also becoming harder and harder in many of these communities for people to exit homelessness and find the places to call home that they can afford and sustain themselves in” (Bloomberg, 2016). Thus, the high cost of housing increases inflow into homelessness, and reduces outflow into permanent housing.
Doherty’s explanation hints at a broader problem. While programs such as SSVF are preventative in nature—designed to hinder veteran inflow into homelessness—macro conditions such as rising rents and the supply of affordable housing exist outside their reach. When rent burdens are high and evictions are frequent, the enabling conditions for veteran homelessness are simply too powerful for even the most impactful programmatic responses. Put another way, every additional HUD-VASH voucher or SSVF referral will only reduce the total number of homeless veterans if others are not being added to the total simultaneously, outside of these programs’ reach. In a society where housing costs remain extremely high in many metro areas and one-time financial shocks can quickly result in evictions, programmatic responses that target individuals, rather than systems, cannot fully deliver an end to veteran homelessness; at some point, policymakers have to address the problem at its source.
Good for Veterans, Good for Everyone
Most reforms that would significantly affect the cost and availability of housing will need to be broader in scope than the veteran-specific programs like HUD-VASH and SSVF, occurring at the neighborhood, city, or state level. These include zoning reform, incentivizing the construction of affordable housing in well-resourced areas, and the reduction of dramatic income and wealth disparities. The expanded scope of such reforms demonstrates an important point about veterans and housing; while veterans rightly deserve specialized, resource-intensive support as the result of their personal sacrifices for the United States, housing policies that positively impact broader swaths of society, such as working families or households with low incomes, will ultimately benefit many veterans as well. Indeed, the original Opening Doors report notes that the causes of homelessness among Veterans are similar to those of non-Veterans, including the shortage of affordable housing.
Looking beyond those currently experiencing homelessness, the financial burden of housing affects vast numbers of veterans as well as low-income non-veteran households. In 2017, nearly 700,000 veterans were living in low-income, extremely rent burdened households. Such households—which devote more than half of their incomes to housing costs—are constantly one unexpected financial shock from facing housing instability, eviction and potentially homelessness. Without addressing this impending source of inflow into homelessness, housing affordability will continue to be an urgent policy issue, not to mention the other negative outcomes that arise from widespread financial precarity. This is true specifically for many veterans, but also for low-income households in areas across the country. Importantly, for both veterans and the general public, the issue of housing insecurity continues to reflect additional layers of disadvantage. As of 2013, more than one quarter of severely rent burdened households included veterans with a service-related disability, and forty percent were single mothers (NLIHC, 2013). In other words, many of the same unfair features of our economy—and the housing market—harm veterans in the same way they harm the broader population.
The VA and HUD have formally recognized the importance of affordable housing to veteran homelessness efforts, with “Increase the supply of and access to affordable housing” listed as a key strategy in a joint statement from April 2021. In November, the VA updated SSVF regulations, allowing for an increase in rent coverage (from 35% to 50%). These programmatic efforts, while important, still remain downstream of issues causing unaffordability in the first place, such as local zoning ordinances and the lack of affordable housing development in high-cost neighborhoods. Without federal, state, and local policies that dramatically change where and how much housing gets built, housing insecurity and homelessness will continue to be urgent crises—for veterans, and for everyone else.
Academic Works Cited:
Brignone, Emily. Fargo, Jamison, and Culhane, Dennis. “Epidemiology of Homelessness Among Veterans” Homelessness Among US Veterans: Critical Perspectives, 13. (2019).
Chhabra, Manik, et al. “Screening for housing instability: providers’ reflections on addressing a social determinant of health.” Journal of general internal medicine 34.7 (2019): 1213-1219.
Montgomery, Ann Elizabeth. “Understanding the Dynamics of Homelessness among Veterans Receiving Outpatient Care: Lessons Learned from Universal Screening.” The ANNALS of the American Academy of Political and Social Science 693.1 (2021): 230-243.
O’Connell, Maria J., and Robert A. Rosenheck. “Supported housing: Twenty-five years of the Housing and Urban Development-Veterans Affairs Supported Housing (HUH-VASH) program.” Homelessness Among US Veterans: Critical Perspectives, 77. (2019).