Access to Care for Homeless Veterans During Disasters

Abstract

Introduction: Since 1970, natural disasters have led to both temporary and permanent closures of multiple medical centers and outpatient clinics at the US Department of Veterans Affairs (VA) nationwide. Access to care during such events is critical for vulnerable populations, especially homeless veterans. As such, facility closures may disproportionately affect homeless veteran patients who are both more likely to experience adverse effects from disasters and face multiple barriers to care. Methods: A cross-sectional survey was administered to a probability sample of 2000 homeless VA patients living in and receiving VA health care in the Northeast United States. The survey was completed by 383 respondents (20% adjusted response rate). This pilot study examines predictors of difficulty accessing care in the event that the VA facility that homeless VA patients routinely use is forced to close because of a natural disaster. Results: In a multivariate logistic regression, homeless VA patients who had Medicaid were less likely (OR 0.38; 95% CI: 0.18-0.78; P < .01) to report that they would have difficulty obtaining care elsewhere if their normal VA facility was closed in a future natural disaster. Conclusions: Findings suggest that Medicaid coverage has the potential to facilitate access to care for homeless veteran VA patients during disasters. Policy changes that decrease Medicaid coverage could limit access to care for homeless veterans during closures of VA medical facilities.

Systematic review of access to healthcare and social services among US women Veterans experiencing homelessness

“…Gender was not a factor in the likelihood of using VA homeless services (66% versus 60%, p = 0.52) 41 being referred to medical or mental health services, 10,51 in the number of days spent in inpatient hospitalization (IRR = 1.3, 95% CI: 0.42-4.04), 41 or in the persistent super-utilization of VA services (statistics not reported). 47 Similarly, other studies, which examined healthcare access found that gender was not a factor in the access to and care coordination experiences between VA healthcare and community care (OR = 0.92, 95% CI: 0.72-1.18), 37 in the ability to access healthcare in the event of a natural disaster (OR = 0.67, 95% CI: 0.28-1.58), 26 or the receipt of naloxone (18.9% for females versus 22.8% for males, p = 1.0) or medication (43.0% for females versus 37.8% for males, p = 1.0) for opioid addiction treatment. 40 There was also not an overall difference between males and females experiencing homelessness in their reported use of any VA homeless or social services (22.5% for females versus 16.5% for males, χ 2 = 0.48, p = 0.49).…”