Improving Consumer Experiences in Permanent Supportive Housing Co-Located With Health Centers: A Case Study From the Department of Veterans Affairs

Abstract

Background: Permanent Supportive Housing (PSH), which provides subsidies for independent housing and supportive services, is an evidence-based practice that improves health and housing for homeless experienced persons. Though most PSH is scattered-site, that is, housing dispersed throughout the mainstream rental market, project-based PSH offers housing and supportive services in dedicated facilities with on-site services. In 2013, the Veterans Health Administration (VA) at Greater Los Angeles opened a novel project-based PSH program located on a VA campus. To inform plans to expand project-based PSH at this VA, we examined participants’ experiences in this program. We aimed to identify participant characteristics that suggested they were well suited for the planned PSH expansion; to characterize services that participants found valuable in this setting; and to highlight gaps between participants’ needs and PSH services provided. Methods: We performed semi-structured interviews with a convenience sample (n = 24) of participants who had engaged in this project-based PSH program. Interviews asked why participants selected housing on a VA campus and explored valued program characteristics, designs, and services. Using rapid analysis methods, we generated templated summaries of each participant’s responses across the domains of our interview guide, then used matrix analyses to identify salient themes across the interviews. Key Findings: Participants appreciated the ease of access to medical and mental health services; however, as services were assumed to be optimized by virtue of co-location with VA healthcare, their PSH providers often did not link them with non-VA social services as assertively as desired. Many participants raised concerns about building safety and on-site substance use. A lack of participant engagement in program oversight, often leading to conflicts with staff and building management, was also highlighted in our interviews. Discussion: Given the value placed on ease of access to healthcare, these data suggest the value of this PSH model for persons with healthcare vulnerabilities. Specific recommendations for the planned PSH expansion include: (1) continuation of proximate, open-access healthcare; (2) clear tenant policies; (3) tenant councils for each development; (4) staff knowledgeable of non-VA resources and social services; (5) Veteran-preferred hiring practices by Property/Service management; (6) gender-specific accommodations; and (7) robust 24/7 security on-site.

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

“…They recommended additional safeguards be established for female Veterans including increased security presence or female only residence areas. 34 …”

“… 51 In addition, female Veteran’s access to permanent housing does not necessarily equate to feelings of safety in permanent supportive housing as safety concerns were noted in several of the female-specific studies included in our review. 23 , 34 , 54 Other researchers 11 , 55 have suggested female-specific housing units, housing specifically for female Veterans with families, are essential in meeting the needs of women who have experienced MST. In addition, ensuring safety features such as adequate lighting, working locks, and security cameras can help increase a sense of safety for women Veterans in transitional and permanent supportive housing.…”

“…They recommended additional safeguards be established for female Veterans including increased security presence or female only residence areas. 34 Differences in access to care and report of unmet needs were also seen across racial categories among women experiencing homelessness. Overall, non-White female Veterans were more likely than White female Veterans to report unmet needs for healthcare and social services.…”