To read the full version of this content please select one of the options below:

Rurality or distance to care and the risk of homelessness among Afghanistan and Iraq veterans

Richard E. Nelson (Veterans Affairs Salt Lake City Health Care System, Salt Lake City, Utah, USA) (Department of Internal Medicine, School of Medicine, University of Utah, Salt Lake City, Utah, USA)
Adi Gundlapalli (Veterans Affairs Salt Lake City Health Care System, Salt Lake City, Utah, USA) (Department of Internal Medicine, School of Medicine, University of Utah, Salt Lake City, Utah, USA)
Marjorie Carter (Veterans Affairs Salt Lake City Health Care System, Salt Lake City, Utah, USA) (Department of Internal Medicine, School of Medicine, University of Utah, Salt Lake City, Utah, USA)
Emily Brignone (Department of Psychology, Utah State University, Logan, Utah, USA)
Warren Pettey (Veterans Affairs Salt Lake City Health Care System, Salt Lake City, Utah, USA) (Department of Internal Medicine, School of Medicine, University of Utah, Salt Lake City, Utah, USA)
Thomas H. Byrne (National Center on Homelessness Among Veterans, Philadelphia, Pennsylvania, USA) (School of Social Work, Boston University, Boston, Massachusetts, USA)
Ann Elizabeth Montgomery (National Center on Homelessness Among Veterans, Philadelphia, Pennsylvania, USA) (School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama, USA)
Randall Rupper (Veterans Affairs Salt Lake City Health Care System, Salt Lake City, Utah, USA) (Department of Internal Medicine, School of Medicine, University of Utah, Salt Lake City, Utah, USA)
Jamison Fargo (Veterans Affairs Salt Lake City Health Care System, Salt Lake City, Utah, USA) (Department of Psychology, Utah State University, Logan, Utah, USA) (National Center on Homelessness Among Veterans, Philadelphia, Pennsylvania, USA)

Housing, Care and Support

ISSN: 1460-8790

Article publication date: 5 June 2017

Abstract

Purpose

Several risk factors have been identified in ongoing efforts by the US Department of Veterans Affairs (VA) to mitigate high rates of homelessness among veterans. To date, no studies have examined the relationship of rurality and distance to nearest VA facility to risk of homelessness. Due to challenges in accessing available services, the hypothesis was that rural-residing veterans are at greater risk for homelessness. The paper aims to discuss these issues.

Design/methodology/approach

The cohort consisted of veterans who had separated from the military between 2001 and 2011. The authors used a forwarding address provided by the service member at the time of separation from the military to determine rurality of residence and distance to care. The authors examined differences in the rate of homelessness within a year of a veteran’s first encounter with the VA following last military separation based on rurality and distance to the nearest VA facility using multivariable log-binomial regressions.

Findings

In the cohort of 708,318 veterans, 84.3 percent were determined to have a forwarding address in urban areas, 60.4 and 88.7 percent lived within 40 miles of the nearest VA medical center (VAMC), respectively. Veterans living in a rural area (RR=0.763; 95 percent CI=0.718-0.810) and those living between 20 and 40 miles (RR=0.893; 95 percent CI=0.846-0.943) and 40+ miles away from the nearest VAMC (RR=0.928; 95 percent CI=0.879-0.979) were at a lower risk for homelessness.

Originality/value

The unique data set allowed the authors to explore the relationship between geography and homelessness. These results are important to VA and national policy makers in understanding the risk factors for homelessness among veterans and planning interventions.

Keywords

Acknowledgements

This material is the result of work supported with resources and the use of facilities at the George E. Wahlen Department of Veterans Affairs Medical Center, Salt Lake City, Utah. This study was supported with funding from the VA Health Services Research and Development Service (Center of Innovation – Informatics, Decision-Enhancement and Analytic Sciences (IDEAS) 2.0 Center, PI: Samore; VA IIR 12-084, PI: Gundlapalli; VA CDA 11-210, PI: Nelson). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Citation

Nelson, R.E., Gundlapalli, A., Carter, M., Brignone, E., Pettey, W., Byrne, T.H., Montgomery, A.E., Rupper, R. and Fargo, J. (2017), "Rurality or distance to care and the risk of homelessness among Afghanistan and Iraq veterans", Housing, Care and Support, Vol. 20 No. 2, pp. 45-59. https://doi.org/10.1108/HCS-10-2016-0013

Publisher

:

Emerald Publishing Limited

Copyright © 2017, Emerald Publishing Limited