1. Characteristics and Service Use of Rural Homeless Veterans
Stephen Metraux, PhD & Dorota Szymkowiak, PhD
National Center on Homelessness Among Veterans
US Department of Veterans Affairs

2. Trends in VHA Homeless Programs Use
Rural Vets consistently constitute 12-13% of all homeless users of VHA Homeless Programs
(or 13-14% of homeless users for whom urban/rural status is known)

3. Methods Sample Measures FY 2013-2016
Homeless Veterans using VHA Homeless Programs
USDA Rural-Urban Commuting Area designations for zips
241,848 Veterans
179,245 urban
30,919 rural/highly rural
31,684 unknown
Demographics
Homeless programs use
Healthcare use
Diagnoses
“Migration” across VAMCs
Cohort includes only Veterans homeless at time of HOMES assessment or entry into SSVF, not all Homeless Programs users

4. Demographics Characteristic Rural (N=30,919) Non-rural (N=179,245)
Female
9.5%
10.0%
Race/ethnicity
Hispanic
6.1%
10.1%
Non-Hispanic black
20.3%
43.0%
Non-Hispanic white
69.0%
43.9%
Other
4.6%
3.0%
Age
18-34
19.2%
15.7%
35-44
14.4%
12.6%
45-54
24.4%
26.7%
55-64
32.0%
35.4%
65+
9.7%
Ns are actually different for each demographic characteristic because of missing data

5. Healthcare Service Rural (N=29,865) Non-rural (N=169,793) Inpatient
16.7%
Medical
7.9%
9.0%
Mental health
6.7%
5.8%
Substance use
5.1%
4.7%
Emergency Department
34.5%
41.2%
Outpatient
Primary care
76.2%
77.0%
Specialty medical
71.2%
73.0%
65.6%
59.6%
28.4%
26.6%
Service use based on services used days after entry into cohort (first HOMES assessment or SSVF entry in FY )
Includes only Vets enrolled in VHA

6. Diagnoses
Diagnoses based on services used days before entry into cohort (first HOMES assessment or SSVF entry in FY )

7. Homeless Programs Programs Rural (N=30,919) Non-rural (N=179,245)
Health Care for Homeless Veterans (HCHV)
76.4%
83.3%
Supportive Services for Veteran Families (SSVF)
34.6%
41.5%
Transitional/short-term housing
46.4%
54.7%
Domiciliary Care for Homeless Veterans (DCHV)
11.7%
8.7%
Contracted Emergency Residential Services (CERS)
17.1%
19.1%
Grant and Per Diem (GPD)
28.6%
40.5%
HUD-Veterans Affairs Supportive Housing (HUD-VASH)
55.3%
62.5%
Case management only
33.8%
30.5%
Housing
21.5%
32.0%
Services for justice-involved Veterans (HCRV, VJO)
20.4%
17.8%
Homeless services use based on services used FY2013-FY2016, may span multiple episodes of homelessness/homeless service use

8. Service Use – Veteran Origin and Service Location
Rural & non-rural Vets using Homeless Programs services at facilities designated as rural & non-rural per USDA RUCA codes
Based on services used days after entry into cohort (first HOMES assessment or SSVF entry in FY )
<100% because:
(1) Cohort includes Vets completing HOMES assessment but not engaging in services and
(2) No agency-level rural/non-rural designations are available for SSVF providers

9. Total Homeless Veterans
Mobility across VAMCs among Homeless Veterans
Total Homeless Veterans
% Non-migratory
10 Most Populated Cities
17,632
62.8%
10 Least Populated Cities
2,566
46.9%

10. Next Steps
Standardize measures of “rural” as apply to VA and homelessness
How are homeless veterans from rural areas different than their non-rural counterparts?
Do urban-based homeless services adequately address needs of rural homelessness?