VA program’s goal: Provide health care to help homeless veterans find stability
Dr. Thomas O’Toole says veterans who served in Afghanistan or Iraq are at risk for a perfect storm of problems that could lead to homelessness.
O’Toole, director of a national program that aims to provide better health care to homeless veterans, said many Afghanistan and Iraq veterans suffer from post-traumatic stress disorder, traumatic brain injury and chronic pain, and they could try to cope by abusing drugs or alcohol. Their deployments have been longer than in past wars, he said, making the transition into civilian life more of a challenge.
They’re returning to a poor U.S. economy, which can make it harder for them to find a job. And “their longer deployments erode their social supports and make it hard to reintegrate with loved ones and the community, which leads to homelessness,” he said.
There is a need to reach those veterans, he said. Recent statistics back him up. In December 2012, USATODAY reported that the number of homeless veterans from Afghanistan and Iraq, and those at risk of being homeless, had doubled since 2010 — from 10,500 to 26,531. The at-risk category included veterans who were in temporary housing or using federal vouchers to help pay rent.
O’Toole’s program, called Homeless Patient Aligned Care Teams or H-PACT, has 37 teams across the U.S. They are pilot programs modeled on development initiatives of the National Center for Homelessness among Veterans.
Homeless veterans can walk in and receive care without an appointment from a primary care physician. Many patients are referred by social workers who try to find homeless veterans and get them to the program. Others come to the emergency room needing treatment.
A doctor with the H-PACT team schedules the appointments the veteran needs to get the treatment necessary for him or her to live a healthy life. The team can also help connect a veteran with housing options. If a veteran can successfully manage health issues, that stability could help him or her find permanent housing; similarly, the stability of permanent housing can help a veteran maintain regular medical care.
H-PACT clinics across the U.S. are seeing about 509 homeless veterans from Afghanistan and Iraq. That number is 7.3 percent of all homeless veterans at H-PACT clinics.
Dr. George Tzanis, chief of ambulatory care at the VA Medical Center in Philadelphia, and Dr. Leah Jones, who helps Tzanis lead the H-PACT program there, believe that a small percentage of those who are 30 years old or younger seek help for substance abuse and mental health issues. Some, Jones said, are living with parents or girlfriends, so they don’t seek resources for the homeless.
It’s a small population, Tzanis said, but “it is a definite group of patients we are helping that are most at risk for chronic homelessness, because they are at their point of their lives where they are stressed out, suffering with PTSD and self-medicating.”
The program is growing, said O’Toole, who is affiliated with the Providence VA Medical Center in Rhode Island. He said the VA expects to increase the number of H-PACT sites to more than 50 this fiscal year. He said the programs, which started 18 months ago, have shown positive results in the reduction of homelessness and increased care for veterans.
The clinics see veterans from other wars, too.
John Bell of Philadelphia has been homeless for years. Although he knew there had to be a better way to live, it seemed impossible to find his way off the city’s streets.
Bell, who served in the 101st Airborne in Vietnam from 1969-71, lost his job when the company he worked for went out of business. He had recurring nightmares and suffered from high blood pressure.
In 2001, he began living on the streets. Last April, he wasn’t feeling well and went to the emergency room at the VA Medical Center in Philadelphia. He met Tzanis and found out about H-PACT.
Today, Bell is getting the care he needs. He will soon begin treatment for prostate cancer. For the veteran who used a McDonald’s bathroom as a place to clean himself up, walking into the H-PACT clinic may have made the difference between life and death.
“John is one of our success stories, for he is no longer homeless. H-PACT is essential, for it leads to housing, which is essential to the management of an illness,” Tzanis said.
The clinic is open five days a week, but patients can contact them anytime, and if there is need, they’ll be able to see one of the doctors.
The pilot program has been in existence since January 2012. Each week, three to five new patients walk through the doors seeking medical attention.
The Philadelphia H-PACT clinic is seeing 433 veterans, 13 of whom are women.
The clinic can use VA computers to get health information and see what medications or treatments a veteran had even if he or she was last seen in California.
Tzanis said the clinic serves to connect a homeless patient with continuing care instead of one-time treatment.
When a patient who goes to the emergency department, he said, staff can’t look at a medical history to see if there are conditions that need attention. A homeless patient may not come back for an appointment, either, he said.
“They may be looking for a job or taking a bus trip to another place or looking for a place to sleep,” he said. “You can send out a letter where they no longer live or call a cell phone that has run out of minutes and no longer works. (But) after you introduce them to clinic, you let them know they have a medical home outside the emergency department.” .
Primary care, he said, is integrated with a behavioral health program.
“This is something that the VA does better than anyone else,” he said. “We treat mind, body and spirit. This clinic is an example of that.”
A veteran who comes to the clinic will be treated for any immediate needs, and then staff will set up a comprehensive physical. The clinic sees the same issues in homeless veterans that affect many other people: diabetes, substance abuse, hypertension, heart failure, heart disease, cardiopulmonary disease, arthritis and depression.
Tzanis sees the success of the program as dramatically reducing the numbers of those using the emergency room. Intake into the hospital is down by 25 to 50 percent, he said.
The result has been substantial reductions in emergency department visits and hospitalizations and increased use of intensive ambulatory services, primary care, mental health, specialty care and expedited placement in permanent housing, O’Toole said.
“It’s an entry way to bring the homeless veterans into the VA system to access care and services,” he said. “A way to get the best possible care for our homeless veterans, care that helps engage them in treatment, keeps them healthier and moves them to permanent housing.”
H-PACT teams in the U.S.
If a veteran has access to the internet, he or she can contact the H-PACT team through e-mail and sign up for My HealtheVet atwww.myhealth.va.gov
Locations of H-PACT teams at Veterans Affairs Medical Centers or Health Care Systems, :
Providence VAMC, Providence, R.I., http://www.providence.va.gov
VA Connecticut HCS, West Haven, Conn., http://www.connecticut.va.gov/
VA Maine HCS, Togus, Maine, http://www.maine.va.gov/
VA Boston HCS, (Causeway Street CBOC), Boston, Mass., http://www.boston.va.gov/locations/Causeway_Street_Boston_CBOC.asp
Leeds VA Primary Care Center, New Bedford, Mass., http://www.centralwesternmass.va.gov/
Canandaigua VAMC, Canandaigua, N.Y., http://www.canandaigua.va.gov/
Northport VAMC, Northport, N.Y., http://www.northport.va.gov/
James J. Peters VAMC, Bronx, N.Y., http://www.bronx.va.gov/
VA Hudson Valley HCS, Montrose, N.Y., http://www.hudsonvalley.va.gov/
Minneapolis VA HCS, Minneapolis, Minn., http://www.minneapolis.va.gov/
Philadelphia VAMC, Philadelphia, Pa., http://www.philadelphia.va.gov/
VA Pittsburgh HCS, Pittsburgh Pa., http://www.pittsburgh.va.gov/
VA Maryland HCS, Baltimore, Md., http://www.maryland.va.gov/
Washington, D.C. VAMC, http://www.washingtondc.va.gov/
Hampton VAMC, Hampton, N.C., http://www.hampton.va.gov/
Birmingham VAMC, Birmingham, Ala., http://www.birmingham.va.gov/
Ralph H. Johnson VAMC, Charleston, S.C., http://www.charleston.va.gov/
James A Haley VAMC, Tampa, Fla., http://www.tampa.va.gov/
Lexington VAMC, Lexington, Ky., http://www.lexington.va.gov/
Chalmers P. Wylie VA Ambulatory Care Center, Columbus, Ohio, http://www.columbus.va.gov/
Battle Creek VAMC, Battle Creek, Mich., http://www.battlecreek.va.gov/
John D. Dingell VAMC, Detroit, Mich., http://www.detroit.va.gov/
Jesse Brown VAMC, Chicago, Ill., http://www.chicago.va.gov/
Southeast Louisiana Veterans HCS, New Orleans, La., http://www.neworleans.va.gov
Michael E. DeBakey VAMC, Houston, Texas, http://www.houston.va.gov/
South Texas Veterans HCS, San Antonio, Texas, http://www.southtexas.va.gov/
Phoenix VA HCS, Phoenix, Ariz., http://www.phoenix.va.gov/
VA Eastern Colorado HCS, Denver, Colo., http://www.denver.va.gov/
VA Puget Sound HCS, Seattle, Wash., http://www.pugetsound.va.gov/
Portland VAMC, Portland, Ore., http://www.portland.va.gov/
San Francisco VAMC, San Francisco, Calif., http://www.sanfrancisco.va.gov/
VA Pacific Islands HCS, Honolulu, Hawaii, http://www.hawaii.va.gov/
Oakland VAMC, Oakland, Calif., http://www.benefits.va.gov/oakland/
VA San Diego HCS, San Diego, Calif., http://www.sandiego.va.gov/
VA Southern Nevada HCS, http://www.lasvegas.va.gov/
VA Greater Los Angeles HCS, Los Angeles, Calif., http://www.losangeles.va.gov/
Iowa City VA HCS, Iowa City, Iowa, http://www.iowacity.va.gov/
Philadelphia-area VA facts
The Philadelphia VA Medical Center serves 50,000 veterans, more than 5,000 of whom are homeless.
At the VA Camden clinic in New Jersey, homelessness is growing. The clinic has a drop-in time for homeless veterans to get medical attention, and it can bring those with need for more health care to the VA Medical Center in Philadelphia.
The Philadelphia VA Medical Center has developed walk-in services to treat veterans who have diabetes or who need to see a podiatrist or a nutritionist.
Source: VA medical centers