1. 8/4/2011
National Center on Homelessness
among Veterans
New Research on Homelessness among
Veterans
July 13, 2011
Delivering research-based solutions to end Veteran homelessness
research-
Agenda
• Veteran Homelessness: A Supplemental Report
to the 2009 Annual Homeless Assessment
Report to Congress
• Modeling Inter-Continuum of Care Variation in
Rates of Veteran Homelessness
• Prevalence and Risk of Homelessness among
U.S. Veterans: A Multisite Investigation
• Aging among Homeless Populations and
Veterans
1

2. 8/4/2011
Veteran Homelessness: A
Supplemental Report to the
2009 Annual Homeless
Assessment Report to Congress
Ellen Munley
Annual Homeless Assessment
Report (AHAR)
• Required annual report
to Congress since 2005
• Estimate levels,
describe homeless
population, location,
patterns of shelter use
• Standard methods for
data collection across
the country
• PSH and HPRP
2

3. 8/4/2011
Veteran Supplement
• New in 2009
• Uses similar methods as
the AHAR
• Adds:
– Differences between
Veteran and non-
Veterans
– Risk of homelessness for
groups of Veterans
Annual and Point in Time Estimates
Annual Point in Time (PIT)
• Full picture of • Answers the question,
homelessness through “How many Veterans
entire year are homeless on a given
• HMIS data from day?”
providers on who • Includes sheltered and
stayed in shelter/TH unsheltered counts
• Unduplicated records
• 300 + communities
report
3

4. 8/4/2011
2009 Estimates
Annual: Point in Time:
Winter
January 29, 2009
Spring 149,635 Fall • 75,609
homeless
Veterans
Summer
Characteristics of Veterans in
Shelter
Almost half
Most are male Most are non-
are white
(93%) Hispanic (89%)
(49%)
Largest age More than half
group is 31-50 are disabled
(45%) (52%)
4

5. 8/4/2011
Comparing Veterans and Non-
Veterans in Shelter
Veterans are more likely to
be:
• male
• white
• non-Hispanic
• older
• disabled
than non-Veterans
Groups of Veterans at High Risk of
Homelessness
• AHAR Veteran Supplement compares risk of
homelessness among groups of Veterans to
risk for groups of non-Veterans.
• Certain groups are at high risk:
– Veterans under 30 years (OEF/OIF era)
– Female Veterans
– African American and Hispanic Veterans
– Risk is higher for poor members of these groups
5

6. 8/4/2011
Risk of Homelessness Compared to
Non-Veterans
Young Veterans
Female Veterans
(OEF/OIF)
2 times the 2 times the
risk risk
In poverty: 4 In poverty: 3
times the risk times the risk
Risk of Homelessness Compared to
Non-Veterans
Poor African Poor Hispanic/Latino
American Veterans Veterans
African
Hispanic/Latino
American
Veterans in
Veterans in
poverty: 3
poverty: 2
times the risk
times the risk
6

7. 8/4/2011
Location of Veterans in Shelter
• More than half of homeless Veterans are
located in just 4 states:
– California
– Florida
– New York
– Texas
• Majority are located in principal cities (72%)
– Compare to 37% of general population.
7

8. 8/4/2011
Length of Stay in Emergency
Shelter
Length of Stay Percent of Veterans in
Shelter
Less than one week 33%
Less than one month 61%
Less than 3 months 84%
Modeling Inter-Continuum of
Care Variation in Rates of
Veteran Homelessness
Ann Elizabeth Montgomery
8

9. 8/4/2011
Background
• Both individual and structural factors
contribute to homelessness
• Previous research on the variation of
homelessness rates across jurisdictions has
some limitations:
– Incomplete data on rates of homelessness
– Difficulty geographically matching predictors to
outcomes
Background
Although limited in geographic coverage, previous research
has found a significant relationship between community-
level homelessness rates and a set of predictors, including:
– Vacancy rate (-) – Unemployment (+)
– Percentage of renters (+) – Female-headed households (+)
– Price of rental housing (+) – Mental health expenditures (+)
– Low-rent housing stock (-) – Growth in employment (-)
– Population density (+) – Single-person households (+)
– Funding for homeless – Temperature (+) and
programs (-) precipitation (-)
9

10. 8/4/2011
Objective
To identify the determinants of variation in
homelessness rates among Veterans across
CoCs as a function of community-level
variables in six domains:
1. Housing 4. Veteran Affairs
2. Economics 5. Health
3. Safety Net 6. Criminal Justice
Dependent Variables
• Rates of homelessness are based on annual and
PIT numbers in all reporting CoCs:
– Proportion of homeless Veterans who are
unsheltered
– Ratio of unsheltered Veterans to sheltered Veterans
– Proportion of homeless adults who are Veterans
– Ratio of homeless Veterans to homeless non-
Veterans
10

11. 8/4/2011
Independent Variables
Housing • Fair market rents
• 50th percentile rent estimates
• Substandard/overcrowded housing units
• Vacancy rate
Economics • Median household income
• % population living below 50% poverty
• Unemployment rate
Safety Net • Section 8 units
• Veterans receiving VA compensation/pension
• State supplements to federal spending
Independent Variables
Veterans • Veterans by service era
Affairs • VA homelessness resources
• Veterans receiving homeless services
Public • Mortality (life expectancy, suicide)
Health • Chronic health conditions
• Uninsured
• Drug and alcohol misuse, smoking
Criminal • Homicide
Justice • Violent crime
• Individuals on probation/parole
11

12. 8/4/2011
Methods
• Match data sources using a common geography
– Most IVs are measured at the county, state, or VA
facility level; DVs are measured at the CoC level
• Conduct multilevel regression of each variable on
selected outcome, controlling for clusters of CoCs
within states
• Develop multilevel model with most important
predictors from all domains
Preliminary Findings
• Through a mapping application, matched each
CoC to one or more counties
• Modeled each predictor variable within each
domain against selected outcome: % homeless
Veterans who were unsheltered
• Variables across multiple domains were
significantly associated with this outcome
12

13. 8/4/2011
Preliminary Findings
Across CoCs, % homeless Veterans who were unsheltered
was significantly associated with:
Housing • % renter-occupied housing units (-)
• % owner-occupied housing units (+)
• % female-headed households (+)
• Total properties with foreclosure filings (+)*
• Doubled-up people (+)*
Criminal • Total individuals in prison (+)
Justice • Property crimes, burglary, theft (+)
*Variable measured at state level
Preliminary Findings
Across CoCs, % homeless Veterans who were unsheltered
was significantly associated with:
Public • % adults with health insurance (-)
Health • % adults in good health (-)
• % adults in fair health (+)
Safety • State expenditures on public assistance (-)*
Net • % Veterans receiving VA compensation or
pension (-)
• State expenditures on Medicaid (-)*
*Variable measured at state level
13

14. 8/4/2011
Preliminary Findings: Summary
Renters
Health insurance
Good health
State expenditures
VA compensation/pension
Owners
Female-headed households
Foreclosures
Doubled-up
Prison
Crimes
Next Steps
• Determine significant predictors for each of the
identified dependent variables
• Develop multi-level, multi-domain model to explain
the variation in homelessness rates across CoCs
• Develop application allowing users to forecast how
changes in predictors (e.g., increasing health
coverage or preventing foreclosures) could impact
rates of homelessness among Veterans
14

15. 8/4/2011
Prevalence and Risk of
Homelessness among U.S.
Veterans: A Multisite
Investigation
Thomas Byrne
Background
• No definitive study on prevalence of
homelessness among Veterans
• Great interest in understanding whether and
why Veterans are at greater risk for
homelessness
– As risk factor for homelessness
– Government response to Veteran homelessness
30
15

16. 8/4/2011
Prior Research
• Previous estimates of Veterans experiencing homelessness
– Rosenheck et al., 1987: % Veteran
• 41% of homeless males were Veteran (Veterans in total male pop. = 34%)
– Urban Institute, 1996: % Veteran
• 23% of homeless adults were Veteran (Veterans in total pop. = 14%)
• 33% of homeless males were Veteran (Veterans in total male pop. = 28%)
• 3-4% of homeless females were Veteran (Veterans in female pop. = 1%)
• White male Veterans at higher risk for homelessness than other race groups
– AHAR, 2009: % Veteran
• 16% of homeless adults were Veteran (Veterans in total adult pop. = 10%)
• 0.6% Veterans experienced homelessness (homeless in total pop. = 0.5%)
31
Limitations of Prior Research
• Many based on point-estimated prevalence rather than
annual counts
• Little information available on risk for homelessness
among Veterans…
– For various age by race by sex subgroups
– For the general population as compared to the population
most at-risk for homelessness, the population in poverty
32
16

17. 8/4/2011
Research Questions
• Are Veterans overrepresented in the homeless
population?
– What is prevalence of Veterans among homeless?
– What proportion of Veterans are homeless?
• What demographic characteristics are risk factors
for homelessness?
– Is Veteran status a risk factor for homelessness?
– Does risk for homelessness vary among age, race, and
sex subgroups?
33
Methodology
• Data Sources
– Obtained individual-level 2008 HMIS data from 7
geographically diverse Continuums of Care (CoC)
– Obtained 2006-2008 American Community Survey
(US Census Bureau) estimates of population
counts for same CoC geographies for age by race
by sex by Veteran by poverty subgroups
34
17

18. 8/4/2011
Methodology
• Data Analysis
– Separate sets of analyses for:
– 1) Total population and subset of population in poverty
– 2) Males and females
– Prevalence of homelessness among Veterans
computed by taking ratios of HMIS over ACS data
for subgroups
– Risk for homelessness computed using
multivariate statistical models with age, sex, race,
and Veteran status assessed as risk factors
35
Prevalence of Veterans In
Homeless Population
Age Race Male Female
18–29 Black 3.8% 1.0%
Non-Black 2.7% 1.0%
30–44 Black 8.2% 3.2%
Non-Black 7.6% 1.3%
45–54 Black 21.0% 2.7%
Non-Black 19.6% 3.1%
55–64 Black 31.9% 1.8%
Non-Black 30.6% 3.1%
65+ Black 32.3% 1.4%
Non-Black 33.7% 2.4%
All Cases 13.6% 1.8%
18

19. 8/4/2011
Prevalence of Veteran
Homelessness: Total Population
Risk Ratio
Comparing %
% Vet in Vet in Homeless
Homeless % Vet in Overall to % Vet in
Population Population General Pop.
Age Race Male Female Male Female Male Female
18–29 Black 3.8% 1.0% 1.9% 0.6% 2.0 1.7
Non-
Black 2.7% 1.0% 2.1% 0.5% 1.3 2.0
19

20. 8/4/2011
Prevalence of Veteran
Homelessness: Total Population
39
Prevalence of Veteran Homelessness:
Population in Poverty
40
20

21. 8/4/2011
Rate of Homelessness Among Veterans
% of Veterans Experiencing % of Veterans Experiencing
Homelessness (Total Homelessness ( Veteran
Veteran Population) Population in Poverty)
Age Race Male Female Male Female
18–29 Black 5.4% 7.9% 52.8% 36.3%
Non-Black 0.7% 1.6% 7.3% 11.9%
30–44 Black 4.7% 6.3% 33.8% 35.4%
Non-Black 1.0% 0.9% 17.2% 12.1%
45–54 Black 7.3% 3.2% 38.0% 29.1%
Non-Black 1.9% 1.1% 21.0% 12.3%
55–64 Black 3.8% 1.4% 24.2% 9.1%
Non-Black 0.6% 0.6% 10.5% 9.3%
65+ Black 0.6% 0.4% 4.8% 1.7%
Non-Black 0.1% 0.1% 2.1% 0.8%
All Cases 1.0% 1.6% 14.6% 15.0%
Prevalence Summary: Total
Population
• Overrepresentation of female (RR = 2.1) and
male (RR = 1.3) Veterans in homeless
population
– Young black male Veterans particularly
overrepresented
• Prevalence of total Veterans who were
homeless: 1% for males and 1.6% for females
– Ranged from 1-8% depending on age and race
(higher proportion among Black subpopulation)
42
21

22. 8/4/2011
Prevalence Summary:
Population in Poverty
• Overrepresentation of female (RR = 3.0) and
male (RR = 2.1) Veterans in homeless
population
– Young black male Veterans particularly
overrepresented
• Roughly 15% of both male and female
Veterans in poverty were homeless.
– Pronounced differences for Black (~27%) and non-
Black (~11%) subpopulations
43
Risk Factors for Homelessness
• Veteran status
– Total population: 2-fold increased risk for females,
50% greater risk for males
– Population in poverty: >3-fold increased risk for
females, 2-fold risk for males
• Race (for both men and women)
– Total population: Blacks were >5 times more likely
than non-Blacks to be homeless
– Population in poverty: Blacks were >3 times more
likely than non-Blacks to be homeless
44
22

23. 8/4/2011
Risk Factors for Homelessness:
Summary
• Age
– As compared to 18-29 year olds…
• Males aged 30-54 were more likely, 55-64 were
equally likely, and 65+ were less likely to be
homeless for both total and poverty populations
• Females, in total population, were less likely to be
homeless as age increased
• Females, in poverty population, aged 30-54 were
equally likely and those older than 55 were
increasingly less likely to be homeless
45
46
23

24. 8/4/2011
Conclusions
• Findings elucidate extent of homelessness among
Veteran population
• Veteran status as risk factor for homelessness
• Finding of increased risk among Veterans is
paradoxical given benefits/services available to
veterans
47
Conclusions
• Findings suggest prevention efforts may be
effective to the extent that they can target the
~1.4 million Veterans in poverty,
• Also, heightened awareness of specific
subpopulations at risk for homelessness
– Young male Black Veterans
– Female Veterans—and young female Veterans in
particular
– Poverty
48
24

25. 8/4/2011
Aging among Homeless
Populations and Veterans
Stephen Metraux
Hahn et al. 2006
25

26. 8/4/2011
• The elderly population has historically been
underrepresented among the homeless population
• research shows more rapid increases in
homelessness among adults ages 50 and older
• predicts that homelessness among elderly persons
will increase substantially over the next decade due
to:
– the overall growth in the elderly population.
– elderly population consistently faces economic
vulnerability.
Findings from New York City
http://www.flickr.com/photos/sam_williams/3593754703/
26

27. 8/4/2011
New York City Sheltered Hom eless Population (singles and families) in 2005: Age Distribution
14%
12%
10%
8%
6%
4%
2%
0%
0- 3- 6- 9- 12 1 1 2 2 2 3 3 3 3 4 4 4 5 5 5 6 6 6
2 5 8 11 -1 5-1 8-2 1-2 4-2 7-2 0-3 3-3 6-3 9-4 2-4 5-4 8-5 1-5 4-5 7-5 0-6 3-6 5+
4 7 0 3 6 9 2 5 8 1 4 7 0 3 6 9 2 5
Age Groups
Age distribution reflects 2005 prevalence population (29,326 single adults and 57,374 persons in 19,048 families)
Age of single adults, change over tim e (1988, 95, 2000 & 05), NYC (proportion by age in years).
14.0%
12.0%
10.0%
1988
8.0%
1995
2000
6.0%
2005
4.0%
2.0%
0.0%
r
21 24 27 30 33 36 39 42 45 48 51 54 57 59 61 64 74 de
to to to to to to to to to to to to to d d to to ol
18 22 25 28 31 34 37 40 43 46 49 52 55 an an 62 65 d
58 60 an
75
27

28. 8/4/2011
Age of family household heads only, change over tim e (1990 & 2000),
NYC (proportion by age in years).
0.2
0.18
0.16
0.14
0.12 1988
1995
0.1
2000
0.08 2005
0.06
0.04
0.02
0
18 to 21 to 24 to 27 to 30 to 33 to 36 to 39 to 42 to 45 to 48 to 51 to 54 and
20 23 26 29 32 35 38 41 44 47 50 53 older
Findings from US Census Data
http://media.namx.org/images/editorial/2010/04/0401/j_simas_homeless_census/j_simas_homeless_census_500x279.jpg
28

29. 8/4/2011
D is tr ibution, by Age, of Male Shelter Us e r s in the US, 1990 and 2000 ( US Cens u s )
12.0
10.0
8.0
2000
6.0
1990
4.0
2.0
0.0
r
21 24 27 30 33 36 39 42 45 48 51 54 57 59 61 64 74 de
to to to to to to to to to to to to to d d to to ol
18 22 25 28 31 34 37 40 43 46 49 52 55 an an 62 65
d
58 60 an
75
Relative Risk for Hom elessness by Age & Sex for 1990 and 2000 US Census Adult Population
2.0 1990 Male
1.8 1990 Female
1.6 2000 Male
2000 Female
1.4
1.2
1.0
0.8
0.6
0.4
0.2
0.0
r
21 24 27 30 33 36 39 42 45 48 51 54 57 59 61 64 74 lde
to to to to to to to to to to to to to d d to to o
18 22 25 28 31 34 37 40 43 46 49 52 55 an an 62 5 d
58 60
6 an
75
29

30. 8/4/2011
Homelessness & Aging Among Veterans
Aging Vet Population
4,000,000
3,500,000
3,000,000
2,500,000
2000
2005
2,000,000 2010
2015
2020
1,500,000
1,000,000
500,000
0
< 20 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70-74 75-79 80-84 85-89 90+
Source – VetPop 97 - http://www.va.gov/VETDATA/Demographics/Demographics.asp
30

31. 8/4/2011
National Survey of Veterans (NSV)
100%
75%
65+
50%
45-64
<45
25%
0%
2002 2003 2005 2007 2008
Aging Among Homeless Vet Population
100%
75%
65+
50%
45-64
<45
25%
0%
2002 2003 2005 2007 2008
Source – NE Program and Evaluation Center Form X data
31

32. 8/4/2011
Future Research
• More detailed description of aging trends
among Veterans – homeless and non-
homeless
• Examination of morbidity trends as homeless
Veterans age
• Models forecasting how aging trends will
impact size and demographics of homeless
veteran population
• Planning for services and accommodations
32