1.10 New Research on Homelessness among Veterans

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

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

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 VeteransAnnual 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

8/4/2011 2009 EstimatesAnnual: Point in Time: Winter January 29, 2009 Spring 149,635 Fall • 75,609 homeless Veterans Summer Characteristics of Veterans in Shelter Almost halfMost 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

8/4/2011 Comparing Veterans and Non- Veterans in ShelterVeterans are more likely to be:• male• white• non-Hispanic• older• disabledthan 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

8/4/2011Risk 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 riskRisk of Homelessness Compared to Non-Veterans Poor African Poor Hispanic/LatinoAmerican Veterans Veterans African Hispanic/Latino American Veterans in Veterans in poverty: 3 poverty: 2 times the risk times the risk 6

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

8/4/2011 Length of Stay in Emergency Shelter Length of Stay Percent of Veterans in ShelterLess 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

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 BackgroundAlthough 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

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

8/4/2011 Independent VariablesHousing • Fair market rents • 50th percentile rent estimates • Substandard/overcrowded housing units • Vacancy rateEconomics • Median household income • % population living below 50% poverty • Unemployment rateSafety Net • Section 8 units • Veterans receiving VA compensation/pension • State supplements to federal spending Independent VariablesVeterans • Veterans by service eraAffairs • VA homelessness resources • Veterans receiving homeless servicesPublic • Mortality (life expectancy, suicide)Health • Chronic health conditions • Uninsured • Drug and alcohol misuse, smokingCriminal • HomicideJustice • Violent crime • Individuals on probation/parole 11

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

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

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

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

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

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

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

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 Female18–29 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

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

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

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

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

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

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

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

8/4/2011 New York City Sheltered Hom eless Population (singles and families) in 2005: Age Distribution14%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

8/4/2011 Age of family household heads only, change over tim e (1990 & 2000), NYC (proportion by age in years). 0.20.180.160.140.12 1988 1995 0.1 20000.08 20050.060.040.02 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

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 )12.010.0 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 Population2.0 1990 Male1.8 1990 Female1.6 2000 Male 2000 Female1.41.21.00.80.60.40.20.0 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

8/4/2011 Homelessness & Aging Among Veterans Aging Vet Population4,000,0003,500,0003,000,0002,500,000 2000 20052,000,000 2010 2015 20201,500,0001,000,000 500,000 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

8/4/2011National Survey of Veterans (NSV) 100% 75% 65+ 50% 45-64 <45 25% 0% 2002 2003 2005 2007 2008Aging 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

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

1.10 New Research on Homelessness among Veterans

by National Alliance to End Homelessness

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