After serving their country, thousands of veterans have nowhere to call home. But nurses are among those providing health services and working on teams that help former military men and women find shelter and get started toward a more comfortable life.
This is what nursing is all about, Carmella Pittman, BSN, MEd, RN, outpatient staff nurse at the VA Hudson Valley Health Care System in Montrose, N.Y., said of working with homeless veterans. We do a lot of everything here and address different needs of veterans.
Pittman and Sophia Reynolds-Barnes, BSN, RN, also an outpatient staff nurse at VA Hudson Valley, work as part of a team. Nurses, psychiatrists and physicians focus on the homeless veterans mental and medical needs. Social workers and others help find housing. The VA Hudson Valleys Montrose campus includes a 60-bed domiciliary and a 94-bed facility operated by a nonprofit partner.
Improvements by the numbers
The number of homeless veterans has declined steadily since 2010. The U.S. Housing and Urban Development 2014 Annual Homeless Assessment Report to Congress reported a decline from 74,770 in 2010 to 49,933 in 2014, about 11% of the homeless population. About 10% of homeless veterans are women, according to the report.
New York State experienced the greatest decline in homeless veterans in the U.S. from 2013 to 2014, according to the report, which noted a drop of 2,117 people, or 45.4%, to 2,542. Since 2010, New Yorks homeless veteran population has declined 56.8%.
New Jerseys homeless veteran population increased by 16.7% from 2013 to 2014, with 630 homeless vets, the report said. The Opening Doors: Federal Strategic Plan to Prevent and End Homelessness deserves some of the credit, as does the U.S. Department of Veterans Affairs, which offers several programs to help homeless veterans.
Care has improved, said Ellen P. Flanagan, MSN, RN, PMHNP-BC, a mental health nurse practitioner with the Housing First ACT team at the VA New York Harbor Healthcare System in Brooklyn. [Without us], there are veterans who would not have connected with the hospital or housing.
Rhonda Garrett, MSN, RN, director of clinical services at the VA New Jersey Health Care System in East Orange and Lyons, agreed that care has improved with the many services available to veterans, including compensated work therapy and relationship-based nursing care 24 hours a day to ensure domiciliary residents have breakfast, transportation to and from the housing site and tools for a successful day.
The nurses offer a lot of confidence and inspiration, Garrett said. We let them know, You have a resource in me. We believe in you and are going to do whatever we can to help you. Many times thats what helps people turn that corner.
VA reaches out
The VA takes a housing-first approach to homelessness. We believe once they are housed, other things will fall into place, Flanagan said.
Nurses work in clinics and in community outreach to provide health and social needs. The team deals with transportation issues, lack of telephone service, malnutrition and the stigma of homelessness, she said.
We collaboratively develop a comprehensive wellness plan, suited to the veterans identified needs and preferences for care, Flanagan said.
Flanagan and her colleagues go into the field, meeting with homeless veterans in parks, train stations, under bridges, in shelters and anywhere the veterans want to meet. EDs, inpatient units and other healthcare providers will call the VA homeless program when a homeless veteran is identified, and the VA will provide the appropriate resource, she said. VA NY Harbor offers domiciliary care and other programs.
The team members screen for PTSD, traumatic brain injury and military sexual trauma. Those issues and financial concerns often land veterans into homelessness, Flanagan said. Team members have received training in cognitive behavioral therapy.
This enables us to provide therapy in nontraditional settings out in the community or in the recently housed veterans apartments, Flanagan said.
Sometimes veterans come to the VA Hudson Valley homeless clinic for an acute illness, such as an upper respiratory infection. Others are referred by a community agency. A nurse meets with the person first, then a social worker and medical professionals, as indicated.
Homeless veterans have chronic illnesses like diabetes, hypertension and hepatitis B, said Reynolds-Barnes, who finds the homeless veterans receptive to the services offered. The VA provides veterans with medications, so while securing needed pharmaceuticals is a challenge for nonveteran homeless, its not an issue for veterans.
We are making a difference, Reynolds-Barnes said. For the most part, they come in homeless and leave with an apartment, a job and their needs taken care of.
Flanagan, on the other hand, finds chronically homeless veterans often are resistant to assistance. They may be afraid of being hospitalized. A peer support specialist on the team helps bridge that gap and builds trust.
In the New Jersey VAs 85-bed domiciliary, nurses help veterans make the transition from homelessness to housing with support. Nurses provide health and wellness education to help them learn about healthy lifestyles and medication management. We have support along the way, Garrett said.
Meeting vets needs
The New York City-based Jonas Center for Nursing and Veterans Healthcare in New York funds the work of doctoral nursing students who focus on veterans healthcare needs, including ones working on homeless issues, preparing the next generation of nurses to help veterans transition to civilian life.
The center convenes experts to discuss the issue and develop strategies to solve it. It is working on a call to action to address the needs of female homeless veterans, said retired Brig. Gen. William T. Bester, RN, MSN, NEA-BC, senior advisor for the Jonas Veterans Healthcare Program. Our job and what we do at the Jonas Center, focused on the nursing profession, is to help people transition through their emotional, mental health and physical injuries, so … they can become stable members of society again, Bester said.
Care for the Homeless in New York uses an integrated outreach nursing model with a team approach to healthcare for veterans and other people on the street or in shelters with a mobile clinic setting operating as medical homes. The model includes prevention, screening, education, chronic-disease management, and addressing acute illnesses and psychiatric disorders.
Debbian Fletcher-Blake, MS, FNP, assistant executive director of Care for the Homeless, reports good outcomes for patients with diabetes, hypertension and asthma management, and stabilization of patients with substance abuse and mental health issues.
We are making a difference, Fletcher-Blake said. The [integrated outreach] nursing model does so much for people regardless of their social situation, but especially for people who do not have.
Debra Anscombe Wood, RN, is a freelance writer.