However, in pushing to meet the Obama Administration’s goal of ending homelessness among veterans by 2015, the Veterans Administration of Greater Los Angeles Healthcare System saw an estimated 21% decline in its homeless veteran population between 2011 and 2012, according to the U.S. Department of Housing and Urban Development. In addition, the VA GLA reports that it increased the number of beds in permanent or transitional housing for homeless veterans by 60% from 2009 to 2012.
By working in new VA GLA programs and in positions that require not only broad clinical skills but also a deft touch with issues of trust, and a willingness to literally meet veterans wherever they are, nurses have been an integral part of ending veteran homelessness, according to Bob Friedman, RN, BSN, chief of community care at VA GLA.
As the VA GLA expands its homeless programs, the number of nurses working in the program most likely will double in the next fiscal year, said Donna Beiter, RN, MSN, director of the VA GLA. "As we’ve learned more about these vets and their needs, we’ve revised our whole strategic plan," she said, "and we found we have a greater need for the RN role."
The average homeless veteran has multiple problems, including medical and psychiatric diagnoses, substance abuse and PTSD that requires all the nursing skill sets, Beiter said. "It takes a unique and well-trained nurse to work with these patients," she said.
Janel Perez, RN, NP, MSN, is part of the VA GLA’s Assertive Community Treatment team, which celebrated its one-year anniversary in March. The multidisciplinary ACT team provides various services to the most vulnerable and chronically homeless veterans. Perez’s position is "street nurse." She tries to find homeless veterans in the community to offer them basic nursing care and, over time, to establish a trusting relationship that would foster their willingness to accept more care and housing.
"It might take two to three months before they let me do a blood pressure," Perez said. "Most want to get off the streets but just say, 'I’ll think about it.’ Living on the streets is a really difficult life, and they have to be on the defensive and protect themselves."
Once veterans agree to be housed, screening nurses quickly evaluate their healthcare needs and determine the most suitable type of housing. Some housing is targeted for mental health or addiction issues; others are for Iraq and Afghanistan veterans; one is for women only; another is for seniors; and one allows pets.
Once veterans are placed, case management nurses, such as Gitta Patel, RN, BSN, CCM, visit them regularly to continue building trust and assessing needs and compliance. "I reinforce the treatment plan and let the provider know what the patient is doing," Patel said. Like other case managers, Patel is an educator but does no direct nursing care.
The VA nurses work within the Housing First model, which makes shelter — not sobriety or other behavioral goals — the top priority. This strategy, according to the U.S. Interagency Council on Homelessness, has been shown to reduce ED visits and be significantly more successful in preventing a relapse to homelessness.
Lori Fagan is a copy editor. Send letters to editorWest@nurse.com.