Running Head: HOMELESS VETERANS 1

Homeless Veterans in the US: A Vulnerable Population

Breanne Michelle Westfall

Professor Kathy S. Faw RN, MSN

Bon Secours Memorial College of Nursing

NUR 3113

April 2, 2017

“I pledge.” -Breanne Westfall

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Homeless Veterans in the US: A Vulnerable Population

Here in the United States of America, there are approximately 49,933 homeless veterans,

accounting for almost 12% of America’s homeless population (Olenick, Flowers, & Diaz, 2015).

These are people who have dedicated their lives to fighting for and serving our country, and now

they have reached a point in their lives where they do not have a solid home or a steady influx of

resources they need in order to thrive and be successful. This is a great injustice, since these

people sacrificed many things for our country, and now they do not even have a place to live. I

am to address the challenges this population faces and how these problems may be fixed.

Social Determinants of Health

Often, there is a stigma against homeless people; they are assumed to be lazy, and the

blame for homelessness is placed directly upon the individuals themselves. However, the reality

is that there are many factors that are involved with people becoming or remaining homeless.

After returning from war, veterans may face a variety of problems. A study of urban homeless

veterans found that 53% suffered from degenerative joint disease or arthritis, 45% had

hypertension, 35% had hyperlipidemia, and 28% had hepatitis. The same study noted that 71%

suffer from alcohol use disorder, 67% have a depressive disorder, 43% use cocaine, 37% suffer

from anxiety disorders, 17% use opioids, and 11% have bipolar disorder (McInnes et al, 2015).

One other study by Iheanacho and Rosenheck (2016) notes that 19% of homeless veterans have

diabetes mellitus and are at a higher risk for co-morbidities related to their diabetes diagnoses.

Being without a home can lead to or exacerbate this issues; for instance, the physical

health issues these individuals face would be more difficult to manage or cure due to the fact that

these people have a limited income and no address to have on file with the doctor or pharmacy.

They may also have transportation issues and not be able to reach the doctor’s office or make it
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to their scheduled appointments. Additionally, the instability, uncertainty, and emotional strain

that comes with not having a home could easily lead to mental health issues like depression and

anxiety, which is why we see such high rates of these issues in this population. This is also due

to what these men and women see and experience while they are deployed; what they go through

affects them greatly.

As far as the substance abuse rates go, I believe that some members of this population use

alcohol and drugs as a coping mechanism to deal with the daily stress and negative emotions

they may face. In the case of homeless veterans, alcohol and drug abuse often go hand in hand,

with 54% of homeless veterans abusing both substances (Tsai, Kasprow, & Rosenheck, 2014).

Living on the streets or in homeless shelters may present these individuals with easier access to

these substances, which can contribute to the beginning and continuation of these addictions.

Socially, this population is not set up to succeed. They often are living outdoors or in poor

conditions which lead to them having negative health outcomes, as listed above. Also, many of

these people return from overseas with issues such as post-traumatic stress disorder (PTSD –

36% of male veterans), traumatic brain injuries (TBI), chronic pain, amputations, and suicidal

ideations, with 18 to 22 veterans committing suicide on a daily basis (Olenick, Flowers, & Diaz,

2015). This population has a great need for support socially, emotionally, financially, and in

many other capacities. They do not choose to come back to America and be homeless; many

factors lead them there. A large number of them need our help to get back on their feet and

succeed.

Evidence-Based Interventions Addressing Health Needs

One of the biggest issues homeless veterans face in terms of healthcare is that they are

not able to access quality healthcare; they face barriers such as transportation issues and a lack of
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monetary resources to pay for healthcare services. Something that could ease the process of

obtaining healthcare would be the advent of technology driven healthcare processes. McInnes et

al (2015) completed a study in which it is determined that homeless veterans could benefit from

mobile technology when it comes to healthcare.

The study found that 90% of the participants have cell phones, either from government-

funded programs or pre-paid cell phones that can be loaded with minutes (Virgin Mobile, etc.).

The goal was to improve health outcomes for these individuals via things such as text or call

reminders for appointments, filled prescriptions, lab test results, and other medical information.

Since these people do not have a solid address or land line phone number, these things could give

them a better chance at consistently being able to access providers and receive medical care. The

study was more of a needs assessment, but it found that homeless veterans would absolutely

benefit from integrating technology into their healthcare. Weber (2016) says that many homeless

veterans overutilize emergency departments and underutilize primary care providers, and this

study proposes ways to try and reverse this trend and get homeless veterans access to more

stable, consistent healthcare.

In 2000, the United Nations (UN) created the Millennium Development Goals (MDGs)

which are 8 overarching goals that aim to improve health globally (Skolnik, 2016). The

homeless veteran population would relate to goal number one, which is to eradicate extreme

hunger and poverty, and goal six, which includes combating diseases (Skolnik, 2016). Goal six

is attempting to be addressed by things like the study mentioned above. By helping these

veterans gain better access to healthcare, researchers are also attempting to improve the health

conditions of these individuals and reduce the number of people who are dealing with diseases

and illnesses. My research did not turn up much information about what is being done to help
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these individuals financially or with finding food and jobs. One study by Tsai, Kasprow, and

Rosenheck (2014) did mention a program run by the Department of Housing and Urban

Development that offers housing to homeless veterans, regardless of whether or not they have

addiction issues. I see this as a great opportunity for these people to get back on their feet and

learn how to re-enter society and eventually begin working again. However, I also realize that

this is a large financial undertaking and at this point could not support all of the homeless

veterans we have here in America. While there is still progress to be made, I do recognize that

efforts are currently being made to help this population.

Global Approach in Addressing “Health for All”

While we do have such a pressing issue in our country of trying to help our homeless

veterans, it is also important to remember the millions of people worldwide who are living in

poor conditions or who may not have access to quality healthcare. There are people in every

country, not just ours, who struggle on a daily basis and need assistance in order to survive and

eventually thrive. One thing we discussed in class is the International Council of Nurses (ICN),

which was established in order to ensure quality nursing care, create sound global health policies,

and support positive work practices such as the MDGs discussed earlier (Faw, 2017). The ICN

truly strives to create a better healthcare environment for people all across the world, and also

aims to achieve equality in healthcare, so that one country or group does not receive preferential

treatment over another. Through working together, this group of nurses tries to improve upon

their own profession and ensure that practices are staying current so that they can try to ensure

that people across the globe are getting access to the best healthcare that they possibly can.

Other things we discussed in class were the World Bank and the International Monetary

Fund, both of which provide loans and grants for things such as education, health, infrastructure,
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and communications (Faw, 2017). These groups would be essential in helping countries try to

improve upon healthcare, and just the quality of life in general for the citizens who are in need.

The reality is that these necessary changes often cannot be made without large sums of money to

back them up, so these organizations would be able to help provide the cash flow these countries

need in order to make the changes that will impact the health and wellbeing of their citizens. It is

groups like the ICN, World Bank, and International Monetary Fund that make it possible for

countries to improve their healthcare for citizens, especially those who are in dire need. As long

as we have organizations that are dedicated to this cause, we should be able to make strides in

improving healthcare globally.

Conclusion

In conclusion, there is a large number of vulnerable populations, both in our own country

as we see with our homeless veterans, and in every other country as well. There will always be

people who need the help of others to succeed in life, and if people band together to help others,

the quality of life and healthcare could greatly improve. While our homeless veterans face many

issues such as chronic illnesses and substance abuse, there are strides being made towards getting

this population better access to the healthcare they need and deserve. In future years, it will be

important to continue this work as an act of gratitude for the men and women who have given

our country so much of themselves.

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References

Faw, K. (2017). Specific common health issues facing vulnerable populations internationally.

[.doc document] Retrieved from blackboard.com.

Iheanacho, T., & Rosenheck, R. (2016). Prevalence and correlates of diabetes mellitus among

homeless veterans nationally in the Veterans Health Administration. Journal of Social

Distress and the Homeless, 25(2), 53-59. doi:10.1080/10530789.2016.1169722

McInnes, D.K., Fix, G.M., Solomon, J.L., Petrakis, B.A., Sawh, L., & Smelson, D.A. (2015)

Preliminary needs assessment of mobile technology use for healthcare among homeless

veterans. PeerJ 3:e1096 https://doi.org/10.7717/peerj.1096

Olenick, M., Flowers, M., & Diaz, V. (2015). US veterans and their unique issues: Enhancing

health care professional awareness. Advances in Medical Education and Practice, 635.

doi:10.2147/amep.s89479

Skolnik, R. L. (2016). Global Health 101, p 12. Burlington, MA: Jones & Bartlett Learning.

Tsai, J., Kasprow, W. J., & Rosenheck, R. A. (2014). Alcohol and drug use disorders among

homeless veterans: Prevalence and association with supported housing outcomes.

Addictive Behaviors, 39(2), 455-460. doi:10.1016/j.addbeh.2013.02.002

Weber, J. (2016). A grounded theory study of how homeless veterans manage their chronic

health problems. (Electronic Thesis or Dissertation). Retrieved from

https://etd.ohiolink.edu/