Identifying Homelessness among Veterans Using VA Administrative Data: Opportunities to Expand Detection Criteria

Abstract

Researchers at the U.S. Department of Veterans Affairs (VA) have used administrative criteria to identify homelessness among U.S. Veterans. Our objective was to explore the use of these codes in VA health care facilities. We examined VA health records (2002-2012) of Veterans recently separated from the military and identified as homeless using VA conventional identification criteria (ICD-9-CM code V60.0, VA specific codes for homeless services), plus closely allied V60 codes indicating housing instability. Logistic regression analyses examined differences between Veterans who received these codes. Health care services and co-morbidities were analyzed in the 90 days post-identification of homelessness. VA conventional criteria identified 21,021 homeless Veterans from Operations Enduring Freedom, Iraqi Freedom, and New Dawn (rate 2.5%). Adding allied V60 codes increased that to 31,260 (rate 3.3%). While certain demographic differences were noted, Veterans identified as homeless using conventional or allied codes were similar with regards to utilization of homeless, mental health, and substance abuse services, as well as co-morbidities. Differences were noted in the pattern of usage of homelessness-related diagnostic codes in VA facilities nation-wide. Creating an official VA case definition for homelessness, which would include additional ICD-9-CM and other administrative codes for VA homeless services, would likely allow improved identification of homeless and at-risk Veterans. This also presents an opportunity for encouraging uniformity in applying these codes in VA facilities nationwide as well as in other large health care organizations.

Fig 1. Map of usage of various administrative indicators for the recognition of homelessness in VA medical facilities across the country (V60.0, V60.1, V60.89. V60.9 and non-ICD codes: clinic stop codes and inpatient treatment codes as described in the text).

The pie charts are derived from a normalized ratio: the frequency of the specific code given as a first indicator of homelessness (numerator) as a proportion of the total number of Veterans identified as homeless in the area (denominator). Two representative years are shown.

Fig 2. A stacked bar graph of the variability in usage of V60 and non-ICD codes to identify homelessness among Veterans across 4 VA regions in the US.

Region 1 includes the East Coast, Region 4 the West Coast. The time period studied is 2002–2012.