Characteristics and Healthcare Utilization Among Aging Veterans in Supported Housing: A Comparison With Independently Housed Age-Matched Veterans

Abstract

Background and objectives: There is a large and growing population of older, formerly homeless adults living in permanent supportive housing, and there are concerns about how to address their healthcare needs. This study compared veterans aged 55 years and older residing in the Department of Housing and Urban Development-Veterans Affairs Supportive Housing (HUD-VASH) program to an age-matched group of independently housed veterans receiving care through the U.S. Department of Veterans Affairs (VA) healthcare system on health and healthcare service use characteristics.

Research design and methods: Cross-sectional analyses were performed on 1,436,537 (66,072 HUD-VASH vs 1,370,465 housed) eligible veterans with index encounter dates between October 1, 2021, and July 31, 2022, using linked data from the VA's Homeless Operations Management and Evaluation System and the Corporate Data Warehouse. Propensity-score-adjusted logistic regression models were constructed to compare aging HUD-VASH versus housed veterans on outpatient and inpatient healthcare utilization.

Results: HUD-VASH veterans were more likely to have physical and mental health morbidities, including substance use disorder than their independently housed counterparts. HUD-VASH veterans were less likely to utilize outpatient medical services, and more likely to use emergency and inpatient care services than independently housed veterans.

Discussion and implications: Older veterans in the HUD-VASH program have greater healthcare needs and different patterns of healthcare utilization than their independently housed counterparts. Targeted interventions that better engage and reduce barriers to care among aging populations in supported housing are needed.

Keywords: Aging; Healthcare services; Homelessness; Propensity scoring; Veterans.