U.S. GOVERNMENT PRINTING OFFICE

WASHINGTON : 

For sale by the Superintendent of Documents, U.S. Government Printing Office

Internet: bookstore.gpo.gov Phone: toll free (866) 512–1800; DC area (202) 512–1800

Fax: (202) 512–2104 Mail: Stop IDCC, Washington, DC 20402–0001

39–457 2008

U.S. DEPARTMENT OF VETERANS AFFAIRS 

GRANT AND PER DIEM PROGRAM 

HEARING 

BEFORE THE

SUBCOMMITTEE ON HEALTH 

OF THE

COMMITTEE ON VETERANS’ AFFAIRS 

U.S. HOUSE OF REPRESENTATIVES 

ONE HUNDRED TENTH CONGRESS 

FIRST SESSION 

SEPTEMBER 27, 2007 

Serial No. 110–48 

Printed for the use of the Committee on Veterans’ Affairs 

( 

erowe on PROD1PC71 with REPORTS

ii 

COMMITTEE ON VETERANS’ AFFAIRS 

BOB FILNER, California, Chairman 

CORRINE BROWN, Florida 

VIC SNYDER, Arkansas 

MICHAEL H. MICHAUD, Maine 

STEPHANIE HERSETH SANDLIN, South 

Dakota 

HARRY E. MITCHELL, Arizona 

JOHN J. HALL, New York 

PHIL HARE, Illinois 

MICHAEL F. DOYLE, Pennsylvania 

SHELLEY BERKLEY, Nevada 

JOHN T. SALAZAR, Colorado 

CIRO D. RODRIGUEZ, Texas 

JOE DONNELLY, Indiana 

JERRY MCNERNEY, California 

ZACHARY T. SPACE, Ohio 

TIMOTHY J. WALZ, Minnesota 

STEVE BUYER, Indiana, Ranking 

CLIFF STEARNS, Florida 

JERRY MORAN, Kansas 

RICHARD H. BAKER, Louisiana 

HENRY E. BROWN, JR., South Carolina 

JEFF MILLER, Florida 

JOHN BOOZMAN, Arkansas 

GINNY BROWN-WAITE, Florida 

MICHAEL R. TURNER, Ohio 

BRIAN P. BILBRAY, California 

DOUG LAMBORN, Colorado 

GUS M. BILIRAKIS, Florida 

VERN BUCHANAN, Florida 

Malcom A. Shorter, Staff Director 

SUBCOMMITTEE ON HEALTH 

MICHAEL H. MICHAUD, Maine, Chairman 

CORRINE BROWN, Florida 

VIC SNYDER, Arkansas 

PHIL HARE, Illinois 

MICHAEL F. DOYLE, Pennsylvania 

SHELLEY BERKLEY, Nevada 

JOHN T. SALAZAR, Colorado 

JEFF MILLER, Florida, Ranking 

CLIFF STEARNS, Florida 

JERRY MORAN, Kansas 

RICHARD H. BAKER, Louisiana 

HENRY E. BROWN, JR., South Carolina 

Pursuant to clause 2(e)(4) of Rule XI of the Rules of the House, public hearing records 

of the Committee on Veterans’ Affairs are also published in electronic form. The printed 

hearing record remains the official version. Because electronic submissions are used to 

prepare both printed and electronic versions of the hearing record, the process of converting 

between various electronic formats may introduce unintentional errors or omissions. Such occurrences are inherent in the current publication process and should diminish as the process 

is further refined. 

erowe on PROD1PC71 with REPORTS

iii 

C O N T E N T S 

September 27, 2007 

Page 

U.S. Department of Veterans Affairs Grant and Per Diem Program ................. 1 

OPENING STATEMENTS 

Chairman Michael Michaud ................................................................................... 1 

Prepared statement of Chairman Michaud .................................................... 30 

Hon. Jeff Miller, Ranking Republican Member ..................................................... 2 

Prepared statement of Congressman Miller ................................................... 30 

WITNESSES 

U.S. Government Accountability Office, Daniel Bertoni, Director, Education, 

Workforce, and Income Security Issues ............................................................. 7 

Prepared statement of Mr. Bertoni ................................................................. 37 

U.S. Department of Veterans Affairs: 

George Basher, Chair, Advisory Committee on Homeless Veterans, and 

Director, New York State Division of Veterans’ Affairs ................................ 17 

Prepared statement of Mr. Basher .................................................................. 44 

Pete Dougherty, Director, Homeless Veterans Programs, Veterans Health 

Administration .................................................................................................. 20 

Prepared statement of Mr. Dougherty ............................................................ 46 

National Coalition for Homeless Veterans, Cheryl Beversdorf, RN, MHS, MA, 

President and Chief Executive Officer ............................................................... 3 

Prepared statement of Ms. Beversdorf ........................................................... 31 

Volunteers of America of Florida, Kathryn E. Spearman, President and Chief 

Executive Officer .................................................................................................. 5 

Prepared statement of Ms. Spearman ............................................................ 34 

SUBMISSIONS FOR THE RECORD 

American Legion, Ronald F. Chamrin, Assistant Director, Economic Commission, statement ..................................................................................................... 48 

MATERIAL SUBMITTED FOR THE RECORD 

Post Hearing Questions and Responses for the Record: 

Hon. Jeff Miller, Ranking Republican Member, Subcommittee on Health, 

Committee on Veterans’ Affairs, to Hon. Gordon Mansfield, Acting Secretary, U.S. Department of Veterans Affairs, letter dated October 5, 2007 52 

erowe on PROD1PC71 with REPORTS

erowe on PROD1PC71 with REPORTS

(1) 

U.S. DEPARTMENT OF VETERANS AFFAIRS 

GRANT AND PER DIEM PROGRAM 

THURSDAY, SEPTEMBER 27, 2007 

U.S. HOUSE OF REPRESENTATIVES, SUBCOMMITTEE ON HEALTH, 

COMMITTEE ON VETERANS’ AFFAIRS, 

Washington, DC. 

The Subcommittee met, pursuant to notice, at 10:02 a.m., in 

Room 334, Cannon House Office Building, Hon. Michael Michaud 

[Chairman of the Subcommittee] presiding. 

Present: Representatives Michaud, Snyder, Salazar, and Miller. 

OPENING STATEMENT OF CHAIRMAN MICHAUD 

Mr. MICHAUD. The Subcommittee on Health will come to order. 

I would like to thank everyone for coming today. Today we will 

examine the U.S. Department of Veterans Affairs (VA) Grant and 

Per Diem (GPD) Program for homeless veterans. 

On any given night, there are approximately 200,000 homeless 

veterans on the streets in America. The majority of these veterans 

served in Vietnam. Ninety-six percent are male and about 45 percent suffer from mental illness. 

VA has many programs to help homeless veterans including the 

Grant and Per Diem Program. VA needs to continually evaluate 

these programs to ensure that veterans are getting the services 

that they need and that provider organizations can effectively provide these services as well. 

For example, while the vast majority of homeless veterans are 

male, female veterans are the fastest-growing segment in this population. Women homeless veterans face similar challenges to their 

male counterparts, but they are very likely to have experienced serious trauma including abuse or rape and a significant number also 

have children to support. VA programs must be flexible to meet 

this new challenge. 

I believe that the VA should make sure that they give community-based organizations the tools they need to provide comprehensive service to our homeless veterans. The way in which the Grant 

and Per Diem Program is currently structured sometimes make 

this difficult, particularly for providers in high-cost areas. 

It is my belief that the goal of the VA homeless program should 

be not only to provide veterans with a bed for the night and a 

meal, but to provide them with the resources they need to attain 

permanent housing and a steady job and a renewed sense of selfworth. 

erowe on PROD1PC71 with REPORTS

2 

Today I hope that we will learn what VA is doing to provide service to homeless veterans to help them break out of this cycle. We 

will hear from the Grant and Per Diem Program on what is working and the ways that it can be changed. This is a problem that 

we can solve by working together. One homeless veteran is too 

many. 

[The prepared statement of Chairman Michaud appears on 

p. 30.] 

Mr. MICHAUD. I would now like to recognize a colleague of mine 

who cares deeply about our veterans, Ranking Member Miller, for 

any opening statement he might have. 

OPENING STATEMENT OF HON. JEFF MILLER 

Mr. MILLER. Thank you very much, Mr. Chairman. 

This year marks the 20th anniversary of VA providing specialized services for homeless veterans. VA’s homeless program began 

in 1987 with Public Law 100–6, which provided VA with $5 million 

to support care for veterans in community-based and domiciliary 

facilities. 

Since that time, VA’s homeless programs have expanded and 

grown significantly. VA currently budgets almost $2 billion to treat 

and assist homeless veterans, and administers over 9 specialized 

programs that integrate housing and mental health and substance 

abuse counseling. 

Although it remains difficult to obtain an accurate count of the 

number of homeless veterans, and I think most of us agree that 

200,000 is a close number. There are indications that we are making good progress in helping reintegrate homeless veterans into 

stable community environments and lead productive and sober 

lives. 

Still, there are far too many veterans out on the street. I concur 

with you, Mr. Chairman, that one homeless veteran on any given 

night is too much. On any given night in my home State of Florida, 

there are 17,000 homeless veterans are on the streets. 

I think that with the increasing number of returning veterans 

from the conflicts in Iraq and Afghanistan, the development of innovative services to help veterans at-risk for homelessness is extremely important. 

Today, we meet to review VA’s Homeless Providers Grant and 

Per Diem (GPD) Program. This program is considered to be a very 

successful collaboration between VA, nonprofit, and faith-based organizations. Our Committee has always worked in a bipartisan 

manner to strengthen healthcare, housing, employment training, 

and other services to assist at-risk veterans. Mr. Chairman, I look 

forward to working with you to continue that relationship. 

I would like to welcome all of the witnesses that are here with 

us today, especially Kathryn Spearman who is with Volunteers of 

America Florida, for participating in our hearing this morning. I 

am grateful for her dedication and many years of service and work 

to provide services that assist homeless veterans in our home State 

of Florida. 

Mr. Chairman, I yield back the balance of my time. 

[The prepared statement of Congressman Miller appears on 

p. 30.] 

erowe on PROD1PC71 with REPORTS

3 

Mr. MICHAUD. I thank the gentleman. 

Our first panel today is Cheryl Beversdorf who is President and 

Chief Executive Officer (CEO) of the National Coalition for Homeless Veterans (NCHV). 

Welcome, Cheryl. 

And Kathryn Spearman who is President and CEO of Volunteers 

of America from Tampa, Florida. 

I also want to welcome you, Kathryn. 

And Daniel Bertoni who is Director of Education, Workforce and 

Income Security Issues from the U.S. Government Accountability 

Office (GAO). 

I would like to welcome our panelists today and we will start off 

with Cheryl and just work down. 

So I turn the floor over to you. 

STATEMENTS OF CHERYL BEVERSDORF, RN, MHS, MA, PRESIDENT AND CHIEF EXECUTIVE OFFICER, NATIONAL COALITION FOR HOMELESS VETERANS; KATHRYN E. SPEARMAN, 

PRESIDENT AND CHIEF EXECUTIVE OFFICER, VOLUNTEERS 

OF AMERICA OF FLORIDA; AND DANIEL BERTONI, DIRECTOR, EDUCATION, WORKFORCE AND INCOME SECURITY 

ISSUES, U.S. GOVERNMENT ACCOUNTABILITY OFFICE 

STATEMENT OF CHERYL BEVERSDORF 

Ms. BEVERSDORF. The National Coalition for Homeless Veterans 

appreciates the opportunity to submit testimony to the Health Subcommittee of the House Veterans’ Affairs Committee regarding the 

VA Grant and Per Diem Program. 

NCHV’s membership represents nearly 280 community-based organizations in 48 States and the District of Columbia. As a network, NCHV members provide the full continuum of care to homeless veterans and their families including emergency shelter, food 

and clothing, healthcare, addiction and mental health services, employment support, educational assistance, legal aid and transitional 

housing and other kinds of services. 

NCHV members serve approximately 150,000 veterans annually. 

Regarding homelessness among veterans, the VA reports homeless 

veterans are mostly males, although 3 percent are females, and the 

vast majority are single, although service providers are reporting 

an increased number of veterans with children seeking their assistance. 

About half of all homeless veterans have a mental illness and 

more than two-thirds suffer from alcohol or other substance abuse 

problems. Nearly 40 percent have both psychiatric and substance 

abuse disorders. 

In addition, the majority of women in homeless veteran programs 

have serious trauma histories, some life threatening, and many of 

these women have been raped and reported physical harassment 

while in the military. 

Veterans are at high risk of homelessness due to 3 factors: Extremely low or no livable income; extreme shortage of affordable 

housing; and limited access to healthcare. These factors combined 

with circumstances experienced during their military service put 

them at even greater risk of homelessness. 

erowe on PROD1PC71 with REPORTS

4 

Findings from a 2006 NCHV survey suggest the homeless veteran population in America is experiencing significant changes. 

Homeless veterans receiving services today are aging and many 

need permanent supportive housing. With more women in the military, the percentage of women veterans seeking services is increasing. 

In general, a growing number of combat veterans returning home 

from Iraq and Afghanistan, both men and women, are suffering 

from war-related conditions including post traumatic stress disorder (PTSD) and traumatic brain injury (TBI), which may put 

them at risk for homelessness. 

The homeless providers Grant and Per Diem Program supports 

development of transitional community-based housing and delivery 

of supportive services for homeless veterans through competitive 

grants to community-based, faith-based, and public organizations. 

To underline the importance of the Grant and Per Diem Program, in September 2006, the GAO released a study that found 

while VA has attempted to improve its services and increase the 

capacity of the Grant and Per Diem Program, an additional 9,600 

transitional housing beds are still needed to meet current demand. 

Regarding Grant and Per Diem appropriations, NCHV is pleased 

both the House and Senate have passed bills increasing the fiscal 

year 2008 appropriations to the fully authorized level of $130 million. If approved, funding at this level will increase beds available 

to serve more men and women veterans at risk of homelessness. 

In addition to the need for more beds and increased program 

funding, NCHV believes the mechanism for paying providers under 

the Grant and Per Diem Program must be modified. 

Regarding payment, many Grant and Per Diem providers report 

even the maximum rate of up to $31.30 provides far less than the 

actual daily cost of care to a veteran in the Grant and Per Diem 

Program. 

Providers often experience lengthy, ongoing communication with 

the VA and questions regarding expenses incurred and accountability resulting in a delay in timely reimbursement and ultimately, interruption of services to their clients. 

The accounting burden is particularly onerous for smaller faithbased and community-based organizations that may lack the necessary resources to easily resolve these issues. 

At the time the law creating the Grant and Per Diem Program 

was written, Congress had limited knowledge as to how services to 

veterans outside VA facilities should be reimbursed. As a result, 

the rate authorized for State homes for domiciliary care was used 

as the standard for paying homeless veterans’ service providers. 

Over time, evidence has shown clients in the two settings have 

very different needs. Accordingly, a modified payment system that 

reflects the special needs of homeless veterans and the comprehensive services they receive must be applied. 

Whereas residents receiving domiciliary care in State homes are 

more likely to remain permanently in VA facilities, the goal of community-based veteran service providers is to promote independent 

living for their clients and reintegration back into civilian life. 

erowe on PROD1PC71 with REPORTS

5 

To address these issues, NCHV urges Congress to introduce legislation that would allow payments for services to be related to 

costs rather than a capped rate. 

In addition to creating a more user-friendly system, this approach may increase service provider participation in high-cost 

service areas. 

A reasonable practice of outcome and performance measurement 

of Grant and Per Diem providers should be included under this 

system. 

The requirements for grant recipients should also allow service 

providers to use other available sources of income besides the 

Grant and Per Diem Program including payments or grants from 

other Federal departments and agencies in addition to those of 

State or local governments. 

While the current law was intended to ensure VA per diem payments do not replace payments or contributions from other income 

sources, it has instead created the unintended consequences of penalizing Grant and Per Diem providers successful in securing other 

sources of income for services to homeless veterans by reducing 

their per diem payment rate. 

Congress should devise a payment provision that encourages 

Grant and Per Diem providers to seek funding from the non-VA 

sources in a manner that does not penalize them if they are successful. 

All payment modifications should also allow VA funds to be used 

as a match or leverage for other Federal funds and allow other 

Federal funds to be used without offset by VA. 

When Grant and Per Diem providers are able to receive the maximum rate in addition to other income sources, they can expand the 

scope and quantity of services to homeless veterans and increase 

the likelihood of their successful reintegration into the community. 

Additional income will help providers develop and support additional housing units, provide veterans a more robust service package, and serve homeless veterans not qualified for Grant and Per 

Diem support. 

In conclusion, I want to thank you for inviting NCHV to present 

our views about the Grant and Per Diem Program. We urge Congress to introduce and pass legislation that will address the concerns that we have presented today. 

I will be happy to answer your questions. 

[The prepared statement of Ms. Beversdorf appears on p. 31.] 

Mr. MICHAUD. Ms. Spearman. 

STATEMENT OF KATHRYN E. SPEARMAN 

Ms. SPEARMAN. Chairman Michaud, Ranking Member Miller, 

and Members of the Subcommittee, thank you for the invitation to 

testify today and for all you do to assist our Nation’s veterans. 

I work for Volunteers of America of Florida, as stated earlier, 

which is a statewide faith-based social service organization in Florida for the past 87 years. And we are an affiliate of the larger Volunteers of America, a national organization around for 111 years 

and with affiliates in 44 States. 

Volunteers of America of Florida offers housing and services and 

we serve multiple and different types of populations including the 

erowe on PROD1PC71 with REPORTS

6 

homeless. Our service continuum includes housing, healthcare, 

training, education, employment, and services that all enhance selfsufficiency. 

We currently operate in 13 Florida cities and we are in development in 3 more cities. And we do some consultation with some 

grass-roots groups that have a rural focus. 

For my Florida Members, I would like to say, Representative 

Miller, we are developing Pensacola and we have some new things 

that are going to be going on there. So we are happy with that. 

And I guess Representatives Brown and Stearns are not present 

right now, but we have some things in their area as well. 

Florida attracts many homeless veterans and we have been focused on addressing the needs of these individuals for the past 10 

years. We partner with the VA Grant and Per Diem Program in 

serving this population. 

And as far as transitional housing and support services currently, we have a 216-bed capacity with 81 in development. And 

most of those are from the Grant and Per Diem. Also included are 

45 U.S. Department of Housing and Urban Development (HUD) 

Supportive Housing Program transitional beds for veterans as well. 

Our first Grant and Per Diem was a 40-foot state-of-the-art vehicle that is a fully-contained medical, dental, and health-service facility that does mobile outreach all over the State of Florida. And 

that is still in operation. 

I would also like to say that all of our beds are filled with veterans. And I know we have the 25-percent rule, but we never had 

any, you know, reason to use that because the need is so great. 

As far as the Grant and Per Diem Program, I would like to say 

some positive things that I really do appreciate as a provider. 

First of all, the dedication of Roger Casey and his staff to try to 

keep making this program what it needs to be, the continual funding that we have been receiving recently to add more beds, the 

grant segment, which provides tremendous leverage and incentive, 

the opportunity for the VA and the community to work together to 

help homeless veterans, the per diem that strengthens the operations and program, the potential for the service center, and also 

I very much see this as a gateway for veterans to become more a 

part of the community. 

Our 10 years of experience have led us to an increasing awareness of the issues facing the Grant and Per Diem Program and the 

providers. And I want to spend the rest of my testimony mentioning some information I would like to share but also a few suggestions. 

In relation to partnership, the overall partnership between the 

VA and the community needs strengthening. Local providers address the needs of veterans every day and complement the VA’s 

services. We are good at what we do and we need the VA and the 

VA needs the community providers. And the veteran needs us to 

work more closely together. 

A partnership approach, I feel strongly does work, and with a 

good partnership comes shared risk because we both own the problem and work together to solve those problems. 

A suggestion I would have today is a work group to advise and 

the task would be for a Grant and Per Diem payment mechanism 

erowe on PROD1PC71 with REPORTS

7 

that is provider friendly and also offers the accountability that the 

VA needs. And the representation on that group would be all the 

members of the partnership. 

Next—what it takes in helping homeless veterans. I think there 

are eleven essential services and I have listed those in my written 

testimony, things that I think are essential to bringing a veteran 

back to being a part of the community. 

I doubt most people know how disengaged and disabled many of 

the homeless veterans are when they come to our programs and 

drug and alcohol addiction is very serious and disruptive to rebuilding a life acceptable in our society. 

Next I want to talk about cost. The services, the eleven essential 

services go all the way from outreach to treatment and then integration back into the community. But the cost, I just want to say 

that the service cost and the payment do not match up, the $32.00 

a day. And I have put some breakdowns in my written testimony 

to show actually what things do cost as an example. 

And then the service center payment mechanism does not relate, 

just does not relate. We need to change that. 

And then the construction, rehab and acquisition require 30 percent cash and we need more flexibility with that. There are many 

creative ways to combine development funding or put together the 

assets of providers, the VA grant and some financing. 

I have proposed some options for payment possibilities in my 

written testimony based on experience. 

I think the flexibility we need now in this program should also 

be with an eye to the future when we will be focused on a new era 

of veterans with a whole new set of circumstances and needs. 

Veterans now returning from Operation Iraqi Freedom (OIF) or 

Operation Enduring Freedom (OEF) should benefit from the lessons we have learned in developing support and interventions. 

As we work together and address program improvements, we will 

be better prepared to continue to meet the needs of current homeless veterans and wisely anticipate the needs of our returning 

troops. 

Thank you for the opportunity to share my views today. 

[The prepared statement of Ms. Spearman appears on p. 34.] 

Mr. MICHAUD. Thank you very much. 

Mr. Bertoni. 

STATEMENT OF DANIEL BERTONI 

Mr. BERTONI. Good morning, Mr. Chairman, Members of the 

Subcommittee. Thank you for inviting me here today to discuss 

VA’s homeless providers’ Grant and Per Diem Program. 

Last year, VA ordered $95 million in GPD grants to over 300 

local agencies who provide transitional housing for veterans. The 

program is not designed to serve all homeless veterans but targets 

those most in need such as veterans with mental illness and substance abuse problems. 

The program’s goals are to help veterans achieve residential stability, increase income or skills, and greater self-determination. 

My testimony today draws on our prior work and focuses on 3 

areas. We have updated some of the data to bring it up to real-time 

time frames. 

erowe on PROD1PC71 with REPORTS

8 

Focusing on VA’s efforts to expand program capacity to meet demand, provide collaboration and challenges to serve homeless veterans, and VA’s processes for gauging program effectiveness. 

In summary, VA estimates that on any given night, about 

196,000 veterans are homeless and in need of transitional beds. 

Since fiscal year 2000, the agency has increased the number of 

beds from about 2,000 to over 8,000 and increased the number of 

annual admissions from 4,800 to over 15,000. 

Although the number of transitional beds available nationwide 

from all sources increased to more than 40,000 in 2006, VA estimates that about 11,000 more beds are needed to meet demands. 

At the time of our review, the agency planned to expand the program by about 2,000 beds and to make beds available in every 

State. However, an important demographic shift may require VA to 

reassess the type of housing and services provided in the future. 

Officials told us that they expect to see more homeless women 

veterans and more veterans with dependents in coming years, a 

trend that is directly related to the current makeup of our active 

and Reserve forces. 

The providers we visited often collaborated with public and nonprofit agencies in helping veterans recover from substance abuse or 

mental illness and obtain permanent housing, employment, financial stability, and services to facilitate independent living. 

However, some providers face challenges serving veterans such 

as finding affordable permanent housing for those ready to leave 

the program as well as transportation, legal assistance, dental 

care, and substance abuse treatment. 

Perhaps most importantly, however, we found that some providers did not fully understand certain program eligibility requirements and stay rules which could affect the veteran’s ability to get 

care. And VA was not consistently holding them accountable to program performance goals. 

For example, some providers incorrectly believe that veterans 

could not participate in the program unless they were eligible for 

VA healthcare. Others understood the life-time limit rule of 3 stays 

but were unaware that waivers could, in fact, be granted. 

Per our recommendation, VA has taken steps to improve communication and ensure its policies are understood by VA liaisons and 

providers responsible for implementing the program. 

To assess program performance, VA primarily relies on measures 

of veterans’ status at the time they leave the program rather than 

obtaining such information months or years later. In part, this has 

been due to concerns about cost, benefits, and feasibility of doing 

more extensive follow-up. 

Generally VA’s data show that since 2000, an increasing percentage of veterans met each of the program’s 3 goals at the time they 

left the program. 

During 2006, over half of veteran participants obtained independent housing. Another quarter were in transitional housing programs, halfway houses, hospitals, and nursing homes. Nearly onethird had jobs and significant percentages also demonstrated 

progress with alcohol and other substance abuse problems. 

To obtain a more complete understanding of the program’s effectiveness, we have recommended that VA explore feasible and costerowe on PROD1PC71 with REPORTS

9 

effective ways to obtain information on how veterans are faring in 

the longer term. 

VA is considering an approach that would allow it to obtain information of participants’ status 30 days after leaving the program. 

While this is a step in the right direction, we continue to believe 

that obtaining additional information at a later point would provide 

a better indication of long-term program success. 

Mr. Chairman, this concludes my statement. I am happy to answer any questions that you or other Members of the Subcommittee may have. Thank you. 

[The prepared statement of Mr. Bertoni appears on p. 37.] 

Mr. MICHAUD. I would like to thank all 3 panelists for your testimony this morning. 

My first question is for Ms. Spearman. As a Grant and Per Diem 

Program provider, can you speak to how the reimbursement process and the restrictions have affected your ability to provide services? And I know you mentioned about setting up a work group, 

but do you have any specific recommendations yourself on how to 

make the reimbursement process less burdensome? 

Ms. SPEARMAN. Well, I would say that I do not have all the answers for that. I think that there are various things on the table 

right now that people are looking for. But I do think that 

uncapping and looking at directly what the real costs are and developing a mechanism for that. 

We have a lot of paperwork and a lot of monitoring that goes on 

and I feel like that it is excessive for the amount of money that it 

takes to do the program. 

And I have mentioned also that the $31.30, I think that it is 

today, is just about what it would cost to just do the housing management or one overlay of service. 

So even though the paperwork has been cumbersome, more important are the delays in getting stuff processed, I think mentioning the contract liaisons, I think that their training is hopefully 

going to improve that. 

But another recommendation in my written comment was that 

we would actually have them as part of the Grant and Per Diem 

Program because I do not think the goals of the VA medical centers 

are the same so that when they are processing, I think that our 

concern is that the VA takes the risk with us about putting people 

in beds at night, if that is what they need, that we are able to process that quickly and that we share some risk that that vet may not 

be exactly the right person for our program or we may be able to 

refer them on or to bring in some additional services. 

We have just made the policy to go ahead and take the person 

into the bed and take all the risk. VA has not been able to step 

forward and say we will pay, you know, due back payments on that 

particular veteran. So we do have that issue of the paperwork 

interfering there. We could go on on lots of individual things, 

but——

Mr. MICHAUD. Thank you. 

Do you want to answer as well, Ms. Beversdorf? Are there any 

specific recommendations how the reimbursement process can be 

less burdensome? 

erowe on PROD1PC71 with REPORTS

10 

Ms. BEVERSDORF. I believe Kathy’s testimony contains recommendations worth considering. There needs to be more dialogue. 

Most of the time, our members are frustrated because there is not 

good communication between the VA liaisons at the VA medical 

center and service providers. 

Sometimes the easy way out is for service providers to not participate in the program or providers choose not to stay in the program. That very much concerns us. Given the need for additional 

beds, there is a need to modify the process so more providers are 

willing to participate. 

Mr. MICHAUD. Mr. Bertoni, you are the Director of Education, 

Workforce, and Income Security Issues. Are there ways that we 

could streamline the reimbursement process? Also, when you look 

at what is happening, particularly with more veterans coming back 

from Iraq and Afghanistan, with the Department of Labor cutting 

career centers, that is what they are called in Maine, how can we 

improve helping homeless veterans in finding job opportunities? 

Mr. BERTONI. I am sorry. What was the first part of your question? 

Mr. MICHAUD. As far as the reimbursement being burdensome 

and ways to streamline the process. 

Mr. BERTONI. All right. The reimbursement aspects and the payment scheme was not part of our review. But in general, I would 

say personally we would like to see some empirical evidence as to 

what the effect is, what impact it would be having on providers, 

whether they are opting out of the program. That would be helpful 

to determine, you know, factual base that there is a problem indeed. 

As far as going to sort of an up front payment versus reimbursement after the fact, I can understand where that would have a 

positive view amongst certainly the providers, why they would 

want that in terms of their planning and their ability basically to 

plan and figure out who they can serve going forward. 

It does take some level of control away from the VA in terms of 

from an internal control standpoint. So, again, GAO would have to 

do some type of analysis to assess the soft points, the sticking 

points, how substantive they really were before we could come 

down. And, you know, what changes would be needed, I could not 

answer at this point. 

As far as job opportunities, I think it is very important. We have 

OIF and OEF servicemembers coming back. Certainly in the Army, 

infantry members, many have very low levels of education, in need 

of job training. There are programs out there. I am not sure to the 

extent they are coordinated. 

We are doing some analysis right now in terms of eligibility for 

those programs, who is eligible, who is not being deemed eligible, 

the programs that are the comprehensive menu of services that are 

out there, as well as participation in outcome rates. 

And the bottom like, I think, from the Dole-Shalala Commission, 

we are trying to follow-up behind them and do some of our own 

analysis of that, there is no good data out there as to outcomes and 

long-term outcomes. So I think we need to do some work there. 

And certainly the changing nature of the injuries coming back 

now, the traumatic brain injuries, PTSD, really a lot of value in uperowe on PROD1PC71 with REPORTS

11 

front screening, finding out what exactly these people need medically and then to get them set up for vocational rehabilitation 

training. 

Mr. MICHAUD. Great. Thank you. 

Mr. Miller. 

Mr. MILLER. Mr. Bertoni, are you pretty satisfied with, or do you 

think the number of 200,000 is a relatively realistic number? 

Mr. BERTONI. That is a tough one. I think we looked at what VA 

did, their point-in-time analysis. And given the unstable nature of 

the homeless population, we had no reason to question the reliability of that information. 

Mr. MILLER. Is there another, more reliable method or recommendation that you could give VA to help them get that number? 

Mr. BERTONI. We did not get behind the methodology or question 

the number, but we did walk through what they did to come to 

that number. I think we are satisfied that they used a reliable approach in terms of point-in-time analysis and going down to the 

local level to try to get those counts. 

They did consult other groups that would have information like 

HUD. So I think while it is probably not a perfect figure, it is a 

reasonable figure. 

Mr. MILLER. The VA Office of Inspector General (IG) recommended that the operational oversight authority and responsibility for the GPD Program be centralized at a national GPD Program office. Do you think this is a positive recommendation or do 

you have a view on it? 

Mr. BERTONI. I do not have a specific view on that. I would just 

say in terms of oversight and accountability, whoever does it, there 

needs to be a sound program put in place with specific guidelines 

and criteria as to what guidelines have to be followed. 

I do not think that is the case right now or it was not the case 

a year ago. So in terms of whether it is centralized or it is decentralized, I think there still needs to be an accountability program 

and oversight aspect to this program that I do not think has always been there. 

Mr. MILLER. Ms. Beversdorf, you talked about reasonable measures of outcome and I had written down prior to that how do we 

grade success. Can you describe what you would call a reasonable 

measure of outcome? 

Ms. BEVERSDORF. Our members report there is an evaluation 

system already. And I would defer to Ms. Spearman for more details on that. 

But there certainly needs to be an evaluation of the outcomes. If 

a community-based organization submits a grant proposal with certain expected outcomes with respect to how many veterans they are 

hoping to treat, how many they are going to employ, how many 

they are going to provide services to, then those outcomes should 

be evaluated. 

Obviously if our community-based organizations receive grant 

funding from the VA, they need to be responsible with respect to 

following through and performing the services they have indicated 

they would do. It is necessary to measure to see if they have accomplished the purposes they said they would do. 

erowe on PROD1PC71 with REPORTS

12 

I will give you a comparison. The National Coalition for Homeless Veterans was recently awarded a grant from the VA to provide 

technical assistance to community-based organizations. We are required to provide quarterly reports indicating what services that 

we have provided to our members in the way of communications, 

training programs, educational programs, and publications. 

Receipt of per diem payment is not a blank check. It requires responsiveness. Community-based organizations must show the funding they receive is spent in a way that will ultimately benefit the 

client. 

Mr. MILLER. This is for both of you, Ms. Spearman and Ms. 

Beversdorf, would not the ultimate success be that the veteran is 

no longer homeless? That he or she is placed, and is off the addiction, the alcohol or whatever drug addiction that they may be suffering from? I know you have to check boxes, but would that not 

be the ultimate measure? 

Ms. SPEARMAN. Definitely, yes. I mean, integration back in, 

working, those are things that I—I think we have all grown in this 

Grant and Per Diem Program since we have been a part of it for 

10 years and the staff have as well. I think it may be time that 

we really could be more articulate about the goals that we are really looking to attain here because, as I said, it is very unrealistic 

when you think about what the steps are to take a person from, 

you know, the Ocala national Forest all the way to, you know, having a job, being retrained, being back into the community, and feeling good about that and, you know, no longer——

Mr. MILLER. Is that one of the things that you track? 

Ms. SPEARMAN. We do all those things, but we do not do it with 

Grant and Per Diem money alone. And so our goal, in fact, in the 

testimony that I have written, we have shown that we have been 

a part of a pilot project, two pilot projects in Florida doing outcomes only. We only get paid if we deliver and it is a marvelous 

way to do business. It takes some time. It really takes sitting at 

the table, deciding what it is you want and how you are going to 

do those measures. 

But we get paid one-twelfth of our grant as long as 80 percent 

of all of our—if every single individual, 80 percent of the individuals move forward toward independence. So it is a marvelous way 

to do business, but it is difficult. But it is definitely an option. 

Mr. MILLER. Thank you for putting Pensacola in the mix. We are 

glad to hear that there are some things planned. 

Again, between the two of you, is there more of a need for homeless veterans services in rural areas or urban areas because most 

of the focus appears to be on urban areas? I was interested that 

you picked Trenton of all places. 

Ms. SPEARMAN. Yeah. 

Mr. MILLER. Trenton is an extremely rural community. I was a 

Deputy Sheriff there when they only had one light in the county. 

Ms. SPEARMAN. It still only has one light. 

Mr. MILLER. Right there in downtown Trenton, the whole county 

had one red light. I know it is great everywhere, but where is the 

need the greatest? 

Ms. SPEARMAN. Well, I will answer that first. Okay. I think there 

is a lot of need in the urban areas and they do congregate, a lot 

erowe on PROD1PC71 with REPORTS

13 

do. But one of the reasons that we did the mobile service center, 

and that came from working with the VA staff in Veterans Integrated Services Network 8, is that everybody got together and sat 

at the table and talked about how were we going to outreach to the 

barrier islands around the Keys and into the national forest and 

how were we really going to go back in there. And that is how the 

mobile service center came about and then, you know, we developed the housing after that. But I do not know. 

Ms. BEVERSDORF. I would echo. Sometimes, frankly, that is the 

frustration. The National Coalition for Homeless Veterans represents community-based organizations in 48 States. However, if 

you take a look at our annual report or a map of the United States, 

which indicates where these community-based organizations are, of 

course, there are fewer in Wyoming and North Dakota and some 

southern States as opposed to Florida or New York or California 

or Texas or Ohio. 

And it is a dilemma. One of the things I am most proud of with 

respect to the direct services NCHV provides is we have a 1–800 

toll free number. And we get as many as 300 calls a month, many 

of them from veterans who are either homeless already or at risk. 

Someone will call and say, ‘‘Hi, I am so and so and I am homeless.’’ He will also say, ‘‘Where can I go?’’ I immediately log onto 

our Web site and ask, ‘‘Where are you calling from?’’ ‘‘Well, Shreveport, Louisiana.’’ Because we have a list of all the community-based organizations, 

I really want to try and connect these individuals with communitybased organizations that are located there. I may be lucky. I may 

be not. 

So then I may have to become more creative. Well, let’s see. How 

about faith-based organizations? I go through that list. How about 

perhaps veteran service organizations that might be able to help 

you? Have you contacted the Red Cross? How about other religious 

organizations? You are absolutely right, Mr. Miller. If there is not 

any community-based organization there, a place where they can 

go, they remain homeless and that’s a problem. They are coming 

to these community-based organizations if they know where they 

are located. This is one of the reasons why NCHV has been trying 

to reach out to non-VA supported community-based organizations 

as well because there are places where VA funding has not been 

provided or, in some cases, these organizations do not know about 

Grant and Per Diem. Major issue. 

Ms. SPEARMAN. And let me just say one more thing in terms of 

I think they are harder to reach in the rural areas. But I think the 

Vietnam era, that is where they have gone to to live. Those who 

have not, you know, stayed in the city. There is a good number. 

So we have found many, many back in the forests. And you do 

not go back in there uninvited. And so you build rapport and it 

takes a very long time. But there are thousands back in the forests 

in Florida that we have identified and actually had an opportunity 

to interact with. 

So they are harder to serve. They are harder to find. They are 

harder to bring into the system. They have been off the streets, in 

the woods. And so it is a mix, but I think the numbers are in the 

urban areas. 

erowe on PROD1PC71 with REPORTS

14 

Mr. MILLER. Thank you. 

Mr. MICHAUD. Thank you. 

Mr. Salazar. 

Mr. SALAZAR. Thank you, Mr. Chairman. 

And, first of all, let me thank all 3 of you for the services that 

you provide for veterans. 

Ms. Spearman, you talked a little bit about taking veterans in 

at risk, not really knowing whether you are going to get reimbursed or not. And, of course, veterans would be eligible for not 

only veterans’ programs but probably eligible for Medicare, Medicaid, and other programs. 

Do you think that maybe centralizing the system like, I think 

that is what you were getting to, Mr. Miller, maybe doing a pilot 

program to figure out if we would have a clearinghouse to see what 

programs each veteran was eligible for? Do you think that would 

help or is there already such a program? 

Ms. SPEARMAN. I do not think there is anything specific like you 

mentioned. And I do not know that would be the answer. I just do 

not have an opinion on the centralization. I am sorry. 

Mr. SALAZAR. Well, when I get questions in my office from many 

veterans, well, you know, I think I am eligible for this, I do not 

know whether I am, can you help me. 

Ms. SPEARMAN. We have staff that do that. We have staff that 

have been trained by the VA, the VA benefits administrators. And 

I think that is one thing about the VA working more closely with 

the community is that a lot of community providers have no idea 

what a veteran is entitled to through the VA. And then those who 

have veterans in their programs who are not a part of the the Veterans Benefits Administration system, just have chosen not to, it 

just works both ways. 

There is a lot of lack of communication about what a veteran is 

entitled to. And we spend a lot of time as Volunteers of America 

of Florida in the State, you know, trying to go to meetings and saying, you know, there are a lot of things that you are providing that 

veterans are eligible for. So I think a close working relationship on 

that, whether a screening or a centralized system. 

I think the key is that we need to be able to respond a lot faster 

than we are responding. And I think that the community providers 

feel that most strongly and I think the VA typically just, you know, 

they do not see it as very positive, so it does not happen that way. 

So we are just much more proactive on an individual person by 

person because we are sitting there eye to eye and we are the provider. 

We are the 24/7, you know, care service for that person or we are 

there in the community and available 24/7 and we have access to 

other linkages, so we spend more time believing in that system and 

how that——

Mr. SALAZAR. So the burden basically becomes yours to figure out 

what programs this individual is——

Ms. SPEARMAN. Yes. 

Mr. SALAZAR [continuing]. Eligible for? 

Ms. SPEARMAN. Yes. 

erowe on PROD1PC71 with REPORTS

15 

Mr. SALAZAR. Mr. Bertoni, could you respond to that? Do you 

think that would help maybe expedite the process and be able to 

reach more veterans than what we are reaching right now? 

Mr. BERTONI. If you had a single entity that essentially counseled folks on the menu and range of services that were available 

to them, the alternatives——

Mr. SALAZAR. Right. 

Mr. BERTONI [continuing]. Is that the question? I suppose it 

would work. I do not know if it is necessary. Again, we have not 

done enough thinking about it to give you a definitive answer. 

I do know at all 57 VA regional offices, there are veteran service 

organizations, VSOs, that are supposed to be doing just that, to sit 

down with veterans who are walking in. And I am sure they have 

a great handle on the range of services. 

And I would hope that the veterans that are involved in the GPD 

Program are interfacing. And I think they would because there is 

a healthcare aspect there in terms of veterans’ healthcare. 

So if right now without a total restructuring, I think a good 

source would be for referral or a more aggressive role for the VSOs. 

Mr. SALAZAR. But do not VSOs just work specifically with VA 

programs? But there are other Government programs such as 

Medicare, Medicaid, that, you know, your veterans are 

transitioning to and become eligible for that maybe some kind of 

a pilot program, Mr. Chairman, could be set up to where we could 

expedite this process. And I think it would make it much simpler 

and the risk would not fall upon the service providers. 

Mr. BERTONI. One observation. I do believe the Social Security 

Administration and VA are beginning a similar effort to try to coordinate in terms of Social Security benefits versus VA benefits. I 

think it is very early on now. I do not know how far along it is. 

We are actually thinking about looking at that. 

Mr. SALAZAR. That is all I have, Mr. Chairman. Thank you. 

Thank you. 

Mr. MICHAUD. Thank you very much. 

Dr. Snyder. 

Mr. SNYDER. Thank you, Mr. Chairman. 

This challenge reminds me of the challenge that we were facing 

several years ago with regard to TRICARE payments to medical 

providers and probably some of my provider friends are probably 

telling me that they are still facing, but I think it is substantially 

improved, which was one of my doctor friends back home that managed a very large practice said that the problem with TRICARE 

payments is that they were low, they were slow, it is complicated. 

And you could handle one of those as a provider. You cannot 

handle all 3 of them together, where if the payment is low, it is 

slow getting to you and the paperwork burden is complicated to finally get the low payment to you in a slow manner. Help me, if 

you would, because this is an area that I do not know a lot about. 

It seems to me that there are like 5 options out there. One is to 

do nothing and just going with the current reimbursement rate 

which I do not think anyone would be satisfied with that. 

The second one would be to increase the per diem rate, but basically keep the system like it is. 

erowe on PROD1PC71 with REPORTS

16 

The third one would be to go to a cost of service option probably 

with some kind of geographical variation that people would have 

to say here is what our actual costs were to get reimbursed. 

A fourth would be to have some kind of grant program that 

would pay for, I assume, some kind of annual grant to provider 

services that may or may not allow for some beds being empty. 

And the fifth one is some kind of program of permanent housing, 

supporting homeless veterans in permanent housing. 

Are those the basic 5 options we are looking at? 

Ms. SPEARMAN. I will respond to that. I think that is definitely 

in the mix. I think there are some others that could be considered. 

Mr. SNYDER. What are those? 

Ms. SPEARMAN. One would be doing a housing per diem base; 

what it really does cost to do housing management and place people in housing and house them. And then maybe some service overlays. I know geographical consideration is important, but also the 

level of service. 

There are providers that are excellent providers that can only do 

a minimal amount of services, whereas Volunteers of America of 

Florida may be able to do, you know, clinical treatment, substance 

abuse treatment, a lot of other things that VA is not able to, you 

know, keep up with. And we could do a lot more levels of service. 

So obviously with services come dollars. So there could be levels 

of service of per diem on top of that. And they are, you know, an 

outcome base where you would have like maybe a grant based on 

cost and then you would do it with performance. 

So there are some others. There are some others that are used 

by HUD that are used by other programs that some of us are familiar with. But you hit on some. I hope we will not pick the one to 

do nothing. I hope that we will move forward. 

Mr. SNYDER. I appreciate what you are saying about the different 

levels of services that different organizations choose to provide or 

can provide or have the capability to provide and some of that is 

going to be geographic because some areas have more services 

available than others. 

But when it is based on cost, what is the incentive for the organization to keep costs down? Tell me how that works as you see it. 

Ms. SPEARMAN. Well, you know, you are going to have to operate 

within your cost if you do the budget and you are monitored on the 

budget to keep your costs within. I do think there should be, you 

know, a cap on, you know, what it is, whatever you presented in 

your budget. 

I think a per diem for a larger organization, the incentive is that 

you have the flexibility to spread some of your costs and get some 

money to the bottom line. In terms of a business, it is an on-going 

concern to make sure that you are putting more money back into 

the program. 

So I mean, I just think you are going to be bringing in other dollars regardless from other—I mean, I do not think that the grant 

per diem is going to pay for all that needs to be done for homeless 

veterans to get them where they need to go. So I mean, I do not 

know. Maybe I did not answer the question. 

Mr. SNYDER. Thank you, Mr. Chairman. 

Mr. MICHAUD. Thank you. 

erowe on PROD1PC71 with REPORTS

17 

Once again, I would like to thank the 3 panelists for your testimony this morning and look forward to working with you as we 

move forward on this issue. So thank you very much. 

Ms. SPEARMAN. Thank you. 

Mr. MICHAUD. I would like to have the second panel come forward. George Basher who is Chair of the United States Department of Veterans Affairs Advisory Committee for Homeless Veterans. He is also Director of the New York State Division of Veterans Affairs. 

Peter Dougherty who is the Director of Homeless Veterans Program at the Department of Veterans Affairs who is accompanied by 

Paul Smits who is Associate Chief Consultant for Homeless and 

Residential Rehabilitation at the Department of Veterans Affairs. 

I would like to welcome this next panel and we will start off with 

Mr. Basher. 

STATEMENTS OF GEORGE BASHER, CHAIR, ADVISORY COMMITTEE ON HOMELESS VETERANS, U.S. DEPARTMENT OF 

VETERANS AFFAIRS, AND DIRECTOR, NEW YORK STATE DIVISION OF VETERANS’ AFFAIRS; AND PETE DOUGHERTY, DIRECTOR, HOMELESS VETERANS PROGRAMS, VETERANS 

HEALTH ADMINISTRATION, U.S. DEPARTMENT OF VETERANS 

AFFAIRS; ACCOMPANIED BY PAUL SMITS, DIRECTOR, HOMELESS AND RESIDENTIAL REHABILITATION, VETERANS 

HEALTH ADMINISTRATION, U.S. DEPARTMENT OF VETERANS 

AFFAIRS 

STATEMENT OF GEORGE BASHER 

Mr. BASHER. Chairman Michaud and Members of the Subcommittee, I am pleased to be here today to discuss the VA Grant 

and Per Diem Program serving homeless veterans. I thank you for 

the invitation to testify before the Subcommittee and discuss this 

worthy program. 

I have had the honor of serving as the Director of the New York 

State Division of Veterans Affairs for the past 10 years and also 

currently serve as the Chair of the Department of Veterans Affairs 

Advisory Committee on Homeless Veterans. 

In both of these roles, I have had the opportunity to witness not 

only the benefits of this program to those veterans who need a 

hand getting back on their feet, but also the challenges it brings 

to the provider community. 

Recent estimates by the National Alliance to End Homelessness 

place the number of homeless individuals in the United States at 

750,000. VA estimates the number of homeless veterans to be approximately 180 to 200,000, making homeless veterans one-quarter 

of the entire homeless population. 

Established by Congress in 1992, the Grant and Per Diem Program has provided nearly 10,000 transitional beds for homeless 

veterans through the efforts of over 300 community-based providers. These community and faith-based organizations provide 

shelter, food, and supportive services to homeless veterans for up 

to 2 years for a per diem currently set at a maximum of $31.30 a 

day. 

erowe on PROD1PC71 with REPORTS

18 

Originally designed to meet the needs of Vietnam era veterans, 

I believe it is time to revisit the Grant and Per Diem Program in 

light of the need to also serve the veterans of the current conflict 

as well as those older veterans. 

VA estimates they have already seen over 1,500 OEF/OIF veterans in various settings with several hundred referred to GPD 

providers for assistance. 

The VA Advisory Committee on Homeless Veterans in its recent 

report discussed concerns about Grant and Per Diem. Specifically, 

first, the VA Grant and Per Diem Program uses a process to reimburse providers designed like the system VA uses to reimburse 

State Governments for the State Home Program. The Advisory 

Committee is concerned that this capped process discourages providers in high-cost areas from even applying. The current $31.30 rate is based in law on the rate paid to State Home programs. There is no basis, in fact, for the $31.30 rate in 

the State Home Program and no defined rationale for determining 

that figure. 

Additionally, the current process does not allow the use of other 

Federal funds without offset by VA. While the State Home Program rules were recently changed to allow this, the restriction of 

offsets still applies to Grant and Per Diem programs. 

Second, the accounting process required for reimbursement is a 

burden on small community-based providers. Asking this group to 

meet the same level of expertise as State Governments with larger 

accounting staff is unreasonable and discourages participation. 

Additionally, recent audits of some providers have led to allegations of significant overpayments sometimes years after the fact 

based on differing interpretations of allowable expenses. 

Parenthetically this devolves from that idea that the contract 

oversight and inspections are done by VA medical center staff, the 

liaisons, and I think we have over 120 different people inspecting 

300 different programs. The notion that this is all being done uniformly, fairly, and accurately is probably silly when you stop and 

think about it. 

Third, community-based Grant and Per Diem providers frequently use other Federal programs to augment the services provided to veterans. Current Grant and Per Diem regulations do not 

allow these funds to be used as a match for VA programs often discouraging participation. 

Conversely, other Federal programs do allow VA funds to be used 

as a match creating a disincentive to participate in VA programs. 

The Advisory Committee recommended the per diem be revised 

to allow payments to be related to service costs rather than a 

capped rate allowing higher cost areas where homeless veterans 

are often numerous to participate. 

The Advisory Committee also recommended allowing other Federal funds to be used as a match to VA funds and also allow other 

Federal funds to be used without offset. 

Incorporated in these recommendations is implied the recommendation that the current burdensome accounting process 

would be scrapped and replaced by a simpler mechanism to provide 

reimbursement and protect the taxpayers’ interest. Paying a feefor-services provided meets the needs of both the veteran client and 

erowe on PROD1PC71 with REPORTS

19 

the providers without placing an undue burden on either the providers or the Government. 

Beyond adjustments to the existing Grant and Per Diem Program, other related concerns need to be addressed. Historically 

most homeless and housing services have been provided by the 

U.S. Department of Housing and Urban Development and the U.S. 

Department of Health and Human Services. 

VA housing initiatives have focused almost exclusively on transitional housing reasoning that traditional VA programs coupled 

with Grant and Per Diem support services were all that was needed to return homeless veterans to a permanent housing environment. 

With 20 years’ experience in homeless veterans programs, we 

now know this is a simplistic view. Veterans with a comorbidity of 

substance abuse and behavioral health disorders are frequently incapable of making the jump from transitional housing and programs to self-sufficiency. Experience has again taught that supportive permanent housing is often the most effective and economical way to have these individuals reenter the mainstream. 

The existing HUD–Veterans Affairs Supportive Housing (HUD– VASH) Program providing Section 8 vouchers is woefully inadequate due to a lack of specific appropriations for the program by 

HUD. The Advisory Committee has recommended to VA that 

HUD–VASH be expanded and further that VA look for opportunities to partner with HUD and other agencies to find innovative 

ways to bring permanent housing and supportive services to veterans. 

Consideration should be given to site-based Section 8 vouchers as 

a way to provide those services on an ongoing basis by communitybased providers. 

Success of programs such as New York City’s New York, New 

York 3 initiative have demonstrated an integrated approach like 

this can provide positive results at an affordable cost. 

The still ongoing Capital Asset Realignment for Enhanced Services, CARES, process VA is using to identify capital requirements 

for the next 20 years has identified a significant amount of surplus 

VA land and facilities. One of the Advisory Committee recommendations was to have VA make reuse of this land for veteran 

housing a priority. 

VA officials contend the existing Enhanced Use Lease Program 

is adequate to meet that need, but experience shows the Enhanced 

Use Lease to be a time-consuming, cumbersome process fraught 

with opportunity for delay and lost opportunities. 

The Department of Defense Base Realignment and Closure procedure, BRAC, is much more efficient in terms of making reuse opportunities a reality in a reasonable period of time. 

There is a growing concern regarding women veterans. With 

women now making up nearly 20 percent of today’s military, VA’s 

programs are being accessed by an increasing number of women 

veterans including programs for homeless veterans. 

There are unique challenges in this shift. Most VA programs 

were designed when the military was nearly exclusively male, necessitating changes by Veterans Healthcare Administration to facilities and procedures that are ongoing even today. 

erowe on PROD1PC71 with REPORTS

20 

Transitional housing programs for women veterans are rare 

given the relatively low numbers involved and the economies of 

scale needed to provide services. Issues of safety and appropriateness of facilities likewise challenge traditional homeless service 

providers. 

Another consideration is the authority of VA to only care for the 

veteran. Children who have no other parent to care for them also 

often accompany the increasing number of women veterans. Accessing VA services by these veterans means leaving children with 

other relatives or nonfamily caregivers, a difficult choice that often 

leads to walking away from VA care and looking for help elsewhere. 

VA should explore ways to cope with the changing demographics 

of the military and adjust accordingly either in partnership with 

other agencies or through programmatic changes of its own. 

The VA Grant and Per Diem Program has provided a valuable 

service to homeless veterans over the past 15 years. Adjusting the 

program in light of experience is appropriate. Creating new policy 

to meet the needs of returning veterans from the current conflict 

is a necessity. 

Mr. Chairman, this concludes my formal remarks. I appreciate 

the opportunity to present my views and am prepared to answer 

any questions you or Members of the Subcommittee may have. 

Thank you. 

Mr. MICHAUD. Thank you very much. 

[The prepared statement of Mr. Basher appears on p. 44.] 

Mr. MICHAUD. Mr. Dougherty. 

STATEMENT OF PETE DOUGHERTY 

Mr. DOUGHERTY. Thank you, Mr. Chairman, Members of the 

Subcommittee. 

VA has the largest and most comprehensive collaboration for 

homeless veterans in the country. We have more than 300 community and faith-based organizations, State and local and tribal Governments who work with us in this program. 

I am very pleased to be joined today with Mr. Paul Smits who 

is the Director of Homeless and Residential Rehabilitation Program 

for the Veterans Health Administration. 

The effort to engage community and faith-based providers began 

with this Committee with the passage of H.R. 5400, the ‘‘Homeless 

Veterans Comprehensive Service Act,’’ later signed by President 

George Herbert Walker Bush on November 10th, 1992. 

VA has offered funding under this proposal or under this law 

since 1994 and has awarded new funding each year since then. We 

now have awarded funding to more than 400 programs and have 

authorized more than 11,000 transitional housing beds. 

There are more than 8,000 transitional beds in service today and 

the remaining ones are coming on once the rehabilitation or the acquisition of property and repairs and renovations have been completed. And we will soon announce that we will add about another 

900 to 1,000 new beds to those that have been previously approved. 

We continue to offer new funding because we have great faith in 

the ability of the many community providers to provide high-quality services to veterans. Our goal based upon this Congress’ manerowe on PROD1PC71 with REPORTS

21 

date is to end chronic homelessness among veterans. We have 

made good strides in achieving that goal. We simply would not be 

able to do so without our community-based partners. 

There was some discussion earlier on and I want to remind the 

Committee that VA unlike any other agency that is out there, both 

private and public, monitor and evaluate every veteran who comes 

to a homeless specific program. 

Since 1987 when VA began homeless specific programs, we have 

identified and provided services to about 400,000 veterans who we 

have identified as being homeless. We have a system of accountability because ultimately it does not matter as much to us about 

the money as to the outcome for the veteran. Just as we do in 

every other healthcare program, if the veteran needs the services 

to get better, we are going to use the money to get the veteran to 

a position where they get well. 

In this case, we do have a capitation on our funding, but we work 

in a very close partnership. What the Committee Members were 

asking about before, is we not only have great community providers 

that we work with, but we have a lot of VA dedicated staff who 

work in community programs. 

Some of them are there on a daily basis working hand in glove. 

Some of the questions about the accessibility and availability of 

benefits and other services are responded to because we have people on both sides (VA and community) who can answer those questions. 

We have performance measures that we have implemented in the 

last few years that we think help. If you are identified as a homeless veteran, we want to make sure you get a primary healthcare 

visit within 30 days and you get follow-up specialty care within 60 

days. 

When we first started it, there was a lot of groaning on our side 

about putting that requirement on us. We are meeting that performance measure. 

We also have many of the providers that we are working with. 

Ms. Spearman and others have very significant, substantial programs. She has a lot of other resources because her organization 

has been very effective at doing that. 

Some of the smaller programs do not have that. One of the good 

things that the Department did this past year is added 30 substance abuse counselors who work on-site in community-based programs. 

We are getting an increasing number of community programs 

where dental care services to these veterans are being provided 

and we now have reentry specialists working with veterans returning from prison. 

We are in the process of completing hiring at least one person 

in each network to work with the criminal justice system to make 

sure that veterans who are coming out of the criminal justice system do not show up in the ranks of the homeless, that they get 

their benefits and get on with their lives and do not become homeless in the meantime. 

We think all of these things are having some increasingly positive results of what is happening. We closely monitor and we aggressively reach out to all veterans who are homeless, but we 

erowe on PROD1PC71 with REPORTS

22 

would like to make note of those who are coming back from Iraq 

and Afghanistan. It gets a lot of attention. We wanted to give you 

an update today. 

During the past 3 years, we have been specifically monitoring 

veterans who have returned from Iraq and Afghanistan who have 

shown up at the ranks of the homeless. More than 1,500 of those 

veterans that we have seen in outreach have served in those theaters of war and more than 400 of those have been in a homeless 

specific program. 

What that tells you in part is that some of the veterans that we 

are seeing in the outreach are not what you and I might consider 

to be literally homeless today. They may, in fact, have a full-time 

job, but they may still be going to a soup kitchen to get something 

to eat. They may have relationship problems with family and others that are putting them at risk. 

It is also important to know, because sometimes people wonder, ‘‘Is this Government sort of turning a blind eye or is this Department turning a blind eye to that problem?’’ The point is it is not 

just our staff and our people out there seeking them out. It is the 

community-based organizations who were at this table a few moments ago and State and county veteran service officers. All those 

people are making contact with us and doing outreach. 

I can tell you on a positive side, although people say is it not 

tragic, what we are finding is those veterans who are coming back 

from Iraq and Afghanistan who are coming in and getting treatment are doing, well. In fact, slightly better than other homeless 

veterans both in getting back into permanent housing and into employment. 

As the Committee knows, we are limited as to how much we can 

provide in reimbursement for support and that is that $31.30 a day 

for housing under the Grant and Per Diem Program. 

As you have heard today, and we understand there is a lot of 

concern among providers about that amount of payment, I think it 

may be a little bit illustrative and informative for the Committee 

to have you understand the process that goes on. 

When a veteran comes into a community-based program, we are 

supposed to have 3 days in which to determine their eligibility to 

be in that program. They provide services to that veteran. They 

provide to us a list with name, date, and Social Security number 

by bed day of care for the veteran who is in the program. We verify 

the information and then we reimburse after the fact. 

One of the things that does make us different than most Federal 

grant agencies is when you get a grant from them to do this type 

of service, you get to draw on a monthly basis. In our case, you 

have to wait until we get verification, until we can assess, make 

sure the information is correct, and we pay you after the fact. 

That creates problems because many of these folks do not have 

a lot of income, if you will, to float. Most other Federal programs 

do it differently. They let you draw in advance during the month 

you are actually doing the services. 

One of the questions that we get and one of the things you heard 

is sort of what is called the flat rate concept. The flat rate concept, 

we are sometimes asked why we do not have it? The reason is per 

diem payments are considered to be a grant under the law. And, 

erowe on PROD1PC71 with REPORTS

23 

therefore, we must comply with the Office of Management and 

Budget (OMB) circulars. 

VA guidance requires us to determine the allowable and unallowable cost based on the OMB circulars. It is our understanding that 

a flat rate of a straight payment. It would only be feasible if we 

had specific statutory authority and a waiver of the circulars from 

OMB. 

Mr. Basher mentioned a moment ago, and I would like to remind 

the Committee under the HUD–VASH Program, which we consider 

to be a very successful initiative where we provide case management services and HUD provides money for permanent housing, 

that you have already passed on the House side in the appropriations bill that would include 1,000 additional HUD–VASH vouchers. The Senate has actually put in its bill $75 million which we 

believe would create more than 6,000 new HUD–VASH vouchers. 

For the first time in many, many years, it looks like there will 

be authority for new permanent housing which is the top unmet 

need according to our Advisory Committee on Homeless Veterans, 

as well has our community partners for more than a decade. 

VA along with our partners have done a good job. I think the 

quality of care veterans get in most of these programs are very 

good. We do understand the frustration of the payment system. We 

are trying to do the best we can with the process that we have. 

Mr. Chairman, this would conclude my formal statement and certainly we would be happy to answer any questions you and the 

Subcommittee have. 

[The prepared statement of Mr. Dougherty appears on p. 46.] 

Mr. MICHAUD. I would like to thank both of you gentlemen once 

again for your testimony this morning. 

Is there a change that we could make that would maintain or improve the oversight of funds while reducing the paperwork burden 

to providers and provide flexibility? 

I mean, everyone has said this morning that it is slow, that it 

is cumbersome. There must be a way that it could be streamlined 

and still have the accountability that we need to make it a worthwhile program. 

Mr. DOUGHERTY. Mr. Chairman, I think that, yes, there probably 

is. We are already tied, if you will, to the State Home reimbursement rate. If we use that as a straight payment system and we 

then said to the recipient of the grant, the recipient of the payment 

what is it you would do specifically with that amount of money, 

then we would simply go back in and we would audit for that purpose of those expenditures. 

Right now we have to look at everything the organization does. 

The bigger and the more complex the organization is, the harder 

it is. 

I think the other thing, as was mentioned by the Committee 

Members as well in questioning, is that also incentivizes me to do 

more. At $31.30 a day, given the kinds of services that we require, 

it is a very modest amount of money. But I think if we could define 

for the providers that this is the amount that is being provided for 

you to do certain things for us. If you may need more employment 

and you could go to the Department of Labor or your State job 

services and they give you funding to provide an employment speerowe on PROD1PC71 with REPORTS

24 

cialist in your program, it is good for the veteran and, if we were 

not paying for it anyhow, so what? 

We need better housing outcomes, it is the most critical problem 

we face in the homeless program. If you come through a good program and you may be too disabled to go back into independent living and go out and get a job. If you could get into good, stable housing, we would get you out of the grant program. We would not keep 

you there without an expectation of getting a better outcome. 

So if you could go to your local continuum of care and get a housing specialist to work part time with you and your program, if VA 

were not funding it under our grant, the veteran would get a better 

housing outcome, good for the veteran, good for the program. 

So I think there is a way to do that, but it would require some 

change in law. 

Mr. MICHAUD. Great. 

Following up on that, when you look at the services that the providers provide depending on which provider it is, they provide a variety of different types of service, is there a minimum standard 

that all Grant and Per Diem providers must follow and, if so, what 

is that? 

Mr. DOUGHERTY. Yes, there are. In the application that they file, 

there are minimum things that we expect you to do be able to provide. 

Now, as Ms. Spearman mentioned this a few moments ago. The 

level of services that may be offered is one of the things when Congress created this program. The program addressed the urban and 

rural conditions. In Los Angeles, California, we have 20-some programs in Los Angeles County. They have some specialty services, 

if you will, that they provide. 

In the more rural areas, you may be a more comprehensive sort 

of service because you may not have just expertise in substance 

abuse treatment or you may not have more expertise in mental 

health services. And so you may be more comprehensive. 

We do expect you to both provide a safe, decent environment in 

which the veteran is to live. You are to provide case management. 

You are to work on objectives of improving your daily living. You 

are supposed to reduce your healthcare dependency. In other 

words, you are to get us connected with that veteran for healthcare 

or to get that veteran to other healthcare services. 

You are to work on improvements in your living skills. You are 

to do other things related to improving their health condition and 

reduce substance abuse and other kinds of destructive behaviors. 

We do have minimum requirements that apply to everybody, but 

many programs have specialties that they provide. And the grant 

process is designed to meet the local need as it is in your community to address the needs of homeless veterans. 

Mr. MICHAUD. Mr. Miller. 

Mr. MILLER. Mr. Basher, are the risk factors for veterans from 

the all-volunteer Army any different from those that were part of 

the draft era? 

Mr. BASHER. In my opinion, yes, they are. The thing that I have 

observed over that period of time is that if you look at the Vietnam 

era veterans, they were largely a component of draftees overseen 

erowe on PROD1PC71 with REPORTS

25 

by a cadre of regular military. Today you have all volunteers. And 

the big difference is age. 

When I came home from Vietnam, I was a unit commander in 

Vietnam and I was 21 years old. When I came home, I was the old 

guy. You know, most of the people in my unit were 17, 18, and 19 

years old. 

Today I think you will find if you look at the 10th Mountain Division in New York, the average age of the second combat brigade 

up there is probably about 25 to 26 years old. They tend more to 

be married. They tend to have more dependents. 

And I think that as we drill down and are starting to learn, the 

very nature of this conflict, particularly in Iraq, is very, very different than any other war we have ever fought. And it is creating 

some new challenges and I think also some new opportunities for 

us. So, yes, they are very different. 

The incidence of Post Traumatic Stress Disorder, incidence of 

Traumatic Brain Injury clearly are already indicated to be higher 

than they have in past conflicts. Those require some different 

things. You know, when you stop and think about it, treating a veteran with a condition like PTSD or treating Traumatic Brain Injury and, again, VA by statute is required to treat the veteran and 

not the family, but everybody that is involved suffers with that 

kind of condition whether it is PTSD or TBI. 

The absurd extreme example would be, you know, the VA is only 

allowed to talk to the Alzheimer’s patient, not the family that is 

with them. So, you know, we need to look at what is to leverage 

all these services and maybe adapt and grow to meet those changing demographics. 

Mr. MILLER. What about other factors like alcohol or drug abuse? 

Mr. BASHER. We are seeing a fair amount of that in New York. 

I mean, the only real on-the-ground experience I have is the 10th 

Mountain and 10th Mountain, the second combat brigade is the 

most deployed unit in this country. 

If you signed on to that group in the year 2000, you have already 

completed your fourth combat tour since 9/11. If you are a promotion hound, you are on your fifth or sixth. So if you do the math 

with the time and rotations, you know what the level of time that 

these people have when they return home. 

So there is some stress on those soldiers and as they return, you 

know, it does not manifest itself immediately, but I think over 

time, you start seeing challenges and family challenges and readjustment. And the military is trying to cope with this too. But we 

definitely see an increase in both substance abuse and also alcoholism coming back from those deployed units. 

Mr. MILLER. Mr. Dougherty. 

Mr. DOUGHERTY. Yes. Mr. Miller, we can tell you that the level 

of homelessness relates very specifically to the military standard. 

As Mr. Basher indicated, when you look at the late Vietnam War 

period and the immediate post Vietnam War period, that is the biggest bulge, if you will, in the list. 

We do get concerned when the military standard changes. Dr. 

Bob Rosenheck who does all the program monitoring and evaluation of all of VA’s homeless programs will tell you that the incidence of homelessness actually went down, have gone down rather 

erowe on PROD1PC71 with REPORTS

26 

dramatically when we went to the all volunteer Army. When you 

look at the late eighties and early nineties, the incidence of homelessness among veterans seemed to have changed. So there is a relationship. 

Regarding the recently returning veterans, we can tell you that 

among those who have shown up in the ranks of the homeless 

there is a significant difference in that the level of substance abuse 

which is much less among this group than all homeless veterans 

and the level of combat and mental illness are related. 

We have a much higher ratio of mental illness among the recently returning veterans from Iraq and Afghanistan than we do in 

all homeless programs, about 45 percent in all homeless programs, 

closer to 70 percent in those who have come back from Iraq and 

Afghanistan. 

One of the differences among all veterans who we see in homeless programs, about 20 percent have been combat veterans or 

what you and I would consider to be combat veterans, and those 

coming back from Iraq and Afghanistan is closer to 70 percent. 

I had a conversation before with the gentleman from GAO. We 

were talking about this issue. And, you know, truck convoys are 

not necessarily combat-related duty, but certainly none of us who 

know anything about what is going on would assume that riding 

convoy patrols is a very safe mission in Iraq and Afghanistan. It 

may have been in many of our previous wars, but it is not in this 

one. 

Mr. MICHAUD. Dr. Snyder. 

Mr. SNYDER. Thank you, Mr. Chairman. 

I just have one question that I would like both Mr. Basher and 

Mr. Dougherty to respond to, if you would. 

In fact, Mr. Dougherty, you mentioned in your written statement 

about the problem of incarcerated veterans and when they are released. 

Would you both talk about this issue of incarcerated veterans 

and where we are at with that and, you know, you always have 

perspectives? So if you each take a couple of minutes. 

Mr. DOUGHERTY. I can talk about it in a broad sense. And Mr. 

Basher, because he is in a State that has done a very good job with 

it, can even talk about it in more specifics. 

This Congress a few years ago asked VA and the Department of 

Labor to work on a pilot initiative which we have been doing for 

the last few years. The initial results of that are rather positive. 

About 40 percent of the veterans that we see in homeless programs have been previously incarcerated which is not surprising 

because many people who end up in the incarcerated ranks are 

substance abusers and have mental illness problems. And many of 

them when they come out without a good discharge planning process show up in homeless programs. It is just sort of a normal happenstance. 

We have been working with the Department of Labor on pilots 

authorized by the Congress. We are actually in the process of finishing a report. We think that what we will be able to show you 

in our report is that there will be a significant reduction among 

veterans going back into incarceration when they have been engaged with community providers prior to discharge, benefits assesserowe on PROD1PC71 with REPORTS

27 

ments have been made, and discharge planning established to get 

the appropriate healthcare they need if eligible when they come 

out. 

I think without sort of prejudging what our final report will say, 

I can tell you clearly it will be at least half of what the normal reincarceration rate is by using this kind of intervention. 

The Volunteers of America in Kentucky, which is one of the pilot 

sites, they believe that it saved re-incarceration costs in the State 

of Kentucky by more than what it costs the entire initiative to cost 

the Federal Government for the 7 pilots across the country. It has 

a very positive relationship. 

I am the Department’s representative at the U.S. Interagency 

Council on the Homelessness, the senior policy group; and we know 

homelessness, one of the biggest risk factors of homelessness is 

having parents who are homeless and parents who are incarcerated. 

And so obviously even though it does not necessarily end the 

problem for us right away, we think that by addressing this issue 

better in the future, we may, in fact, help society down the line. 

Mr. SNYDER. Thank you. 

Mr. Basher. 

Mr. BASHER. Yeah. In New York, what we did about 7 years ago 

was we started definitely identifying veterans who were entering 

the State prison system and we currently have about 60,000 inmates. And out of that number with an average sentence length of 

a little over 31⁄2 years, we graduate about 1,000 veterans into society at the end of every year. 

And we discovered early on that nobody has got enough money 

to do everything, so the VA cannot take this on by themselves. The 

State of New York Prison System certain cannot. Our parole system cannot. But we have worked together and figured out, first of 

all, how to get around some of the programmatic things. 

New York has 2 VA networks, Network 2, Network 3, and their 

geography and their chain of command is very different than how 

our State Prison System works. Most of our offenders come from 

the major metropolitan areas, the largest being the New York City 

area. And if you have been incarcerated, you wind up serving your 

sentence primarily up in the Adirondacks, some place far, far, far 

away from home in a different VA network. 

As you get closer to your release date, you get moved closer to 

home. But what we have managed to do is seamlessly follow these 

people and when they get within 6 months of release, our parole 

people start working on their release plan. 

And we send a counselor, one of our State counselors in because 

we are not constrained by the same rules as VA and make sure 

that we know if somebody has got eligibility for comp to be turned 

back on when they get out. We make sure that happens seamlessly. 

We make sure that if they do not have family to go back to and 

a place to live that they get handed off to the VA, to the system, 

and work into the dom system or whatever appropriate program 

there is. 

We think we have managed to reduce the recidivism for that 

group of people to under 40 percent which we think is more than 

erowe on PROD1PC71 with REPORTS

28 

cost effective. It has taken us a long time to work out all the kinks, 

but now it is almost automatic. 

Mr. SNYDER. Thank you. 

Thank you, Mr. Chairman. 

Mr. MICHAUD. Just one last question to follow-up on Mr. Miller’s 

question about dealing with homelessness for veterans in rural 

areas and the programs that are available. Unfortunately in some 

instances, service providers may not be able to reach some of these 

rural veterans, which brings up the use of faith-based organizations. 

My question is, do you work very closely with the Red Cross in 

rural areas to see if they could help with some of these problems? 

Mr. DOUGHERTY. We work very closely with a whole host of agencies across the country and rural areas. Mr. Miller talked about 

being a Deputy Sheriff. I was a County Magistrate in West Virginia. And, those kinds of relationships are where it does not matter who you are and what you do. 

The problem comes forward in little towns and little communities 

in ways that big communities have the bureaucracy to deal with; 

in little communities, somebody just calls somebody who calls 

somebody. 

We work with a whole variety of partners. We have been out to 

the White House Faith-Based and Community Initiatives Program 

telling them about the availability of healthcare and services. We 

meet with the State Directors on a regular basis, the County Veteran Service Officers across the country. We have met with the Red 

Cross and Volunteers of America and national organizations like 

that, Salvation Army, to make those kind of relationships. 

In this day and age, even in most rural communities, there is a 

pretty good understanding, I think, that there is some help. It is 

really a question of access. And that is why one of the reasons that 

what we have done in the last few years is tried to make sure that, 

for example, on tribal lands, we have put some targeting in our 

funding to make sure that tribal lands, which are historically pretty remote and rural, have some opportunity to get funding or enhanced opportunities to get funding so that programs can be there. 

The other good thing about this program is it does not have a 

minimum and a maximum. In other words, some Federal programs 

say you have to have 50 units before you can get funded. We have 

programs as small as 6. Those are the kinds of programs that meet 

local needs. 

I use the terminology a lot that there is an intensity of need and 

the intensity of need is, different where there are a lot more homeless veterans in New York City than in an upstate New York. But 

if you have that problem in your upstate New York location, you 

also want to have an opportunity to get some reasonable way to address it for the veterans who are in your community. And so I 

think we have the opportunity to do that. 

Mr. BASHER. Just to use New York as an example, our Division 

of Veterans Affairs is in 60 different locations in New York State. 

And while we have 11 offices in New York City, we also have an 

office in Malone. So, you know, it is local knowledge on the grounds 

of who the providers are and generally they have a pretty good 

erowe on PROD1PC71 with REPORTS

29 

sense of who the customers are, too, when the homeless folks show 

up. 

And as Mr. Dougherty pointed out, big programs are in the 

urban area, but Glens Falls, New York, has a little 7-bed house 

that does not have any empty beds. So, you know, the need is up 

there. And it is almost an if you build it, they will come situation. 

Mr. DOUGHERTY. Also, Mr. Chairman, many communities come 

to us because they do stand downs. And the Interagency Council 

on the Homeless now does a thing called Project Connect. And the 

largest one in the country last year was Libby, Montana, which is 

not exactly the biggest metropolis on the face of the Earth. Over 

1,000 veterans and family members of veterans came to that event. 

And, you know, it did not just attract you purely because you are 

homeless, but a lot of veterans who needed services came to that 

event. 

And so there are increasing opportunities. We support those opportunities. We provide a lot of staff both from the Benefits Administration and the Health Administration to help make sure that 

healthcare and benefits are there and in some cares are provided 

on-site. 

Mr. MICHAUD. Once again, I would like to thank this panel and 

the first panel very much for your testimony today and look forward to working with you as we move forward on this very important issue. 

So, once again, thank you. This hearing is adjourned. 

[Whereupon, at 11:29 a.m., the Subcommittee was adjourned.] 

erowe on PROD1PC71 with REPORTS

(30) 

A P P E N D I X 

Prepared Statement of Hon. Michael H. Michaud, 

Chairman, Subcommittee on Health 

Today, we will examine the Department of Veterans Affairs Grant and Per Diem 

Program for homeless veterans. 

On any given night, there are approximately 200,000 homeless veterans on the 

streets in America. The majority of these veterans served in Vietnam, 96 percent 

are male and about 45 percent suffer from some mental illness. 

VA has many programs to help homeless veterans—including the Grant and Per 

Diem Program. VA needs to continually evaluate these programs to ensure that veterans are getting the services that they need and that provider organizations can 

effectively provide these services. 

For example, while the vast majority of homeless veterans are male, female veterans are the fastest growing segment of this population. 

Women homeless veterans face similar challenges to their male counterparts, but 

they are very likely to have experienced serious trauma including abuse or rape and 

a significant number also have children to support. VA programs must be flexible 

to meet this new challenge. 

I believe that VA should make sure that they give Community Based Organizations the tools they need to provide comprehensive services to our homeless veterans. 

The way in which the Grant and Per Diem program is currently structured sometimes makes this difficult—particularly for providers in high cost areas. 

It is my belief that the goal of VA homeless programs should be to not only provide veterans with a bed for the night and a meal—but to provide them with the 

resources that they need to attain permanent housing, a steady job and a renewed 

sense of self-worth. 

Today, I hope that we will learn what VA is doing to provide services to homeless 

veterans to help them break out of this cycle. We will hear about the Grant and 

Per Diem Program—both what is working and ways that it can be. 

One homeless veteran is one too many. This is a problem that we can solve by 

working together. 

f 

Prepared Statement of Hon. Jeff Miller, 

Ranking Republican Member 

Thank you Mr. Chairman. 

This year marks the 20th Anniversary of VA’s programs to provide specialized 

services for homeless veterans. VA’s first homeless program began in 1987, with the 

enactment of Public Law 100–6. This law provided VA with $5 million to support 

care for veterans in community-based and domiciliary facilities. 

Since that time, VA’s homeless programs have expanded and grown significantly. 

VA budgets almost $2 billion to treat and assist homeless veterans and administers 

over nine specialized homeless programs that integrate housing and mental health 

and substance abuse counseling. 

Although it remains difficult to obtain an accurate count of the number of homeless veterans, there are indications that we are making good progress in helping to 

reintegrate homeless veterans into stable community environments and lead productive and sober lives. 

Still, there are far too many veterans out on the streets. On any given night in 

my home State of Florida alone it is estimated that there are 17,000 homeless veterans. 

Critical to ending homelessness among veterans is being able to identify vulnerable service men and women early and make sure that these veterans are aware 

erowe on PROD1PC71 with REPORTS

31 

and have immediate access to the services and benefits available through VA and 

in coordination with other Federal agencies. 

With the increasing number of returning veterans from the conflicts in Iraq and 

Afghanistan, the development of innovative services to help especially at risk veterans is extremely important. 

Another area of great concern is addressing the needs of women veterans and increasing the availability of facilities that are able to provide appropriate accommodations for women and women veterans with children. 

Today, we will review VA’s Homeless Providers Grant and Per Diem Program 

(HGPD). 

The Grant and Per Diem program is considered to be a very successful collaboration between VA and non-profit and faith-based organizations. 

However, in a 2006 report that we requested from GAO, they found that improved 

communications and follow-up could further enhance the program. GAO reported 

that liaisons responsible for coordinating with local providers sometimes found it 

hard to assist due to large caseloads and other administrative tasks within their duties and a VA identified need for an additional 9,600 beds. 

Our Committee has always worked in a bipartisan manner to strengthen health 

care, housing, employment training, and other services to assist at risk veterans. 

I look forward to continuing to work with Chairman Michaud to provide aggressive oversight of VA’s implementation of homeless programs and establish greater 

Federal collaboration between VA, HUD, and HHS to coordinate efforts to assist 

homeless veterans. 

I would like to welcome all of our witnesses. Especially I would like to thank 

Kathryn Spearman with the Volunteers of America, Florida for participating in our 

hearing this morning. I am grateful for your dedication and many years of work to 

provide services to assist homeless veterans in my home State of Florida. 

Thank you Mr. Chairman, I yield back the balance of my time. 

f 

Prepared Statement of Cheryl Beversdorf, RN, MHS, MA, 

President and Chief Executive Officer, 

National Coalition for Homeless Veterans 

Introduction 

The National Coalition for Homeless Veterans (NCHV) appreciates the opportunity to submit testimony to the Health Subcommittee of the House Committee on 

Veterans’ Affairs regarding the VA Grant and Per diem Program. Established in 

1990, NCHV is a not for profit organization with the mission of ending homelessness among veterans by shaping public policy, promoting collaboration, and building 

the capacity of service providers. NCHV is the only national organization wholly 

dedicated to helping end homelessness among America’s veterans. 

NCHV was founded by a group of community-based homeless veteran service providers who sought to educate the public about the extraordinarily high percentage 

of veterans among the homeless population and to place the needs of homeless veterans on the national public policy agenda. The founders, all former members of the 

military, were concerned that neither the public nor policy makers understood either the unique reasons for homelessness among veterans or appreciated the reality 

that so many veterans were overlooked and underserved during their periods of personal crisis. 

In the years since its founding, NCHV’s membership has grown to nearly 280 organizations in 48 states and the District of Columbia. As a network, NCHV members provide the full continuum of care to homeless veterans and their families, including emergency shelter, food and clothing, primary health care, addiction and 

mental health services, employment supports, educational assistance, legal aid and 

transitional housing. 

Homelessness Among Veterans 

The VA reports homeless veterans are mostly males (3 percent are females) and 

the vast majority are single, although service providers are reporting an increased 

number of veterans with children seeking their assistance. About half of all homeless veterans have a mental illness and more than two thirds suffer from alcohol 

or other substance abuse problems. Nearly 40 percent have both psychiatric and 

substance abuse disorders. The VA reports the majority of women in homeless veteran programs have serious trauma histories, some life-threatening, and many of 

these women have been raped and reported physical harassment while in the military. 

erowe on PROD1PC71 with REPORTS

32 

According to the VA Northeast Program Evaluation Center (NEPEC), male veterans are 1.3 times more likely to become homeless than their non-veteran counterparts, and female veterans are 3.6 times more likely to become homeless than their 

non-veteran counterparts. Like their non-veteran counterparts, veterans are at high 

risk of homelessness due to extremely low or no livable income, extreme shortage 

of affordable housing, and limited access to health care. But these factors combined 

with their military service put them at even greater risk of homelessness. 

Prior to becoming homeless, a large number of veterans at risk of homelessness 

have struggled with Post Traumatic Stress Disorder, also known as PTSD, or have 

addictions acquired during or after their military service. NEPEC reports nearly 74 

percent of homeless veterans are likely to have medical problems upon admission 

to either VA or community-based assistance programs. About 70 percent will have 

alcohol-related problems; 63 percent will have drug abuse histories; and 69 percent 

will have a mental illness diagnosis. These conditions can interrupt their ability to 

keep a job, establish savings, and in some cases, live with their families. Veterans’ family, social, and professional networks may have been damaged and their lives 

disrupted due to extensive mobility while in service or lengthy periods away from 

their hometowns and their civilian jobs. These problems are directly traceable to 

their experience in military service or to the difficulty of transitioning back into civilian society. 

While most Americans believe our Nation’s veterans are well-supported, in fact 

many go without the services they require and are eligible to receive. According to 

a Congressional staff analysis of 2000 U.S. Census data, 11⁄2 million veterans have 

incomes that fall below the Federal poverty level, including 634,000 with incomes 

below 50 percent of poverty. Neither the VA nor State and county veteran service 

departments are adequately funded to respond to these veterans’ health, housing, 

and supportive services needs. Moreover, community-based and faith-based service 

providers also lack sufficient resources to keep up with the number of veterans 

needing help. 

The VA reports its homeless veteran programs serve about 100,000 veterans annually. NCHV member community-based organizations (CBOs) serve 150,000 each 

year. With an estimated 400,000 veterans experiencing homelessness at some time 

during the year, and the VA reaching only 25 percent and CBOs reaching 35 percent of those in need, that still leaves almost 40 percent of the nation’s homeless 

veterans who do not receive the help they need. It is likely some of these veterans 

are receiving assistance from other community resources, but there is no way to determine the extent or nature of services being provided. 

In testimony presented to Congress in 2006, a U.S. Department of Veterans Affairs (VA) representative reported the number of homeless veterans on the streets 

of America on any given night decreased by nearly 25 percent during the last 5 

years, from about 250,000 to 190,000. Despite the reported decrease, many veterans 

still need help. Findings from a survey conducted by NCHV in November 2006 suggest the homeless veteran population in America may be experiencing significant 

changes. Homeless veterans receiving services today are aging and many are in 

need of permanent supportive housing. With the increase in the number of women 

serving in Iraq and Afghanistan, the percentage of women veterans seeking services 

is growing. According to studies published by the New England Journal of Medicine 

and the VA, a growing number of combat veterans of Operation Iraqi Freedom, Operation Enduring Freedom and the Global War on Terror are returning home and 

suffering from war-related conditions including PTSD and Traumatic Brain Injury, 

which may put them at risk for homelessness. 

Homeless Provider Grant and Per Diem Program 

Administered by the U.S. Department of Veterans Affairs, the Homeless Providers 

Grants and Per Diem (GPD) program is the nation’s largest VA program to help address the needs of homeless veterans and supports development of transitional, community-based housing and delivery of supportive services. The program also funds 

GPD liaisons who coordinate outreach, case management, referrals to benefits counselors, and linkage to health care and housing assistance. Also funded under the 

GPD program are Special Needs Grants, which assist homeless women veterans including homeless women veterans with children, in addition to veterans who are 

chronically mentally ill, frail elderly and terminally ill. 

The Homeless Provider Grant and Per Diem Program provides competitive grants 

to community-based, faith-based, and public organizations to offer transitional housing or service centers for homeless veterans. The GPD program is an essential component of the VA’s continuum of care for homeless veterans, assuring the availability of social services, employment supports, and direct treatment or referral to 

medical treatment. 

erowe on PROD1PC71 with REPORTS

33 

In September 2006 the Government Accountability Office (GAO) released its 

study, Improved Communications and Follow-up Could Further Enhance the Grant 

and Per Diem Program. The agency found while VA has attempted to improve its 

services and increase the capacity of the GPD program, an additional 9,600 transitional housing beds are needed to meet the current demand. According to the study, 

VA reports a total of 45,000 transitional beds are needed and has identified 35,400 

beds available from various sources, including the GPD program, resulting in a 

shortfall of about 9,600 beds. In FY 2005, the GPD program had about 8,000 available for homeless veterans. GAO states VA plans to increase GPD beds by 2,200 

in the near future. 

NCHV is pleased that both the House and Senate have already passed bills increasing FY08 appropriations for the GPD program to the fully authorized level of 

$130,000,000. Funding at this level will make more beds available to serve the expected number of men and women returning from Iraq and Afghanistan who are 

at risk of homelessness. NCHV is hopeful Congress will soon pass a final bill that 

includes this level of funding and the bill will be signed into law. 

Payment for Services 

In addition to needed increased program funding, however, NCHV believes the 

mechanism for paying providers under the Homeless Providers Grant and Per Diem 

Program (GPD) must be simplified. Current law (38 U.S.C. 2012(a)(2)) authorizes 

the VA Secretary to provide per diem payments to GPD providers at a rate not to 

exceed the rate authorized for State homes for domiciliary care. GPD providers report even this maximum rate (up to $31.30 per day) provides far less than the actual daily cost of care to a veteran in the GPD program. 

Moreover, VA has applied current law in a manner such that GPD providers must 

expend a significant level of effort and resources to gather and submit extensive documentation about each source of income and the location of costs for each homeless 

veteran being served with GPD funds. Providers often experience lengthy ongoing 

communication with the VA and questions regarding expenses incurred and accountability, resulting in a delay in timely reimbursement and ultimately, interruption of services to their clients. The accounting burden is particularly onerous for 

smaller faith-based and community-based organizations, and is contrary to the aim 

of the President’s Faith-Based and Community Initiative, which seeks to welcome 

grassroots organizations to Federal funding streams. 

Often the VA demands repayment of funds when providers temporarily have 

empty beds—the problem that comes about because the formula is based on an unsuitable model. At the time the original law was written, Congress was limited in 

determining how services to veterans outside traditional VA facilities should be reimbursed. As a result, the rate authorized for State homes for domiciliary care was 

used as the standard for paying homeless veteran service providers. Over the past 

several years, however, evidence has shown because clients in the two settings have 

different needs a payment system reflecting those needs and the more comprehensive services they are receiving must be applied. Residents receiving domiciliary 

care in State homes are more likely to remain permanently in VA facilities while 

the goal of community based homeless veteran service providers is to promote independent living for its clients and reintegration back into civilian life. The current 

GPD system is too rigid and doesn’t reflect the reality of hiring and compensating 

staff even when beds are temporarily empty. 

To address these issues, NCHV urges Congress to introduce legislation that would 

provide relief to current community- and faith-based providers in addition to organizations that may be interested in applying to the GPD program in the future. The 

new legislation would revise the per diem payment program to allow payments to 

be related to service costs rather than a capped rate and would also encourage high 

cost service areas to participate. The revised system would allow the Secretary to 

increase annually and adjust accordingly the rate of payment to providers to reflect 

changes in the cost of furnishing services in a particular geographic area. The Secretary would set a maximum amount providers would receive based on available 

funds. 

To ensure GPD funds are being spent in accordance with the purpose of the GPD 

program, NCHV supports statutory language requiring the VA Secretary to develop 

a reasonable system of outcome and performance measurement of GPD providers. 

In the current arena, the VA Homeless Grant and Per Diem liaison (HGPD) assigned to each grant program through the local VA medical center, provides continuous oversight throughout the year and conducts an annual inspection of each program. Results of these activities are reported to the VA HGPD Office. Oversight includes an inspection of the physical plant where the program operates, and a review 

and evaluation of the overall program including veterans’ goals, objectives and outerowe on PROD1PC71 with REPORTS

34 

comes as described in the original grant proposal that received the award. Maintaining the reporting process between the VA HGPD Office and the Secretary ensures 

the Secretary has in place a procedure that can determine if GPD funds are justified 

and utilized appropriately. Grant recipients provide the VA with information on financial integrity, solvency, operational accounting systems, as well as an annual 

independent audit. 

Use of Other Funding 

In addition to revising the GPD payment system, new legislation should change 

the requirements for grant recipients and allow service providers to use other available sources of income besides the GPD program to furnish services to homeless veterans. These sources may include payments or grants from other departments and 

agencies of the United States or from departments or agencies of State or local Government. 

While the current law was intended to ensure VA per diem payments do not replace payments or contributions from other income sources, it has instead created 

the unintended consequence of penalizing GPD providers successful in securing 

other sources of income for services to homeless veterans by reducing their per diem 

payment rate. Thus, the predictable effect of this provision is that it discourages 

providers from developing partnerships with other Federal agencies or State and 

local Governments. Congress should devise a payment provision that encourages 

GPD providers to continue to seek funding from non-VA sources in a manner that 

does not penalize them if they are successful. 

Matching Funds 

All payment modifications should also allow VA funds to be used as a match or 

leverage for other Federal funds and allow other Federal funds to be used without 

offset by VA. When GPD providers are able to receive the maximum rate in addition 

to other income sources, they are able to expand the scope and quantity of services 

to homeless veterans and increase the likelihood of their successful reintegration 

into the community. Conversely, when GPD providers are forced to use other 

sources of income to offset any reduction in payments made under the GPD program, as is currently the case, new services cannot be offered. Providers may not 

use such other income to develop and support additional housing units, provide veterans a more robust service package, or serve homeless veterans not qualified for 

GPD support. 

Currently, GPD grantees are being required to submit extensive documentation 

on all of their sources of project funding in order to secure per diem payments at 

the maximum rate permitted by statute, straining grantees and VA alike. If the 

GPD program is to remain viable in the future, Congress needs to simplify the conditions under which GPD payment amounts are established. 

Conclusion 

The verdict is clear from homeless veteran service providers and veterans’ advocates that the current GPD payment mechanism affects the ability of communityand faith-based organizations to effectively and efficiently serve veterans experiencing homelessness. We urge Congress to address this situation in whatever legislation is deemed an appropriate vehicle. 

Thank you for providing NCHV an opportunity to present our views. I am happy 

to answer your questions. 

f 

Prepared Statement of Kathryn E. Spearman, 

President and Chief Executive Officer, 

Volunteers of America of Florida 

Chairman Michaud, Ranking Member Miller and Members of the Subcommittee: 

Thank you for the invitation to testify today and for all you do to assist our Nation’s veterans. Volunteers of America of Florida is a statewide 501(c)(3) non-profit, 

faith-based social service community provider in Florida for 87 years. We are an affiliate of Volunteers of America, a national organization whose headquarters are located in the Washington, DC area, in existence for 111 years, with affiliates in 44 

states. 

Volunteers of America of Florida, in partnership with various committed funding 

sources, provides housing and services to the homeless, low-income elderly, persons 

with mental illness, and persons with developmental disabilities. With a continuum 

of services, Volunteers of America offers housing, health care, training, education 

and employment services to advance self-sufficiency. Housing and support services 

erowe on PROD1PC71 with REPORTS

35 

are offered in 13 Florida cities: Jacksonville, Gainesville, Tampa, Sebring, Bradenton, Clearwater, Orlando, Cocoa, Lakeland, Miami, Ft. Lauderdale, Pompano, 

and Key West. Currently, there are new projects in development in Pensacola, 

Punta Gorda, and Lake City, and assistance is being offered to potential providers 

in Trenton and Sebastian, Florida. 

Florida attracts many homeless veterans, and Volunteers of America of Florida 

has been focused on addressing the needs of these individuals for the past 10 years. 

We partner with the VA Grant and Per Diem Program in serving this population 

of veterans. This partnership is demonstrated by the fact that Volunteers of America of Florida and VISN 8 have jointly responded to five major hurricanes utilizing 

the Mobile Service Center which we will mention later in our talk. On any given 

night in Florida between 17,000 and 23,000 homeless veterans are living in shelters, 

on the streets, in encampments, on derelict boats or in other places not meant for 

human habitation. Volunteers of America of Florida currently has transitional housing and support services capacity for 216 homeless veterans in seven Florida cities: 

Jacksonville, Gainesville, Cocoa, Key West, Miami, Ft. Lauderdale, and Lake City. 

There are 171 beds through the VA Grant and Per Diem Program and 45 through 

our HUD Supportive Housing Programs. Another 81 beds are in development bringing our service capacity to 297 veterans in nine Florida cities and surrounding communities. Our first and most innovative Grant and Per Diem program is the Florida 

Veterans Mobile Service Center, a 40-foot state-of-the-art vehicle with a fully contained medical, dental and health service facility that outreaches to homeless veterans throughout the state. Veterans also benefit from a Multi-Service Center in 

some cities. 

Volunteers of America of Florida currently has the largest number of Veterans Affairs Grant and Per Diem supportive housing and service programs in Florida, as 

well as one of the largest number of HUD McKinney-Vento Supported Housing Programs in the State. 

Our service to veterans is based on excellent partnerships and common goals to 

support the needs of homeless veterans. As a provider, I appreciate the dedication 

of Roger Casey and his staff to make the program what it needs to be; the continual 

funding to add more beds; the grant segment which provides tremendous leverage 

and incentive; the opportunity for the VA and the community to partner to address 

the needs of homeless veterans; the per diem that strengthens the operations and 

program; the service center potential; and the strategic gateway for veterans to live 

in and be part of the community. 

Volunteers of America of Florida’s success with homeless veterans is founded in 

strong partnerships, the ability to work statewide, a continuum of housing options 

and array of support services, and diligence in combining Federal and local resources to get the job done. Our 10 years of experience in working with homeless 

veterans, first in outreach and then in providing housing and support services including multi service centers, has led us to an increasing awareness of the issues 

facing Grant and Per Diem providers. From a provider perspective I will spend the 

rest of my testimony offering information and suggestions. 

Partnership—The overall partnership between the VA and the community needs 

strengthening. Local providers address the needs of veterans everyday and complement the VA services. We accept this as our role and we would like the VA to 

value that role in partnership—often a tall order I believe for the ‘‘big VA’’. In service to the homeless veterans, local community providers offer easier accessibility, 24/ 

7 availability of staff in our programs, fewer barriers to receive immediate service, 

and a more coordinated individualized, and timely approach to the needs of each 

homeless veteran. Providers are good housing developers; problem solvers; resource 

developers; and grant writers. We are a linkage for the veteran to the community 

where we offer an expansion to VA’s clinical and substance abuse treatment as well 

as training and education in preparation for employment. 

Furthermore, the community needs the VA and its tremendous assets and resources in order to meet the goal of ending homelessness among veterans. The 

homeless veteran needs us both and the homeless veteran needs us to work together. A partnership approach does work and Volunteers of America of Florida is 

becoming more selective in its funding partners because so much more can be accomplished if we sit at the same table trying to find ways to reach an agreed upon 

outcome. With a good partnership comes shared risk because we own the problem 

together. 

• Suggestion: A work group to advise on a provider friendly/VA accountability and 

funding mechanism for Grant and Per Diem payment with representation from 

all members of the partnership. 

erowe on PROD1PC71 with REPORTS

36 

VA Medical Center Relationship—Volunteers of America of Florida has worked 

well with the Health Care for Homeless Veterans and Compensated Work Therapy 

staff. In my experience, the staff from the VA hospitals that provide contract management and site inspections often lack the same goals as the VA Grant and Per 

Diem Program. However, as in many monitoring situations, it becomes confusing 

when the monitoring staff misconstrues their role as the expert in housing development, safety, service delivery, client intake, and generally—everything that is good 

for the veterans. I believe being a more integral part of the Grant and Per Diem 

staff and its strategies to work with the community could be beneficial. 

• Suggestion: Staff those positions under Grant and Per Diem. Training, scheduling and a positive attitude could build a better rapport with community providers serving veterans. We could actually problem solve as a team. At a minimum the hospital representatives, as well as everyone representing the VA 

Grant and Per Diem Program, need to focus on the positive partnership. 

Helping the Homeless Veterans—In order to move a homeless veteran to a 

healthful and productive life in the Grant and Per Diem Program, most of the following services will be required: 

• Outreach to identify, locate, establish trust and rapport, and link veterans to 

services • Immediate access to shelter, food, clothing, and health care • Assessment of need • Housing placement • Medical and dental care • Support Services—transportation, linkage to assistance and benefits, legal aid, 

and building a personal support system • Mental Health and/or Substance Abuse Treatment 

• Training and education, and employment assistance 

• Employment assistance 

• Community integration, support networks 

• Relocation to permanent housing 

Outreach and services will be successful when they are conducted to build trust 

and respect. Recognition should be given to the importance of all sources that help 

the homeless veteran succeed. I must say that I doubt most people realize how disengaged and disabled many of the homeless veterans are when they enter our programs. Drug and alcohol addiction is very serious and disruptive to rebuilding a life 

acceptable to our society. 

Costs in Relation to the VA Grant and Per Diem Payment—The complex barriers experienced by our Nation’s homeless veterans reinforce the need to be flexible 

as a service provider. Costs for housing and services must be constantly evaluated 

to offer the highest quality of service. The following are some industry costs for your 

information on this topic. While costs will vary by factors such as quality and volume, the information below shows activities and associated costs. 

Activity Cost 

Housing Management $25/day 

Clinical Care (non clinic) $32/day 

Service Center Operation (for serving 50 veterans) $1,000/day 

Therefore, the $32/day per diem note will always fall short of paying in total for 

what is needed. Identification and combining of resources is essential and should 

be encouraged strongly. In my opinion, the VA Grant and Per Diem service center 

payment does not relate to operating a center. 

Construction, rehab and acquisition require a 35 percent cash match from the provider. This usually comes from additional funding sources that are easier to access 

with the VA portion committed as a grant and a per diem to strengthen the ability 

to operate. Flexibility needs to be exercised to create projects that offer beds to 

homeless veterans. There are many creative ways to combine development funding 

or put together assets of providers, VA grant, and financing. It is crucial also that 

VA Grant and Per Diem be understood as providers attempt to mesh funding and 

funders’ requirements. It is not a perfect process and each is different and often 

challenging. 

• Suggested Options of Service Payment: 

erowe on PROD1PC71 with REPORTS

37 

1. Provider prepares an expense budget reflecting housing and services expenses 

they want the VA to pay for. The provider is then monitored according to that 

proposed budget and the services those expenses covered. VA is flexible and 

helpful as circumstances require adjustments. Cost is impacted by the level 

and type of service. 

2. Determine a housing base per diem and then two or three levels of service per 

diem as an overlay (basic to more intensive). 

3. Determine outcomes desired and steps to arrive at those outcomes. Then determine cost and pay the provider monthly (1⁄12) of budget if 80 percent of outcomes are being met or if veterans are moving toward independence that 

month (documented). Volunteers of America of Florida has two pilots of this 

nature with the State Department of Children and Families, Office of Substance Abuse and Mental Health. It has a remarkable impact on how services 

are delivered! 

Note: The VA must pay their portion of administrative overhead based on a 

reasonable percent. It costs a viable organization between 12 and 25 percent 

(12–25 percent) of administrative costs—the higher percent for the smaller organization. 

The flexibility we build now, in this program, should also be with an eye to the 

future when we will be focused on a new era of veterans with a whole new set of 

circumstances and needs. Our work over the last decade has been primarily with 

homeless veterans who served during the Vietnam era. Veterans now returning 

from Operation Iraqi Freedom or Operation Enduring Freedom should benefit from 

the lessons we have learned in developing support and interventions. Our returning 

troops have Post Traumatic Stress Disorder, Traumatic Brain Injury, and other serious mental health/substance abuse disorders which will require services on a longer 

term basis. Please consider the need for permanent supported housing for these veterans. As we work together to address program improvements, we will be better 

prepared to continue to meet the needs of current homeless veterans and wisely anticipate the needs of our returning troops. 

In closing, I hope the pressure on the Grant and Per Diem Program will lift so 

the staff can more effectively advance the Program goals. We all need to be more 

secure in what we are doing and why we are doing it! When we embrace common 

goals to serve and support homeless veterans, and reach out with a sincere helping 

hand, powerfully positive outcomes will result. 

Thank you for the opportunity to share my views on this important and worthwhile program. I hope my comments are representative of other providers or that 

their opinions are represented in the comments of my other colleagues testifying 

with me today. 

f 

Prepared Statement of Daniel Bertoni, Director, 

Education, Workforce, and Income Security Issues, 

U.S. Government Accountability Office 

Homeless Veterans Programs—Bed Capacity, Service and Communication 

Gaps Challenge the Grant and Per Diem Program 

GAO Highlights 

Why GAO Did This Study 

The Subcommittee on Health of the Committee on Veterans’ Affairs asked GAO 

to discuss its recent work on the Department of Veterans Affairs’ (VA) Homeless 

Providers Grant and Per Diem (GPD) program. 

GAO reported on this subject in September 2006, focusing on (1) VA’s estimates 

of the number of homeless veterans and transitional housing beds, (2) the extent 

of collaboration involved in the provision of GPD and related services, and (3) VA’s 

assessment of program performance. 

What GAO Found 

VA estimates that about 196,000 veterans nationwide were homeless on a given 

night in 2006, based on its annual survey, and that the number of transitional beds 

available through VA and other organizations was not sufficient to meet the needs 

of eligible veterans. The GPD program has quadrupled its capacity to provide transitional housing for homeless veterans since 2000, and additional growth is planned. 

As the GPD program continues to grow, VA and its providers are also grappling 

erowe on PROD1PC71 with REPORTS

38 

1GAO, Homeless Veterans Programs: Improved Communications and Follow-up Could Further Enhance the Grant and Per Diem Program, GAO–06–859 (Washington, D.C. Sept. 11, 

2006). 

with how to accommodate the needs of the changing homeless veteran population 

that will include increasing numbers of women and veterans with dependents. 

The GPD providers we visited collaborated with VA, local service organizations, 

and other State and Federal programs to offer a broad array of services designed 

to help veterans achieve the three goals of the GPD program—residential stability, 

increased skills or income, and greater self-determination. However, most GPD providers noted key service and communication gaps that included difficulties obtaining 

affordable permanent housing and knowing with certainty which veterans were eligible for the program, how long they could stay, and when exceptions were possible. 

VA data showed that many veterans leaving the GPD program were better off in 

several ways—over half had successfully arranged independent housing, nearly onethird had jobs, one-quarter were receiving benefits, and significant percentages 

showed progress with substance abuse, mental health or medical problems or demonstrated greater self-determination in other ways. Some information on how veterans fare after they leave the program was available from a onetime follow-up 

study of 520 program participants, but such data are not routinely collected. 

We recommended that VA take steps to ensure that GPD policies and procedures 

are consistently understood and to explore feasible means of obtaining information 

about the circumstances of veterans after they leave the GPD program. VA concurred and, following our review, has taken several steps to improve communications and to develop a process to track veterans’ progress shortly after they leave 

the program. However following up at a later point might yield a better indication 

of success. 

Mr. Chairman and Members of the Subcommittee: 

Thank you for inviting me here today to discuss the Homeless Providers Grant 

and Per Diem (GPD) program, the largest program of its kind administered by the 

Department of Veterans Affairs (VA). On any given night in the United States, an 

estimated 750,000 people, including veterans, are homeless and may sleep on the 

streets or in shelters. Veterans constitute about one-third of the adult homeless population, and many veterans who are not yet homeless may be at risk. To address 

the needs of these homeless veterans, VA officials told us that through the GPD program they fund over 300 grants to local agencies to house approximately 15,000 

homeless veterans over the course of a year at a cost of about $95 million. The program is not designed to serve all homeless veterans—it focuses on transitional housing and supportive services for veterans who are most in need, including those who 

have had problems with mental illness, substance abuse, or both. 

My statement draws on GAO’s report on this program issued in September 2006 

that reviewed (1) VA’s estimates of the number of homeless veterans and transitional housing beds, (2) the extent of collaboration involved in the provision of GPD 

and related services, and (3) VA’s assessment of program performance. 1 I have also 

included information we obtained in following up on VA’s efforts to implement our 

recommendations. 

In summary, VA reported in 2006 that about 196,000 veterans were homeless and 

that not enough transitional beds were available through VA and other organizations to meet the needs of homeless veterans eligible to use this assistance. To help 

meet these needs, the GPD program has quadrupled its capacity since 2000 to about 

8,200 beds, and additional growth is planned. In addition to increasing transitional 

bed capacity, VA and its providers are also grappling with how to accommodate the 

needs of the changing homeless veteran population that will include increasing 

numbers of women and veterans with dependents. When we met with GPD providers who operate the program and their local VA liaisons, we found that they were 

working collaboratively with other organizations to deliver supportive services, but 

most also noted key resource and communications gaps. Specifically, providers reported difficulties finding affordable permanent housing for veterans ready to leave 

the program. In addition the eligibility rules for the GPD program were not always 

clear, a fact that could cause confusion and could keep veterans from obtaining 

needed care. VA data showed that many veterans were better off in terms of housing; employment; receipt of public benefits; and progress with substance abuse, 

mental health, or medical problems at the time they left the program, but VA did 

not know how they were faring months or years later. 

erowe on PROD1PC71 with REPORTS

39 

2The other five programs are the Contracted Residential Treatment Program, the Domiciliary 

Residential Rehabilitation and Treatment Program, the Compensated Work Therapy/Transitional Residence Program, the Loan Guarantee for Multifamily Transitional Housing, and the 

Housing and Urban Development-VA Supported Housing program. 3On a limited basis, special needs grants are available to cover the additional costs of serving 

women, frail elderly, terminally ill, or chronically mentally ill veterans. 4The definitions appear at 42 U.S.C. § 11302 and 38 C.F.R. § 61.1. 5Liaisons told us in 2006 that they experienced large caseloads and multiple GPD responsibilities—including eligibility determination, verification of intake and discharge information, case 

management, fiscal oversight, monitoring program compliance and inspections of GPD facilities, 

among other duties. To address some of these concerns, VA obtained funding to increase the 

number of full-time positions to 122. 

We recommended that VA take steps to ensure that GPD policies and procedures 

are consistently understood and to explore feasible means of obtaining information 

about the circumstances of veterans after they leave the GPD program. VA concurred and, following our review, has taken several steps to improve communications and to develop a process to track veterans’ progress shortly after they leave 

the program. However following up at a later point might yield a better indication 

of success. 

Background 

The GPD program is one of six housing programs for homeless veterans administered by the Veterans Health Administration, which also undertakes outreach efforts and provides medical treatment for homeless veterans. 2 VA officials told us in 

Fiscal Year 2007 they spent about $95 million on the GPD program to support two 

basic types of grants—capital grants to pay for the buildings that house homeless 

veterans and per diem grants for the day-to-day operational expenses. 3 Capital 

grants cover up to 65 percent of housing acquisition, construction, or renovation 

costs. The per diem grants pay a fixed dollar amount for each day an authorized 

bed is occupied by an eligible veteran up to the maximum number of beds allowed 

by the grant—in 2007 the amount cannot exceed $31.30 per person per day. VA 

pays providers after they have housed the veteran, on a cost reimbursement basis. 

Reimbursement may be lower for providers whose costs are lower or are offset by 

funds for the same purpose from other sources. 

Through a network of over 300 local providers, consisting of nonprofit or public 

agencies, the GPD program offers beds to homeless veterans in settings free of 

drugs and alcohol that are supervised 24 hours a day, 7 days a week. Most GPD 

providers have 50 or fewer beds available, with the majority of providers having 25 

or fewer. Program rules generally allow veterans to stay with a single GPD provider 

for 2 years, but extensions may be granted when permanent housing has not been 

located or the veteran requires additional time to prepare for independent living. 

Providers, however, have the flexibility to set shorter timeframes. In addition, veterans are generally limited to a total of three stays in the program over their lifetime, but local VA liaisons may waive this limitation under certain circumstances. 

The program’s goals are to help homeless veterans achieve residential stability, increase their income or skill levels, and attain greater self-determination. 

To meet VA’s minimum eligibility requirements for the program, individuals must 

be veterans and must be homeless. A veteran is an individual discharged or released 

from active military service. The GPD program excludes individuals with a dishonorable discharge, but it may accept veterans with shorter military service than required of veterans who seek VA health care. A homeless individual is a person who 

lacks a fixed, regular, adequate nighttime residence and instead stays at night in 

a shelter, institution, or public or private place not designed for regular sleeping accommodations. 4 GPD providers determine if potential participants are homeless, 

but local VA liaisons determine if potential participants meet the program’s definition of veteran. VA liaisons are also responsible for determining whether veterans 

have exceeded their lifetime limit of three stays in the GPD program and for issuing 

a waiver to that rule when appropriate. Prospective GPD providers may identify additional eligibility requirements in their grant documents. 

While program policies are developed at the national level by VA program staff, 

the local VA liaisons designated by VA medical centers have primary responsibility 

for communicating with GPD providers in their area. VA reported that in Fiscal 

Year 2007, there were funds to support 122 full-time liaisons. 5

VA Has Expanded GPD Program Capacity to Help Meet Homeless Veterans’

Needs, but Demand Still Exceeds Supply 

Since Fiscal Year 2000, VA has quadrupled the number of available beds and significantly increased the number of admissions of homeless veterans to the GPD proerowe on PROD1PC71 with REPORTS

40 

gram in order to address some of the needs identified through its annual survey of 

homeless veterans. In Fiscal Year 2006, VA estimated that on a given night, about 

196,000 veterans were homeless and an additional 11,100 transitional beds were 

needed to meet homeless veterans’ needs. However, this need was to be met through 

the combined efforts of the GPD program and other Federal, state, or community 

programs that serve the homeless. VA had the capacity to house about 8,200 veterans on any given night in the GPD program. Over the course of the year, because 

some veterans completed the program in a matter of months and others left before 

completion, VA was able to admit about 15,400 veterans into the program, as shown 

in figure 1. Despite VA rules allowing stays of up to 2 years, veterans remained in 

the GPD program an average of 3 to 5 months in Fiscal Year 2006. 

Figure 1—Numbers of GPD Admissions and Beds in 

Fiscal Years 2000 and 2006 

The need for transitional housing beds continues to exceed capacity, according to 

VA’s annual survey of local areas served by VA medical centers. The number of 

transitional beds available nationwide from all sources increased to 40,600 in Fiscal 

Year 2006, but the need for beds increased as well. As a result, VA estimates that 

about 11,100 more beds are needed to serve the homeless, as shown in table 1. VA 

officials told us that they expect to increase the bed capacity of the GPD program 

to provide some of the needed beds. 

erowe on PROD1PC71 with REPORTS


39457A.001
41 

6Through the local Continuum of Care networks, the Department of Housing and Urban Development contracts with public housing agencies for the rehabilitation of residential properties 

that provide multiple single-room dwelling units. These agencies make Section 8 rental assistance payments generally covering the difference between a portion of the tenant’s income (normally 30 percent) and the unit’s rent to participating owners (i.e., landlords) on behalf of homeless individuals who rent the rehabilitated dwellings. 

Table 1—Available and Needed Transitional Beds for 

Homeless Veterans, Fiscal Year 2006 

Available and Needed Transitional Beds FY 2006 

Transitional beds needed 51,700 

Total transitional beds available, including GPD 40,600 

Additional beds still needed 11,100 

Source: GAO analysis of VA’s annual survey estimates rounded to nearest 100. 

Most homeless veterans in the program had struggled with alcohol, drug, medical 

or mental health problems before they entered the program. Over 40 percent of 

homeless veterans seen by VA had served during the Vietnam era, and most of the 

remaining homeless veterans served after that war, including at least 4,000 who 

served in military or peacekeeping operations in the Persian Gulf, Afghanistan, 

Iraq, and other areas since 1990. About 50 percent of homeless veterans were between 45 and 54 years old, with 30 percent older and 20 percent younger. AfricanAmericans were disproportionately represented at 46 percent, the same percentage 

as non-Hispanic whites. Almost all homeless veterans were men, and about 76 percent of veterans were either divorced or never married. 

An increasing number of homeless women veterans and veterans with dependents 

are in need of transitional housing according to VA officials and GPD providers we 

visited. The GPD providers told us in 2006 that women veterans had sought transitional housing; some recent admissions had dependents; and a few of their beds 

were occupied by the children of veterans, for whom VA could not provide reimbursement. VA officials said that they may have to reconsider the type of housing 

and services that they are providing with GPD funds in the future, but currently 

they provide additional funding in the form of special needs grants to a few GPD 

programs to serve homeless women veterans. 

GPD Providers Collaborate to Offer a Range of Services, but Face Challenges in Helping Veterans 

VA’s grant process encourages collaboration between GPD providers and other 

service organizations. Addressing homelessness—particularly when it is compounded by substance abuse and mental illness—is a challenge involving a broad 

array of services that must be coordinated. To encourage collaboration, VA’s grants 

process awards points to prospective GPD providers who demonstrate in their grant 

documents that they have relationships with groups such as local homeless networks, community mental health or substance abuse agencies, VA medical centers, 

and ancillary programs. The grant documents must also specify how providers will 

deliver services to meet the program’s three goals—residential stability, increased 

skill level or income, and greater self-determination. 

The GPD providers we visited often collaborated with VA, local service organizations, and other State and Federal programs to offer the broad array of services 

needed to help veterans achieve the three goals of the GPD program. Several providers worked with the local homeless networks to identify permanent housing resources, and others sought Federal housing funds to build single-room occupancy 

units for temporary use until more permanent long-term housing could be developed. 6 All providers we visited tried to help veterans obtain financial benefits or 

employment. Some had staff who assessed a veteran’s potential eligibility for public 

benefits such as food stamps, Supplemental Security Income, or Social Security Disability Insurance. Other providers relied on relationships with local or State officials 

to provide this assessment, such as county veterans’ service officers who reviewed 

veterans’ eligibility for State and Federal benefits or employment representatives 

who assisted with job searches, training, and other employment issues. GPD providers also worked collaboratively to provide health care-related services—such as 

mental health and substance abuse treatment, and family and nutritional counseling. While several programs used their own staff or their partners’ staff to proerowe on PROD1PC71 with REPORTS

42 

7 VA issued a directive for a onetime dental care opportunity for homeless veterans (VHA Directive 2002–080) in line with 38 U.S.C. § 101 note. VA officials told us that funding was provided in 2006 to implement this directive. 8 VA may waive the lifetime limit on program stays if the services offered are different from 

those previously provided and may lead to a successful outcome. The VA liaisons must review 

and approve or deny the waiver based on their best clinical assessment of the individual case. 9 Independent housing comprises apartments, rooms, or houses. While independent housing 

may be a more desirable outcome, for some veterans, including those with severe disabilities, 

secured housing may be more appropriate. 

vide mental health or substance abuse services and counseling directly, some GPD 

providers referred veterans offsite—typically, to a VA local medical center. 

Despite GPD providers’ efforts to collaborate and leverage resources, GPD providers and VA staff noted gaps in key services and resources, particularly affordable 

permanent housing for veterans ready to leave the GPD program. Providers also 

identified lack of transportation, legal assistance, affordable dental care, 7 and immediate access to substance abuse treatment facilities as obstacles for transitioning 

veterans out of homelessness. VA staff in some of the GPD locations we visited told 

us that transportation issues made it difficult for veterans to get to medical appointments or employment-related activities. While one GPD provider we visited was 

able to overcome transportation challenges by partnering with the local transit company to obtain subsidies for homeless veterans, transportation remained an issue for 

GPD providers that could not easily access VA medical centers by public transit. 

Providers said difficulty in obtaining legal assistance to resolve issues related to 

criminal records or credit problems presented challenges in helping veterans obtain 

jobs or permanent housing. In addition, some providers expressed concerns about 

obtaining affordable dental care and about wait lists for veterans referred to VA for 

substance abuse treatment. 

We found that some providers and staff did not fully understand certain GPD program policies—which in some cases may have affected veterans’ ability to get care. 

For instance, providers did not always have an accurate understanding of the eligibility requirements and program stay rules, despite VA’s efforts to communicate its 

program rules to GPD providers and VA liaisons who implement the program. Some 

providers were told incorrectly that veterans could not participate in the GPD program unless they were eligible for VA health care. Several providers understood the 

lifetime limit of three GPD stays but may not have known or believed that VA had 

the authority to waive this rule. 8 As a consequence, we recommended that VA take 

steps to ensure that its policies are understood by the staff and providers with responsibility for implementing them. 

In response to our recommendation that VA take steps to ensure that its policies 

are understood by the staff and providers with responsibility for implementing 

them, VA took several steps in 2007 to improve communications with VA liaisons 

and GPD providers, such as calling new providers to explain policies and summarizing their regular quarterly conference calls on a new Web site, along with new 

or updated manuals. Language on the number and length of allowable stays in the 

providers’ guide has not changed, however. 

VA Data Show Many Veterans Have Housing and Jobs on Leaving the Program and Plans Are Under Way for Follow-up 

VA assesses performance in two ways—the outcomes for veterans at the time they 

leave the program and the performance of individual GPD providers. VA’s data 

show that since 2000, a generally steady or increasing percentage of veterans met 

each of the program’s three goals at the time they left the GPD program. 

Since 2000, proportionately more veterans are leaving the program with housing 

or with a better handle on their substance abuse or health issues. During 2006, over 

half of veterans obtained independent housing when they left the GPD program, 

and another quarter were in transitional housing programs, halfway houses, hospitals, nursing homes, or similar forms of secured housing. 9 Nearly one-third of veterans had jobs, mostly on a full-time basis, when they left the GPD program. Onequarter were receiving VA benefits when they left the GPD program, and one-fifth 

were receiving other public benefits such as Supplemental Security Income. Significant percentages also demonstrated progress in handling alcohol, drug, mental 

health, or medical problems and overcoming deficits in social or vocational skills. 

For example, 67 percent of veterans admitted with substance problems showed 

progress in handling these problems by the time they left. Table 2 indicates the 

numbers or percentages involved. 

erowe on PROD1PC71 with REPORTS

43 

10 Veterans Affairs Office of Inspector General, Evaluation of the Veterans Health Administration Homeless Grant and Per Diem Program, Report No. 04–00888–215 (Washington, D.C.: Sept. 

20, 2006). 

Table 2—Number Served by VA’s Health Care for Homeless Veterans and 

Grant and Per Diem Program and Veterans’ Outcomes, Fiscal Years 2000 

and 2006 

Participants Served and Outcomes 2000 2006 

Number of 

• veterans treated by VA’s Health Care for Homeless Veterans’ (HCHV) staff 43,082 60,857 

• intake assessments of homeless veterans by HCHV 

staff a 34,206 38,667 

• admissions of veterans to GPDs 4,841 15,433 

• discharges from GPDs 4,020 15,037 b

Days a veteran stays at a GPD, on average 91 139 c

Housing stability outcomes: 

Number of discharges from GPDs with 

• independent housing 1,163 7,723 

• placement in halfway house or institution such as hospital, nursing home, or domiciliary 991 3,648 

Increased income or skills outcomes: 

Number of discharges from GPDs with 

• full-time or part-time employment 1,404 4,766 

• VA benefits d Not Available 3,648 

• Other public benefits d Not Available 3,001 

Greater self-determination outcomes: Percentage of discharges from GPDs with 

• improved alcohol, drug, mental health e 38–42 60–67 

• improved medical, social/vocational condition e 43–46 57–62 

• success in meeting GPD provider requirements 30 47 

Source: GAO analysis of VA data aggregated from individual discharge forms completed by VA or GPD providers for veterans at the time they leave the program and compiled in annual reports by VA’s evaluation center. a Intake assessments are completed by HCHV staff when they first encounter a homeless veteran, unless the 

contact is casual and no services are offered or referrals made. After a year, new assessments are required if 

VA care or services are provided and VA staff have not been working with the veteran. b Number of discharges with complete data on their status is 14,710 and is used to calculate all numbers 

below. cMean is shown. Median is 81 days. 

d Numbers shown here include veterans who receive both types of benefits as well as those who receive only 

the designated benefits. ePercentages are ranges showing the highest and lowest of each of two or three outcome measures. 

VA’s Office of Inspector General (OIG) found when it visited GPD providers in 

2005–2006 that VA officials had not been consistently monitoring the GPD providers’ annual performance as required. 10 The GPD program office has since moved 

to enforce the requirement that VA liaisons review GPD providers’ performance 

when the VA team comes on-site each year to inspect the GPD facility. 

To assess the veterans’ success, VA has relied chiefly on measures of veterans’

status at the time they leave the GPD program rather than obtaining routine information on their status months or years later. In part, this has been due to concerns 

about the costs, benefits, and feasibility of more extensive follow-up. However, VA 

completed a onetime study in January 2007 that a VA official told us cost about 

$1.5 million. The study looked at the experience of a sample of 520 veterans who 

participated in the GPD program in five geographic locations, including 360 who responded to interviews a year after they had left the program. Generally, the finderowe on PROD1PC71 with REPORTS

44 

ings confirm that veterans’ status at the time they leave the program can be maintained. 

We recommended that VA explore feasible and cost-effective ways to obtain information on how veterans are faring after they leave the program. We suggested that 

where possible they could use data from GPD providers and other VA sources, such 

as VA’s own follow-up health assessments and GPD providers’ follow-up information 

on the circumstances of veterans 3 to 12 months later. VA concurred and told us 

in 2007 that VA’s Northeast Program Evaluation Center is piloting a new form to 

be completed electronically by VA liaisons for every veteran leaving the GPD program. The form asks for the veterans’ employment and housing status, as well as 

involvement, if any, in substance abuse treatment, 1 month after they have left the 

program. While following up at 1 month is a step in the right direction, additional 

information at a later point would yield a better indication of longer term success. 

Mr. Chairman, this concludes my remarks. I would be happy to answer any questions that you or other Members of the Subcommittee may have. 

Contact and Acknowledgements 

For further information, please contact Daniel Bertoni at (202) 512–7215. Also 

contributing to this statement were Shelia Drake, Pat Elston, Lise Levie, Nyree M. 

Ryder, and Charles Willson. 

f 

Prepared Statement of George Basher, Chair, 

Advisory Committee on Homeless Veterans, 

U.S. Department of Veterans Affairs, 

and Director, New York State Division of Veterans’ Affairs 

Chairman Michaud and Members of the Subcommittee: 

I am pleased to be here today to discuss the VA Grant and Per Diem program 

serving homeless veterans. I thank you for the invitation to testify before the Subcommittee and discuss this worthy program. I have had the honor of serving as the 

Director of the New York State Division of Veterans’ Affairs for the past 10 years 

and also currently serve as the Chair of the Department of Veterans Affairs Advisory Committee on Homeless Veterans. In both of these roles I have had an opportunity to witness not only the benefits of this program to those veterans who need 

a hand getting back on their feet but also the challenges it brings to the provider 

community. Recent estimates by the National Alliance to End Homelessness 

(NAEH) place the number of homeless individuals in the United States at 750,000. 

VA estimates the number of homeless veterans to be approximately 180,000, making 

homeless veterans one quarter of the entire homeless population. 

Established by Congress in 1992, the Grant and Per Diem (GPD) program has 

provided nearly 10,000 transitional beds for homeless veterans through the efforts 

of over 300 community-based providers. These community- and faith-based organizations provide shelter, food, and supportive services to homeless veterans for up 

to 2 years for a per diem currently set at a maximum of $31.30 per day. 

Originally designed to meet the needs of Vietnam era veterans, I believe it is time 

to revisit the Grant and Per Diem program in light of the need to also serve the 

veterans of the current conflict as well as those older veterans. VA estimates they 

have already seen over 1500 OEF/OIF veterans in various settings with several 

hundred referred to GPD providers for assistance. 

The VA Advisory Committee on Homeless Veterans in its recent report discussed 

concerns about GPD. Specifically: 

1. The VA GPD program uses a process to reimburse providers designed like the 

system VA uses to reimburse State Governments for the State Home program. 

The Advisory Committee is concerned this capped process discourages providers in high-cost areas from even applying. The current $31.30 rate is based 

in law on the rate paid to State Home programs. There is no basis in fact for 

the $31.30 rate in the State Home program and no defined rationale for determining that figure. Additionally, the current process does not allow the use of 

other Federal funds without offset by VA. While the State Home program rules 

were recently changed to allow this, the restriction still applies to GPD programs. 

2. The accounting process required for reimbursement is a burden on small community-based providers. Asking this group to meet the same level of expertise 

as State Governments with large accounting staff is unreasonable and discourages participation. Additionally, recent audits of some providers have led to alerowe on PROD1PC71 with REPORTS

45 

legations of significant overpayments—sometimes years after the fact—based 

on differing interpretations of allowable expenses. 

3. Community based GPD providers frequently use other Federal programs to 

augment the services provided to veterans. Current GPD regulations do not 

allow these funds to be used as a match for VA programs, often discouraging 

participation. Conversely, other Federal programs do allow VA funds to be used 

as a match, creating a disincentive to participate in VA programs. 

The Advisory Committee recommended the Per Diem be revised to allow payments to be related to service costs rather than a capped rate, allowing higher cost 

areas where homeless veterans are often numerous to participate. 

The Advisory Committee also recommended allowing other Federal funds to be 

used as a match to VA funds and also allow other Federal funds to be used without 

offset. 

Incorporated in these recommendations is the implied recommendation that the 

current burdensome accounting process would be scrapped and replaced by a simpler mechanism to provide reimbursement and protect the taxpayer’s interest. Paying a fee-for-services provided meets the needs of both the veteran client and the 

providers without placing an undue burden on either the providers or the Government. 

Beyond adjustments to the existing Grant and Per Diem program, other related 

concerns need to be addressed. Historically, most homeless and housing services 

have been provided by the U.S. Department of Housing and Urban Development 

(HUD) and the U.S. Department of Health and Human Services (HHS). VA housing 

initiatives have focused almost exclusively on transitional housing, reasoning that 

traditional VA programs coupled with GPD support services were all that was needed to return homeless veterans to a permanent housing environment. With 20 years 

experience in homeless veteran programs, we now know this is a simplistic view. 

Veterans with the co-morbidity of substance abuse and behavioral health disorders 

are frequently incapable of making the jump from transitional housing and programs to self-sufficiency. Experience has again taught that supportive permanent 

housing is often the most effective and economical way to have these individuals reenter the mainstream. The existing HUD–VASH program providing Section 8 

vouchers is woefully inadequate due to a lack of specific appropriations for the program by HUD. The Advisory Committee has recommended to VA that HUD–VASH 

be expanded and further that VA look for opportunities to partner with HUD and 

other agencies to find innovative ways to bring permanent housing and supportive 

services to veterans. Consideration should be given to site-based Section 8 vouchers 

as a way to provide those services on an ongoing basis by community based providers. Success of programs such as New York City’s New York, NY III initiative 

have demonstrated an integrated approach can provide positive results at an affordable cost. 

The still ongoing Capital Asset Realignment for Enhanced Services (CARES) process VA is using to identify capital requirements for the next 20 years has identified 

a significant amount of surplus VA land and facilities. One of the Advisory Committee recommendations was to have VA make reuse of this land for veteran housing a priority. VA officials contend that the existing Enhanced Use Lease (EUL) program is adequate to meet that need, but experience shows the EUL to be a time 

consuming, cumbersome process fraught with opportunity for delay and lost opportunities. The Department of Defense Base Realignment and Closure (BRAC) process 

is much more efficient in terms of making reuse opportunities reality in a reasonable period of time. 

There is a growing concern regarding women veterans. With women now making 

up nearly 20 percent of today’s military, VA programs are being accessed by an increasing number of women veterans, including programs for homeless veterans. 

There are unique challenges in this shift. Most VA programs were designed when 

the military was nearly exclusively male, necessitating changes by the Veterans 

Health Care Administration to facilities and procedures that are ongoing even 

today. Transitional housing programs for women veterans are rare, given the relatively low numbers involved and the economies of scale needed to provide services. 

Issues of safety and appropriateness of facilities likewise challenge traditional 

homeless service providers. 

Another consideration is the authority of VA to only care for the veteran. Children 

who have no other parent to care for them also often accompany the increasing 

number of women veterans. Accessing VA services by these veterans means leaving 

children with other relatives or non-family caregivers; a difficult choice that often 

leads to walking away from VA care and looking for help elsewhere. VA should explore ways to cope with the changing demographics of the military and adjust acerowe on PROD1PC71 with REPORTS

46 

cordingly, either in partnership with other agencies or through programmatic 

changes of its own. 

The VA Grant and Per Diem program has provided a valuable service to homeless 

veterans over the past 15 years. Adjusting the program in light of experience is appropriate; creating new policy to meet the needs of returning veterans from the current conflict is a necessity. 

Mr. Chairman, this concludes my formal remarks. I appreciate the opportunity to 

present my views and am prepared to answer any questions you or Members of the 

Subcommittee may have. Thank you. 

f 

Prepared Statement of Pete Dougherty, Director, 

Homeless Veterans Programs, Veterans Health Administration, 

U.S. Department of Veterans Affairs 

Mr. Michaud, and Members of the Subcommittee: 

I am pleased to be here today to discuss the Department of Veterans Affairs’ (VA) 

Grant and Per Diem program. This program is VA’s largest and most comprehensive 

collaboration with more than 300 communities, faith based non-profit organizations, 

state, local and tribal Governments. I am pleased to be accompanied by Mr. Paul 

Smits, Director of Homeless and Residential Rehabilitation Programs within the 

Veterans Health Administration. 

I would like to thank you for inviting us to join in today’s hearing. I am always 

reminded that the efforts to engage hundreds of community and faith-based service 

providers began with this Committee when in July 1992, the House passed HR 

5400, the Homeless Veterans Comprehensive Service Programs Act 1992. Later that 

year, the Senate also passed that legislation and it was signed into law by President 

George H. W. Bush on November 10, 1992. 

The 102nd Congress acted upon a concern that veterans were appearing in a disproportionately high percentage among what was seem as an ever increasing number of Americans who were homeless. Congress also found that veterans were not 

able to access existing efforts to assist the homeless. Since the provision of that authorization required specific appropriation, which took another year to accomplish, 

VA did not offer its first Notice of Funding Availability until 1994 when we awarded 

15 grants in September, 1994. Since that time each year, we have offered one or 

more notices of funding availability and today we now have more than 450 programs that have authorized 11,000 beds. As of September 2007, we have over 300 

programs and 8,000 beds in service today. The remaining 3,000 beds are expected 

to come into service as soon as needed construction, renovation or repairs have been 

completed. VA must also complete its inspection of the physical facility to ensure 

that the program is ready to open with appropriate staffing and operational plans. 

As you know, VA will soon announce awards under its latest notice of Funding 

Availability. We expect that we will be able to add 950 beds under this program. 

We have continued to offer new funding because of our great faith in the ability of 

many community providers to provide high quality services to veterans. Our goal, 

based upon this Congress’ mandate, is to end chronic homelessness among veterans. 

We have made good strides in achieving that goal and we simply would not be able 

to do it without our community-based partners. 

It is troubling when veterans or their families become homeless, especially in light 

of the service these brave men and women have made to our country. Our efforts, 

since the initial programs, have been to create positive partnerships. VA is committed to working with local communities to find those veterans through outreach 

programs. VA is committed to provide the care and services they need in order to 

facilitate their return to productive lives in their communities. 

Our efforts are national as well as local. We partner with other Federal agencies, 

national, state, local, tribal Governments, local non-profits and faith based community providers. Each year, we provide health care services to more then 100,000 

homeless veterans. We do not sit and wait for homeless veterans to come to us. We 

reach out to homeless veterans in shelters, soup kitchens, in parks, on the streets, 

and other places homeless persons frequent, including stand downs for homeless 

veterans. We have dedicated over 330 of our own staff who work collaboratively in 

communities across the country to find homeless veterans. 

Mr. Chairman, we understand that this Committee is very interested in the effectiveness of our Homeless Grant and Per Diem program to serve veterans. The number of veterans being seen has increased and we have every intention to continue 

to increase the availability of transitional housing. We have rapidly increased the 

number of beds since last year. We expect to add nearly 2,700 before the end of the 

erowe on PROD1PC71 with REPORTS

47 

year. Our performance measures to increase access and availability to both primary 

health care and specialty care within 30 and 60 days are showing great success. We 

are adding substance abuse counselors on-site of the community programs. In addition, we are increasing the number of veterans in community programs getting dental care, adding VA staff to work with community programs both in the form of reentry specialists working with veterans returning from incarceration, and fulltime 

health care network coordinators. These efforts are increasingly showing positive results. 

In Fiscal Year 2006, VA provided transitional housing services to nearly 15,500 

homeless veterans. This year, we anticipate that before the end of this Fiscal Year, 

we will serve more than 18,000 veterans. We anticipate that the number of veterans 

will continue to increase as programs already approved begin to provide direct services. 

We have been closely monitoring and aggressively reaching out to ensure that 

those men and women who have served in the war in Iraq and Afghanistan are seen 

and offered appropriate services. During the past 3 years, we have seen more than 

1,500 veterans who served in Iraq and Afghanistan through our outreach efforts and 

more than 400 have sought our assistance and been placed in a VA or VA supported 

community based treatment program. 

As the Committee knows, VA can provide up to $31.30 for each day of care a veteran receives in a Transitional Housing program approved under VA’s Homeless 

Providers Grant and Per Diem Program. We are aware that there are concerns 

about how we make payments to providers under the Grant and Per Diem Program, 

and that as a result of these concerns, H.R. 2699 was introduced to make a number 

of amendments to the program. Although the Department transmitted our views on 

H.R. 2699 to Congress on August 19, 2007, I would like to take advantage of this 

opportunity to discuss VA’s position on the different provisions of the bill. 

Section 1 of that bill would eliminate the statutory offset for other, outside sources 

of income when calculating the amount of a grantee’s per diem payment. While we 

support this provision and appreciate the need for such a measure, we remain concerned that H.R. 2699, as written, could result in a grantee-provider receiving more 

than 100 percent of its costs for furnishing services to homeless veterans. We therefore recommend that Congress amend that provision to ensure safeguards to prevent such an occurrence. 

Section 2 would require the Secretary to carry out a demonstration program in 

at least three locations for the purpose of identifying members of the Armed Forces 

on active duty who are at risk of becoming homeless after they are discharged or 

released from active duty. The demonstration program would also have to include 

the provision (either directly or by contract) of referral, counseling, and supportive 

services to help those members, upon becoming veterans, from becoming homeless. 

Section 2 would further require the Secretary to consult with the Secretary of Defense and other appropriate officials in developing and implementing the criteria for 

identifying those members who are at-risk of becoming homeless. Finally, Section 

2 would authorize the demonstration program up to September 30, 2011, and it 

would also authorize $2 million to be appropriated to carry out the program. 

VA supports Section 2. Research and related literature in this area suggest that 

prevention activities may be of value in identifying high-risk individuals and preventing them from becoming homeless. The challenge, of course, is in our ability to 

consult with others and, to identify criteria that can be used to successfully identify 

those service members who are at high-risk of becoming homeless once they leave 

the service. The demonstration program would help to add evidence to the current 

body of research and help us to determine whether this type of approach is effective 

in reducing the incidence of homelessness among recently discharged veterans. 

The cost of Section 2, if enacted, would be insignificant and absorbed within the 

current budget. 

Section 3 would extend, until September 30, 2011, VA’s current program of referral and counseling for veterans who are transitioning from certain institutions and 

who are at risk for homelessness and will eliminate the program’s demonstration 

status. Section 3 would also expand the program to include at least six more locations, thereby requiring a minimum of 12 sites. 

VA defers to the views of the Department of Labor (DOL), which administers this 

program. DOL’s staff advise us that they believe that the Incarcerated Veterans 

Transition Program pilot stage played an important and successful role in reducing 

recidivism among transitioning veterans who have been incarcerated. 

Section 4 would authorize grants awarded under the Homeless Providers Grant 

and Per Diem Program to be used by service centers to meet staffing requirements. 

erowe on PROD1PC71 with REPORTS

48 

VA supports Section 4 in principle. However, we recommend that the bill be modified so that funding is based on increased per diem payments rates for the service 

center, not provided to the center in the form of a grant. 

Section 5 would require the Secretary to take appropriate actions to ensure that 

the Domiciliary Care programs are adequate, in terms of capacity and safety, for 

women veterans. 

VA supports Section 5. VA has increased, and will continue to increase, the development of women specific residential treatment programs in VA’s domiciliary program. This focus will include efforts to develop new programs for women veterans, 

along with improving therapeutic environments and clinical approaches in existing 

residential program. 

VA, along with our partners, continues to make progress in prevention and treatment of homeless veterans. We firmly believe that one homeless veteran is too 

many. The brave men and women who have served and continue to serve deserve 

no less. 

Mr. Chairman, this concludes VA’s formal statement. We welcome the opportunity 

to respond to any questions you or Members of the Subcommittee may have. 

f 

Prepared Statement of Ronald F. Chamrin, Assistant Director, 

Economic Commission, American Legion 

Mr. Chairman and Members of the Subcommittee: 

Thank you for this opportunity to submit The American Legion’s view on the Department of Veterans Affairs (VA) Grant and Per Diem (GPD) program. 

The Fiscal Year (FY) 2006 Department of Veterans Affairs Community Homelessness Assessment, Local Education and Networking Groups (CHALENG) report estimates that there are nearly 200,000 veterans that are homeless at any point in 

time. According to the February 2007 Homeless Assessment Report to Congress 

(U.S. Department of Housing and Urban Development 2007), veterans account for 

19 percent of all homeless people in America. 

Since 2001, approximately 300,000 servicemembers are becoming veterans every 

year. This large influx of veterans, some of whom have high risk factors of becoming 

homeless, is unnerving. The mistake in incorrectly failing to recognize the increase 

in homelessness amongst Vietnam veterans in the late 1970’s and early 1980’s cannot be made again. 

According to the Urban Institute report in relation to the 1980’s spike in homeless 

veterans (Homelessness: Programs and the People They Serve, Findings of the National Survey of Homeless Assistance Providers and Clients): ‘‘. . . some observers 

felt that the problem was a temporary consequence of the recession 1981–1982, and 

would go away when the economy recovered, while others argued that the problem 

stemmed from a lack of affordable housing and that homeless clients were simply 

a cross section of poor Americans.’’ This 2000 study stated that of current homeless 

veterans: ‘‘21 percent served before the Vietnam era (before August 1964); 47 percent served during the Vietnam era (between August 1964 and April 1975); and 57 

percent served since the Vietnam era (after April 1975). Many have served in more 

than one time period.’’

In order to prevent a national epidemic of homeless veterans in the upcoming 

years, measures must be taken to assist those that are chronically homeless. Steps 

must also be taken to prevent the future homelessness of veterans and their families. 

Therefore, The American Legion strongly supports funding the Grant and 

Per Diem Program for a 5-year period (instead of annually) and supports 

increasing the funding level to $200 million annually. 

The American Legion Homeless Veterans Task Force 

The American Legion coordinates a Homeless Veterans Task Force (HVTF) 

amongst its 55 departments. Our goal is to augment existing homeless veteran providers, the VA Network Homeless Coordinators, and the Department of Labor’s 

Homeless Veterans Reintegration Program (HVRP), Veterans Workforce Investment 

Program (VWIP), Disabled Veterans Outreach Personnel (DVOPs) and Local Veterans Employment Representative (LVERs). In addition to augmentation, we then 

attempt to fill in the gaps where there is no coverage. Each of The American Legion’s Departments contains an HVTF Chairman and an employment Chairman. 

These two individuals coordinate activities with The American Legion’s local posts 

within their state. The three-tiered coordination of these two chairmen and numererowe on PROD1PC71 with REPORTS

49 

ous local posts attempt to symbiotically assist homeless veterans and prevent future 

homelessness. 

The American Legion has conducted training with the assistance of the National 

Coalition for Homeless Veterans (NCHV), DOL–VETS, Project Homeless Connect, 

and VA on how to apply for Federal grants in various assistance programs, most 

notably the ‘‘Stand Down’’ and Grant and Per Diem programs. It is our goal to assist the Grant and Per Diem program by enabling individual posts and homeless 

providers to use The American Legion as a force multiplier. We may not have the 

job-specific expertise in the fields of social work and mental health, but we do have 

2.7 million volunteers with an impressive network of resources within their communities. 

The American Legion augments homeless veteran providers with transportation, 

food, clothing, cash and in-kind donations, technical assistance, employment placement, employment referral, claims assistance, veterans’ benefits assistance, and in 

some cases housing for homeless veterans. The American Legion department service 

officers are accredited representatives that assist homeless veterans with their VA 

compensation and pension claims, and are fierce advocates for assuring that all VA 

benefits are afforded to the unfortunate homeless veterans that they may encounter. 

Potential Homeless Veterans of Operation Enduring Freedom (OEF) and 

Operation Iraqi Freedom (OIF) 

OEF/OIF veterans are at high risk of becoming homeless. Combat veterans of 

OEF/OIF and the Global War on Terrorism (GWOT) in need of assistance are beginning to trickle into the nation’s community-based veterans’ service organizations’

homeless programs. Already stressed by an increasing need for assistance by postVietnam Era veterans and strained budgets, homeless services providers are deeply 

concerned about the inevitable rising tide of combat veterans who will soon be requesting their support. 

Since 9/11, over 800,000 American men and women have served or are serving 

in a war zone. Rotations of troops returning home from Iraq are now a common occurrence. Military analysts and Government sources say the military deployments, 

then the reintegration of combat veterans into the civilian society, is unlike anything the Nation has experienced since the end of the Vietnam War. 

The signs of an impending crisis are clearly seen in VA’s own numbers. Under 

considerable pressure to stretch dollars, VA estimates it can provide assistance to 

about 100,000 homeless veterans each year, only 20 percent of the more than 

500,000 who will need supportive services. Hundreds of community-based organizations nationwide struggle to provide assistance to as many of the other 80 percent 

as possible, but the need far exceeds available resources. 

VA’s HCHV reports 1,049 OEF/OIF era homeless veterans with an average age 

of 33. HCHV further reports that nearly 65 percent of these homeless veterans experienced combat. Now receiving combat veterans from Iraq and Afghanistan daily, 

VA is reporting that a high percentage of those casualties need treatment for mental 

health problems. That is consistent with studies conducted by VA and other agencies that conclude anywhere from 15 to more than 35 percent of combat veterans 

will experience some clinical degree of PTSD, depression or other psychosocial problems. 

Homeless Women Veterans and Children 

Homeless veteran service providers’ clients have historically been almost exclusively male. That is changing as more women veterans, especially those with young 

children, are seeking assistance. Access to gender-appropriate care for these veterans is essential. 

The FY 2006 VA CHALENG (Community Housing Assessment, Local Education 

and Networking Group) report states, ‘‘Homeless providers continue to report increases in the number of homeless veterans with families (i.e., dependent children) 

being served at their programs. Ninety-four sites (68 percent of all sites) reported 

a total of 989 homeless veteran families seen, with Los Angeles seeing the most 

families (156). This was a 10 percent increase over the previous year of 896 reported 

families. Homeless veterans with dependents present a challenge to VA homeless 

programs. Many VA housing programs are veteran-specific. VA homeless workers 

must often find other community housing resources to place the entire family—or 

the dependent children separately. Separating family members can create hardship.’’

To assist women and veterans with families, The American Legion supports adequate funding for all domiciliary programs for all qualified veterans. 

erowe on PROD1PC71 with REPORTS

50 

VA Homeless Providers Grant and Per Diem Program Reauthorization 

In 1992, VA was given authority to establish the Homeless Providers Grant and 

Per Diem Program under the Homeless Veterans Comprehensive Service Programs 

Act 1992, Public Law 102–590. The Grant and Per Diem Program is offered annually (as funding permits) by VA to fund community agencies providing service to 

homeless veterans. VA can provide grants and per diem payments to help public 

and nonprofit organizations establish and operate supportive housing and/or service 

centers for homeless veterans. There was an initial lag in the congressional authorization and appropriations for this program that delayed the delivery of funding 2 

years after the initial legislation passed and only 15 grants were awarded. We have 

observed that the staff of the program has been working diligently and should be 

commended, but the central office staff could use additional members to expand the 

program to reach even more participants. 

The current level of 300 programs and 8,000 beds is not enough to assist 200,000 

homeless veterans. Reports of an additional 3,000 beds to come into service as soon 

as needed construction, renovation or repairs have been completed will bring the 

total to 11,000 or about 5 percent capacity of all homeless veterans. 

Funds are available for assistance in the form of grants to provide transitional 

housing (for up to 24 months) with supportive services. Funds can also be used for 

supportive services in a service center facility for homeless veterans not in conjunction with supportive housing, or to purchase vans. VA can provide up to $31.30 for 

each day of care a veteran receives in a transitional housing program approved 

under VA’s Homeless Providers Grant and Per Diem (GPD) Program. This token 

amount is far too little to fully assist a single veteran. Finally, all providers must 

justify that their costs are attributed to veterans. 

The American Legion is concerned with the ebb and flow of the homeless veteran 

population and assert that measures should be enacted that allows a provider to always maintain a space for a homeless veteran. Due to the transient and drifting 

nature of chronically homeless veterans, seasonal weather changes (allowing more 

homeless veterans to venture outside), and other factors, there are periods when 

GPD providers may have an empty bed. If a provider has an empty space dedicated 

for a homeless veteran under the program and (due to factors out of their control) 

a bed remains empty for a period of time, they have occasional difficulty justifying 

the grant and therefore may be penalized. However, there are many instances in 

which a random appearing homeless veteran requires their assistance and a bed 

must always be ever ready. 

Unfortunately, we have observed that many homeless veteran providers choose 

not to apply for funding from this program due to difficult mechanisms. As stated 

above, the accounting process required for reimbursement is in constant flux during 

the year and the strain of accurately reporting is laden on small community-based 

providers. Additionally, there are other Federal programs that can provide monetary 

assistance to homeless veterans, yet the GPD does not allow these funds to be used 

as a match for VA programs. This often discourages participation. However, other 

Federal programs do allow VA funds to be used as a match. VA’s GPD program requires unique flexibility due to the nature of the funding, homeless veteran providers, and homeless veterans. 

VA reports success in their performance measures to increase access and availability to both primary health care and specialty care within 30 and 60 days. Shortterm assistance (30 and 60 days) is imperative in order to prevent chronic homelessness. Many times, a veteran may be in transition due to loss of a job, a medical 

issue, poor finances, or some other factor and only requires a short-term transitional 

shelter that can be provided by the GPD program. In FY 2006, VA reported that 

they provided transitional housing services to nearly 15,500 homeless veterans and 

expects to assist 18,000 veterans for FY 2007. It is imperative that these numbers 

continue to increase and be adjusted to meet demand; the consequences will be a 

stagnant, steady number of homeless veterans rather than a decrease of the number 

of homeless veterans. 

Departments of Housing and Urban Development—Veterans Affairs Supportive Housing (HUD–VASH) Homeless Program 

The American Legion advocates for increased funding for the Grant and Per Diem 

program and recently adopted a resolution to require mandatory funding for the Departments of Housing and Urban Development (HUD)-Veterans Affairs (VA) Supportive Housing (HUD–VASH) Homeless Program. 

The American Legion supports funding for vouchers for the HUD–VASH Program 

be set aside and transferred to the Secretary of the Department of Veterans Affairs 

from amounts made available for rental assistance under the Housing Choice 

Voucher program. The Homeless Veterans Comprehensive Assistance Act of 2001 

erowe on PROD1PC71 with REPORTS

51 

(P.L. 107–95) codified the HUD–VASH Program, which provides permanent housing 

subsidies and case management services to homeless veterans with mental and addictive disorders. Under the HUD–VASH Program, VA screens homeless veterans 

for program eligibility and provides case management services to enrollees. HUD allocates rental subsidies from its Housing Choice Voucher program to VA, which then 

distributes them to the enrollees. A decade ago, there were approximately 2000 

vouchers earmarked for veterans in need of permanent housing. Today, less than 

half that amount is available for distribution. 

The Veterans Benefits, Health Care, and Information Technology Act of 2006, P.L 

109–461, re-authorizes appropriations for additional rental assistance vouchers for 

veterans. In FY 2007, there will be 500 vouchers available for veterans and increased to 2,500 by FY 2011. At a time when the number of homeless veterans on 

any given night is approximately 200,000, the need for safe, affordable, and permanent housing is imperative. The Senate passed its fiscal 2008 Transportation-Housing spending bill (HR 3074) that funds programs at the Department of Transportation and the Department of Housing and Urban Development. 

The House FY 2008 Transportation, Housing and Urban Development, and Related Agencies (THUD) appropriations bill, H.R. 3074, which passed the House on 

July 24, includes funding for incremental vouchers, specifically targeted to the nonelderly disabled population and homeless veterans. The bill provides $30 million for 

these vouchers. Of the incremental vouchers provided, 1,000 vouchers are to be provided for homeless veterans, in accordance with the HUD–VASH Program. 

The Senate recently passed the THUD appropriations bill, which provides $75 

million for new vouchers for the HUD–VASH Program. Funding, if enacted, should 

be sufficient to provide assistance for 6,000 vouchers affecting approximately 8,000 

to 10,000 homeless veterans. 

Census of Homeless Veterans 

The VA CHALENG program, NCHV, HUD and numerous homeless veteran providers have all collaborated to make rather accurate estimates on the number of 

homeless veterans on the street each night. This number, approximately 200,000 

each night, is a travesty. Because of the numerous systems in place to attempt to 

count the number of homeless veterans, additional funding should be directed to 

programs assisting and preventing homeless veterans and not entirely to assist a 

census program in counting homeless veterans. Funding would be better spent on 

programs and not just exclusively on counting. 

CONCLUSION 

The Homeless Grant and Per Diem program is effective and should be continued 

but augmented with HUD–VASH Program vouchers. With 300,000 servicemembers 

becoming veterans each year and the increased visibility and outreach of all veteran 

programs administered by VA, the availability of transitional housing must be increased. Our observations have shown that when the GPD program is allocated 

money, they are successful in distributing grants and administering their program 

and are only limited by the total dollar amount of funds available. 

The American Legion looks forward to continue working with the Subcommittee 

to assist the nation’s homeless veterans and to prevent future homelessness. Mr. 

Chairman and Members of the Subcommittee, this concludes my testimony. 

f 

erowe on PROD1PC71 with REPORTS

52 

POST HEARING QUESTIONS AND RESPONSES FOR THE RECORD 

Committee on Veterans’ Affairs 

Subcommittee on Health 

Washington, DC. 

October 5, 2007 

Honorable Gordon Mansfield 

Acting Secretary 

U.S. Department of Veterans Affairs 

810 Vermont Avenue, NW 

Washington, DC 20420 

Dear Secretary Mansfield: 

On Thursday, September 27, 2007, Peter Dougherty, Director, Homeless Veterans 

Programs, testified before the Subcommittee on Health on the U.S. Department of 

Veterans Affairs (VA) Homeless Grant and Per Diem program. In September 2006, 

the VA Office of Inspector General (OIG) issued a report, Evaluation of the Veterans 

Health Administration Homeless Grant and Per Diem Program. The Government 

Accountability Office (GAO) also conducted a review in 2006. As a follow-up to the 

hearing and the reports, I request that Mr. Dougherty respond to the following 

questions in written form for the record: 

1. Has VA evaluated the benefits of establishing a centralized office of appropriately trained staff that conduct and ensure the quality of financial assessments of GPD providers? If so, what were the results of the evaluation? 

2. Have GPD program staff received training that explains the difference between 

donations and discounts and emphasizes that provider funding can include nations but cannot include discounts received when purchasing goods or services? 

How is this training translated to the field? 

3. The IG report recommended that the Under Secretary for Health review the 

financial oversight of GPD providers to ensure that per diem rates are accurately established and incurred cost reviews are properly conducted. VHA 

agreed to address this issue by obtaining an advisory and assistance contractor 

to review existing policies and procedures and to make recommendations to improve policies and procedures and financial oversight of the GPD program. 

What is the status of the contractor’s review and what are the preliminary 

findings and recommendations? What specific steps have been taken to improve financial oversight of the program? The target date for full implementation of the recommendations of the contractor is January 2008. Will this date 

be met and if not, why and what is the new target date? 

4. Of the 122 GPD Liaison positions that were funded, how many positions are 

currently filled? When will the remaining positions be filled? What are the specific responsibilities of the GPD Liaisons and has the Handbook been revised 

to reflect these responsibilities? What specific training do the liaisons receive 

and have they all been trained? How does VA measure the effectiveness of the 

training? 

5. Of 21 full-time Network Homeless Coordinator positions that have been funded, how many are currently filled? When will the remaining positions be filled? 

What are the specific responsibilities of the Network Homeless Coordinators? 

How has VHA specifically revised inspection procedures to ensure that GPD 

providers receive timely feedback on the inspection and management of their 

programs? 

6. The September 2006 GAO report, Homeless Veterans Programs Improved Communications and Follow-up Could Further Enhance the Grant and Per Diem 

Program, made the following two recommendations: (1) To aid GPD providers 

in better understanding the GPD policies and procedures, we recommend that 

VA take steps to ensure that its policies are understood by the staff and providers who are to implement them. (2) To better understand the circumstances 

of veterans after they leave the GPD program, we recommend that VA explore 

feasible and cost-effective ways to obtain such information, where possible 

using data from GPD providers and other VA sources. What actions has VA 

taken to respond to these recommendations? 

The attention to these questions by the witnesses is much appreciated, and I request that they be returned to the Subcommittee on Health no later than close of 

business, 5:00 p.m., Friday, November 2, 2007. If you or your staff have any queserowe on PROD1PC71 with REPORTS

53 

tions, please call Dolores Dunn, Republican Staff Director for the Subcommittee on 

Health, at 202–225–3527. 

Sincerely, 

Jeff Miller 

Ranking Member 

Questions for the Record 

Hon. Jeff Miller, Ranking Republican Member 

Subcommittee on Health 

House Committee on Veterans’ Affairs 

September 27, 2007 

VA Homeless Grant and Per Diem Program 

Question 1: Has VA evaluated the benefits of establishing a centralized office of 

appropriately trained staff that conduct and ensure the quality of financial assessments of GPD providers? If so, what were the results of the evaluation? 

Response: The Department of Veterans Affairs (VA) has hired a contractor to 

evaluate the benefit of establishing a centralized office and to evaluate other initiatives that can improve the providing of per diem payments. The recommendations 

provided through the contractor will address whether centralization of per diem rate 

determinations is beneficial and, if so, recommendations would follow regarding the 

resources required to make these per diem determinations in accordance with regulations and statute. This evaluation should be completed in December 2007. 

Question 2: Have GPD program staff received training that explains the difference between donations and discounts and emphasizes that provider funding can 

include donations but cannot include discounts received when purchasing goods or 

services? How is this training translated to the field? 

Response: VA does not provide training to the Grant and Per Diem (GPD) program staff on the difference between donations and discounts, as VA clinical staff 

are not required to understand these differences. VA has hired and relies on an 

auditor to makes determinations on GPD capital invoices submitted for reimbursement. Included as part of the auditor’s review is whether the required match for 

capital expenditures is a donation or discount. Providers are required to call the 

auditor to participate in budget reviews before capital funds are requested; information regarding donations and discounts is given to the provider at that time and the 

auditor advises providers accordingly. It is a concept that VA’s auditor and the 

grantees billing VA must understand. Grantees are to participate in budget reviews 

before capital funds are requested. We feel that it is far more effective to consolidate 

the information from a single source rather than have hundreds of VA employees 

respond to inquiries. 

Question 3: The IG report recommended that the Under Secretary for Health review the financial oversight of GPD providers to ensure that per diem rates are accurately established and incurred cost reviews are properly conducted. VHA agreed 

to address this issue by obtaining an advisory and assistance contractor to review 

existing policies and procedures and to make recommendations to improve policies 

and procedures and financial oversight of the GPD program. What is the status of 

the contractor’s review and what are the preliminary findings and recommendations? What specific steps have been taken to improve financial oversight of the program? The target date for full implementation of the recommendations of the contractor is January 2008. Will this date be met and if not, why and what is the new 

target date? 

Response: Recommendations under the advisory and assistance contract are 

pending. The contractor initiated work during October 2007, and continues to evaluate the feasibility of various methods that could ensure that per diem rates are accurately established and incurred cost reviews are properly conducted. It is expected 

that the target date for implementation of the recommendations will be met; however, full implementation may depend on the extent of the additional resources 

needed. VA has taken specific steps to increase the likelihood of the accuracy of per 

diem rate determinations by standardizing forms and allowing providers to input 

data on the Internet. 

Question 4: Of the 122 GPD Liaison positions that were funded, how many positions are currently filled? When will the remaining positions be filled? What are the 

erowe on PROD1PC71 with REPORTS

54 

specific responsibilities of the GPD Liaisons and has the Handbook been revised to 

reflect these responsibilities? What specific training do the liaisons receive and have 

they all been trained? How does VA measure the effectiveness of the training? 

Response: Presently 111 of the 122 funded GPD liaison positions filled. The Veterans Health Administration (VHA) is recruiting for the remaining vacancies. The 

GPD liaison is responsible for: providing services to, and oversight of, the GPD-funded community-based programs; verifying the veteran status and eligibility of program participants and verifying admission and discharge dates of program participants; collecting and submitting GPD-funded program participant data; complying 

with criminal conflict of interest laws and Executive Branch Standards of Conduct; 

and providing oversight of GPD-funded program participants’ care. The responsibilities of the GPD liaison are reflected in the VHA Handbook 1162.01 (Grant and Per 

Diem Program Handbook) which has been revised and was published August 8, 

2007. 

VHA provides face-to-face training to GPD liaisons. During fiscal 2007 two such 

training sessions were provided. VHA also developed an online training program for 

GPD liaisons which provides information about the GPD program and the role and 

responsibility of the liaison. The effectiveness of liaison training is evaluated 

through post-training surveys and by follow up activities conducted by VA Employee 

Education Service. 

Question 5: Of 21 full-time Network Homeless Coordinator positions that have 

been funded, how many are currently filled? When will the remaining positions be 

filled? What are the specific responsibilities of the Network Homeless Coordinators? 

How has VHA specifically revised inspection procedures to ensure that GPD providers receive timely feedback on the inspection and management of their programs? 

Response: All 21 of the full-time network homeless coordinator positions have 

been filled. Each network homeless coordinator has Veteran Integrated Services 

Network (VISN)-level responsibility for oversight and monitoring of the GPD programs in their VISN. The responsibilities of the network homeless coordinator include; participating in the initial and annual inspections of GPD-funded programs; 

reviewing copies of the completed initial and annual re-inspections in the VISN, and 

ensuring completeness; reviewing the medical centers’ plans of correction that have 

been developed as a result of inspection deficiencies noted in GPD-funded programs 

and tracking follow-up activities associated with the deficiencies; ensuring the annual re-inspections of GPD-funded programs are submitted timely and in the proper 

format and are reviewed and approved by the VA Medical Center Director; forwarding reports regarding the status of each inspection package for their VISN; ensuring GPD-funded community programs are monitored and evaluated as prescribed 

by established protocols; working with GPD liaisons and medical center quality 

management staff to develop risk management and reporting systems for GPD-funded programs; reviewing GPD critical incidents and initiating appropriate investigation and follow-up activities in collaboration with the medical center; providing regular reviews of GPD liaison clinical and administrative documentation to ensure 

compliance with GPD policies and procedures; monitoring liaison follow-up of GPDfunded program clinical care and administrative issues; providing support, guidance, 

and advice to GPD liaisons. 

VA has revised the GPD Handbook to include a policy that GPD liaisons are required to provide the final inspection report to the GPD provider. Under the new 

procedures the finalized inspection form will be signed by both the GPD liaison and 

GPD provider. 

Question 6: The September 2006 GAO report, Homeless Veterans Programs Improved Communications and Follow-up Could Further Enhance the Grant and Per 

Diem Program, made the following two recommendations: (1) To aid GPD providers 

in better understanding the GPD policies and procedures, we recommend that VA 

take steps to ensure that its policies are understood by the staff and providers who 

are to implement them. (2) To better understand the circumstances of veterans after 

they leave the GPD program, we recommend that VA explore feasible and cost-effective ways to obtain such information, where possible using data from GPD providers 

and other VA sources. What actions has VA taken to respond to these recommendations? 

Response: The GPD program has initiated a number of actions to help ensure 

policies are understood by staff and providers. GPD liaison face-to-face training sessions were held in March and August of 2007. These 2-day training sessions included an overview of the GPD program, the rules and regulations, and monitoring 

and inspection procedures. Additionally, monthly conference calls were conducted 

erowe on PROD1PC71 with REPORTS

55 

with liaisons through 2007. The minutes of these calls were placed on the GPD liaison Web page. Web-based liaison training was developed and is currently available 

nationally, and a new VHA Handbook was published and distributed to VA network 

homeless coordinators and GPD liaisons. Additionally, the GPD liaison Web site was 

revised and expanded to include, along with the regulations, handbooks and legislation, template letters, and guidance on reviewing scope and site changes. 

Providers’ conference calls were held for the ‘‘new grant awardees’’ (January, February, and June 2007) and for current operational programs (December 2006, June 

and August 2007). A Providers Web Page was developed and is currently posted on 

the Internet. The Web site includes revised capital grant and per-diem-only grant 

recipient guides, conference call minutes, program rules and regulations, methods 

for calculating per diem rates, relevant public laws, and links to other helpful Web 

sites. 

VA has invested in a total of nine outcome studies of its homeless programs, five 

of which are either under analysis or currently collecting data. We have completed 

three outcome studies of our homeless programs which consistently showed 60–80 

percent of veterans housed at 8–12 month follow-up. In addition, we have completed 

data collection on four outcome studies of homeless programs involving 2,500 homeless veterans that include follow-up of veterans after completion of the program. Finally, two additional programs are underway, one evaluating a critical time intervention, and the other, outcomes for women’s programs. Together, these programs 

represent an investment of several million dollars in evaluating and improving outcomes. 

VA believes that the most feasible and cost-effective approach to understanding 

the circumstances of veterans after they leave the GPD program would be to complete analysis of these data that have already been collected and to determine the 

best approach to further data collection on the basis of the analysis of data already 

collected. Once on-going studies and analyses are completed, VA would have more 

information to make evidence-based decisions on whether to narrow the direction of 

follow up or, as suggested in the report, use more broad parameters such as information from existing data bases. While these efforts are in progress, we will explore 

the feasibility, limits, and utility of using existing health care performance measures 

and quality indicators, stratified on the basis of previous participation in homeless 

programs as a way to evaluate its continued engagement in health care. 

Æ 

erowe on PROD1PC71 with REPORTS