Homeless Veterans Programs: Improved Communications and Follow-up Could Further Enhance the Grant and Per Diem Program
Published: 2006-09-11T00:00:00

Fast Facts:

Highlights:
section_title: Why GAO Did This Study
paragraphs: About one-third of the nation's adult homeless population are veterans, according to the Department of Veterans Affairs (VA). Many of these veterans have experienced substance abuse, mental illness, or both. The VA's Homeless Providers Grant and Per Diem (GPD) program, which is up for reauthorization, provides transitional housing to help veterans prepare for permanent housing. As requested, GAO reviewed (1) VA homeless veterans estimates and the number of transitional housing beds, (2) the extent of collaboration involved in the provision of GPD and related services, and (3) VA's assessment of GPD program performance. GAO analyzed VA data and methods used for the homeless estimates and performance assessment, and visited selected GPD providers in four states to observe the extent of collaboration.
section_title: What GAO Found
paragraphs: VA estimates that on a given night about 194,000 veterans were homeless in 2005. The estimate, generally lower than the numbers reported prior to 2004, is considered by VA officials to be the best available. VA officials believe that its new estimation process and use of better local data have improved the estimate. While VA has increased the capacity of the GPD program over the past several years, VA reports that an additional 9,600 transitional housing beds from various sources are needed to meet current demand. VA has plans to make 2,200 additional GPD beds available. GPD providers collaborate with other agencies to help veterans regain their health and obtain housing, jobs, and various services to enable them to live independently. However, resource and communications gaps may stand in the way of VA and provider efforts to meet these goals. Limited availability of affordable permanent housing, for example, may make it difficult to move veterans out of homelessness, according to GPD providers. We also identified instances of misunderstandings of program policies related to eligibility and program stay limits that could prevent homeless veterans from being admitted into the GPD program. VA assesses overall program performance by the success of veterans in attaining stable housing, income, and self-determination at the time they leave the program. VA data show that the percentage of veterans achieving these goals has generally increased or held steady over time. In 2006, VA also stepped up its assessment of the performance of GPD providers. While these assessments do not indicate how veterans fare after they leave the program, preliminary results of a onetime VA study indicate positive housing outcomes were maintained 1 year later. However, VA does not routinely collect follow-up data and may not be able to determine how veterans who were not included in the study are faring after they leave the program.

section_title: Letter
paragraphs: On any given night in the United States, an estimated 700,000 people,  including veterans, are homeless and sleep on the streets or in shelters.  Veterans constitute about one-third of the adult homeless population,  according to the Department of Veterans Affairs (VA). Many veterans who  are not homeless may be at risk of homelessness as a result of poverty,  lack of support from family and friends, or precarious living conditions in  overcrowded or substandard housing.
To help address the needs of homeless veterans, VA operates several  programs, the largest of which is the Homeless Providers Grant and Per  Diem (GPD) program. Scheduled for reauthorization in 2007, this program  provides a transitional setting to help veterans prepare for permanent  housing. The program is not intended to serve all homeless veterans but is  focused instead on serving those who are most in need, including veterans  whose circumstances make them likely to remain homeless unless they  receive assistance, such as those who have had problems with mental  illness, substance abuse, or both. Through a network of local nonprofit or  public agencies, the program provides beds to homeless veterans in  settings free of drugs and alcohol that are supervised 24 hours a day,   7 days a week. Program rules generally allow veterans to stay with a single  GPD provider for 2 years, but providers have the flexibility to set shorter  time frames. In addition, veterans are generally limited to a total of three  stays in the program over their lifetime. The program’s goals are to help  homeless veterans achieve residential stability, increase their skill levels  or income, and attain greater self-determination.
As Congress considers the reauthorization of the GPD program, you asked  us to review (1) VA estimates of the total number of homeless veterans  and the number of transitional beds available, (2) the extent of  collaboration involved in the provision of GPD and related services, and  (3) VA’s assessment of GPD program performance.
In examining VA’s estimates of the number of homeless veterans, we  reviewed relevant reports and interviewed outside experts as well as  officials with the Bureau of the Census, the Department of Housing and  Urban Development (HUD), and VA’s Community Homelessness  Assessment, Local Education and Networking Group for Veterans  (CHALENG). To assess the extent of coordination among community  partners serving homeless veterans, we visited 13 GPD providers located  in California, Florida, Massachusetts, and Wisconsin, including some in  rural areas as well as large cities. In addition, we analyzed data from a  survey of GPD providers conducted by VA’s Northeast Program Evaluation  Center (NEPEC) and attended a meeting of VA’s Advisory Committee on  Homeless Veterans. We focused our review on those GPD providers  serving homeless veterans in general rather than special subgroups, such  as the chronically mentally ill. In each of these locations, we interviewed  local VA officials, GPD staff, community partners, and, where possible,  current and former program participants. To develop information on GPD  performance, we interviewed officials and analyzed data from NEPEC and  VA’s national program office. Data obtained were considered sufficiently  reliable for our purposes. We coordinated with VA’s Office of Inspector  General so that our review complemented but did not duplicate its recent  review related to GPD financial management and oversight issues. We  conducted our work between August 2005 and July 2006 in accordance  with generally accepted government auditing standards. For more  information on our scope and methodology, see appendix I.
subsections: section_title: Background
paragraphs: The GPD program is one of nine VA programs that specialize in serving  homeless veterans. Six of these programs fall under the responsibility of  the Veterans Health Administration, which obligated about $224 million in  fiscal year 2006 for these programs as well as $1.2 billion for outreach and  treatment of homeless veterans. Outreach is considered particularly  important to locate and serve veterans living on the street and in  temporary shelters who otherwise would not seek assistance. Treatment  involves primary and specialty medical care, mental health care, and  alcohol and drug abuse services for eligible homeless veterans. Three of  the nine programs are run jointly or solely by the Veterans Benefits  Administration that also serves homeless veterans as part of its broader  mission to provide disability compensation and pensions to eligible  veterans. Figure 1 illustrates some of the key programs and services for  homeless veterans—including the GPD program that is the focus of this  report—provided by VA. (App. II provides a general description of the  eight programs not otherwise covered in this report.)
subsections: section_title: GPD Transitional Housing Program for Homeless Veterans
paragraphs: The GPD program—-VA’s major transitional housing program for  homeless veterans—-spent about $67 million in fiscal year 2005. It became  VA’s largest program for homeless veterans after fiscal year 2002, when VA  began to increase GPD program capacity and phase out national funding  for the more costly contracted residential treatment—another of VA’s  transitional housing programs. To operate the GPD program at the local  level, nonprofit and public agencies compete for grants. The program  provides 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.
Capital grants cover up to 65 percent of housing acquisition,  construction, or renovation costs and require that agencies  receiving the grants cover the remaining costs through other  funding sources. Generally, agencies that have received capital  grants are considered for subsequent per diem grants, so that the  VA investment can be realized and the buildings can provide  operational beds.
Per diem grants support the operations of about 300 GPD providers  nationwide. 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. Generally under  this grant, VA does not pay for empty beds. VA makes payments  after an agency has housed the veteran, on a cost reimbursement  basis, and the agency may use the payments to offset operating  costs, such as staff salaries and utilities. By law, the per diem  reimbursement cannot exceed a fixed rate, which was $29.31 per  person per day in 2006. Reimbursement may be lower for providers  receiving funds for the same purpose from other sources.
On 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. Although the primary focus of the GPD  program is housing, grants may also be used for transport or to operate  daytime service centers that do not provide overnight accommodations.  According to VA, in fiscal year 2005, GPD grants supported about 75 vans  that were used to conduct outreach and transport homeless veterans to  medical and other appointments. Also, 23 service centers were operating  with GPD support.
Most GPD providers have 50 or fewer beds available for homeless  veterans, with the majority of providers having 25 or fewer.  Accommodations vary and may range from rooms in multistory buildings  in the inner city to rooms in detached homes in suburban residential  neighborhoods. Veterans may sleep in barracks-style bunk beds in a room  shared by several other participants or may have their own rooms. Figure  2 shows the exteriors and interiors of selected GPD buildings we visited.
Generally housing is either male only or has separate sleeping areas for  males and females. Multipurpose rooms may be available for television,  games, and conversation, as well as communal kitchen facilities where  meals can be purchased or made by the participants themselves. Not all  GPD providers supply food. Some may assist the participants in obtaining  items from community food banks. GPD providers may require veterans to  pay rent, but the rent cannot exceed 30 percent of a veteran’s income,  after deducting the costs of medical, child care, and court-ordered  payments. In addition, veterans may be charged fees for other services not  supported by the GPD grant, such as cable television. According to VA  rules, veterans may stay with a single GPD provider for 24 months or  longer under certain conditions. GPD providers may specify shorter limits  such as 3, 6, or 12 months. In fiscal year 2005, the average stay for veterans  was about 4 months with a single GPD provider.
section_title: Veteran Eligibility for the GPD Program
paragraphs: To meet VA’s minimum eligibility requirements for the program,  individuals must be veterans and must be homeless. A veteran is defined  as an individual who has been discharged or released from active military  service and includes members of the Reserves and National Guard with  active federal service. Although the GPD program definition excludes  individuals who have received a dishonorable discharge, it is less  restrictive in terms of length of service requirements. As a result, some  homeless veterans may be eligible for the GPD program and not eligible  for VA health care. VA does not pay for spouses and children of veterans  who are not themselves veterans, but they may be served by GPD  providers using other funds. Consistent with the definition used in many  other federal programs, VA defines a homeless individual as 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. Prison inmates are not deemed  homeless, but may be at risk of homelessness and may be eligible for the  program upon their release. GPD providers determine if potential  participants are homeless, but VA officials determine if potential  participants meet the program’s definition of veteran. VA officials are also  responsible for determining whether veterans have exceeded their lifetime  limit of three stays in a GPD program and for issuing a waiver to that rule  when appropriate.
Prospective GPD providers may identify additional eligibility requirements  in their grant documents. Because the providers are responsible for  providing a clean and sober environment that is free of illicit drugs, about  two-thirds of providers require that veterans entering the program be  sober and free from alcohol and drug use for a given length of time. The  time frames set by many providers range from 1 to 30 days of sobriety.  Many providers also conduct drug tests of veterans after they enter the  program to ensure their continued sobriety. Most providers will not accept  veterans considered to be a danger to themselves or others, in need of  detoxification, or under the influence of drugs or alcohol. About one-fifth  of providers also exclude veterans who are considered seriously mentally  ill, because the providers may not be able to provide adequate care.
section_title: Characteristics of Veterans Eligible for the GPD Program
paragraphs: The GPD program is focused primarily on helping those most in need— veterans who might remain homeless for long periods of time if no  intervention occurs—and is not intended to serve all homeless veterans.  About two-thirds of homeless veterans in the program in fiscal year 2005  had struggled with alcohol, drug, medical, or mental health problems.  About 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 over 2,500 who served in military operations in the  Persian Gulf, Afghanistan, and Iraq. Almost all homeless veterans seen by  VA are males; about half are between 45 and 54 years old, one-quarter are  older, and one-quarter are younger. African-Americans are  disproportionately represented, constituting the largest racial group at   47 percent; whites are the next largest group at 45 percent. About   75 percent of veterans are either divorced or never married.
section_title: Roles of Various Agencies Serving Homeless Veterans
paragraphs: The complex problems faced by homeless veterans require a system of  comprehensive, integrated services that often involves multiple  organizations. Key federal agencies with programs specifically targeted to  the homeless, including veterans, are HUD, the Department of Health and  Human Services (HHS), and the Department of Labor (DOL). HUD makes  funds available to bring together community organizations to plan and  coordinate service delivery through local or regional networks designated  as the “Continuums of Care.” In their planning role, the Continuums  arrange for counts of the homeless in their area, and since 2003, are  required to report the number for a given point in time and to do so at  least every 2 years. Further, as part of their coordination role, the  Continuums review agency applications for certain HUD grants. HUD also  funds emergency shelters that are open seasonally or year-round for  temporary, overnight accommodations. In addition, HUD is the only  federal agency that is authorized to provide permanent subsidized housing  for the homeless. HHS specializes in funding health care and researching  the needs of homeless with substance abuse and mental health issues.  DOL, like VA, has programs targeted specifically to veterans within the  homeless population, with DOL’s emphasis on helping veterans obtain  employment. Charities, businesses, and state and local governments are  also involved in meeting the needs of homeless veterans and, in some  cases, providing funding to GPD providers.
At the federal level, VA works with these and other federal agencies  through two key committees. VA’s Advisory Committee on Homeless  Veterans is responsible for assessing the needs of homeless veterans and  determining if VA and others are meeting these needs. The committee  comprises homeless veterans, experts and advocates, community-based  service providers, state and federal government officials, and  representatives of veterans’ service organizations. The committee has  made several recommendations on improvements to homeless veterans’  programs, including the GPD program, some of which have been  implemented. In 2004 the committee urged VA to fund GPD providers  serving veterans with special needs, especially female veterans; in fiscal  year 2005 there were 29 programs of this kind, including 8 for female  veterans.
VA is also a participant on the Interagency Council on Homelessness,  which coordinates the federal response to homelessness and works with  state and local governments to develop plans for ending chronic  homelessness among individuals, including veterans, in 10 years.  Although the chronic homeless represent only 10 to 20 percent of all  homeless adults, they take up roughly half of all shelter beds and also use  a disproportionate share of resources for the homeless.
At the local level, VA works with various agencies through the Community  Homelessness Assessment, Local Education and Networking Groups for  Veterans, referred to as Project CHALENG. An arrangement of this kind is  needed, according to VA, because no single agency can provide the full  range of services required to help homeless veterans become more  productive members of society. Through CHALENG, a designated VA  official in each medical center, usually VA’s homeless coordinator, reaches  out to community agencies that provide services to the homeless to raise  awareness of homeless veterans’ particular needs and to plan to meet  those needs. Specific needs to be addressed include outreach, counseling,  health care, education and training, employment, and housing. Every year  these VA officials prepare estimates of the total number of homeless  veterans in their area, based on input from various sources. In addition,  the officials meet with community representatives to complete a survey of  available resources, additional resources needed, priorities for service,  and an action plan.
section_title: VA Estimates about 194,000 Veterans Are Homeless and Has Increased Its Capacity to Provide Transitional Housing
paragraphs: VA estimates that on a given night in fiscal year 2005 about   194,000 veterans were homeless. The estimate, generally lower than the  numbers reported prior to 2004, is considered by VA officials to be the  best estimate available. VA officials believe that a new methodology and  use of local HUD data has improved the estimate, although some homeless  veterans may not have been included because they could not be found  when the estimate was developed. While VA has increased its capacity to  provide transitional housing for homeless veterans in recent years, its  program planning efforts indicate that an additional 9,600 transitional  housing beds from various sources are needed to meet current demand.  VA officials report that they are working to operationalize an additional  2,200 beds for the GPD program.
subsections: section_title: VA Considers Its Homeless Veterans Estimate to Be the Best Available
paragraphs: VA bases its national estimate of homeless veterans on the summation of  local estimates developed by VA officials for the areas served by VA  medical facilities. This process is part of the annual CHALENG planning  effort, which involved 135 local VA officials in 2005. Local VA officials are  not responsible for conducting their own counts of homeless veterans, but  are expected to rely on data from other groups that have collected these  data. More than 75 percent of VA officials use multiple data sources, in  part because the areas covered by VA medical facilities often comprise  several cities, counties, or even states, while local data sources may cover  one or more of these jurisdictions, but rarely cover the full area served by  the medical facility. Most often, local VA officials rely on data collected by  the HUD-funded Continuums of Care, local governments, university  researchers, or other groups along with information from local homeless  providers. The estimates reported by local VA officials are compared to  the previous year’s and if they have significantly changed, the local VA  officials are asked to explain the differences before their estimates are  incorporated into the national figure.
Prior to 2004, local VA officials used a methodology to develop their  estimates that was the equivalent of mixing apples with oranges and, as a  result, yielded less consistent, reliable counts of the homeless veteran  population. This mixed methodology combined cumulative numbers such  as the total who were homeless over the course of a year with point-in- time numbers involving the number homeless on any given day or night.  The numbers were not comparable because over the course of a year some  individuals who were not homeless when the counts were conducted later  became homeless. Generally, the number of veterans who are homeless  sometime over the course of a year is larger than the number who are  homeless on any given night. Since 2004, local VA officials have been  directed to use point-in-time data exclusively in developing their estimates  to reflect the number of homeless veterans on any given day of the year.  VA reports that this standardized method yields more reliable estimates  than were developed for earlier years, although there may be some  veterans who cannot be located. Figure 3 shows VA’s estimates of the  homeless veteran population from fiscal years 2000-2005.
Recent estimates are also likely to be more reliable, according to VA,  because local VA officials increasingly use homeless data from counts  funded by HUD’s Continuum of Care, which are believed to be more  accurate. In 2005, more than twice as many local VA officials used HUD  counts as was the case in 2003. HUD-funded counts in many communities  are gradually improving as the census takers increasingly seek out the  “hidden” homeless who do not contact service providers as well as the  homeless who congregate at soup kitchens and shelters. In both Atlanta  and Los Angeles, homeless individuals were hired in 2005 to assist the  census takers in locating areas where homeless individuals could be  found. As a result, the local counts that were conducted in these two  communities were more accurate than the counts conducted in earlier  years, according to VA officials.
Although VA officials believe that the number is likely an underestimate,  VA officials consider their 2005 year estimate of 194,000 homeless veterans  on any given night to be the best available. Counting the homeless is a  challenge for several reasons, as VA and other agencies have  acknowledged, since the homeless are hard to locate and some may not  be included in the current estimate. Also, the number may change in  relation to social and economic factors, such as job layoffs or a tighter  housing market. In addition, veterans who are doubled up and sharing  crowded living quarters with others are considered at risk of becoming  homeless but are not included in the counts because they do not meet VA’s  definition of homeless.
section_title: VA Expanded GPD Program Capacity and Plans Further Expansion to Help Meet Homeless Veterans’ Needs
paragraphs: Since fiscal year 2000, VA has almost quadrupled the number of available  beds and the number of admissions of homeless veterans to the GPD  program in order to address some of the needs identified through the  CHALENG survey. In fiscal year 2005, VA had the capacity to house about  8,000 veterans on any given night. However, 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 16,600 veterans  into the program. Figure 4 illustrates the growth in GPD program capacity  from fiscal years 2000 through 2005.
VA has pursued a policy of making GPD beds available in all states and the  District of Columbia, in line with the recommendation made by the VA  Advisory Committee on Homeless Veterans. As shown in figure 5, all but  three states had beds available in May 2006, and VA officials told us that  they were working with potential providers to develop the capacity in  these states. The greatest number of beds is in California (1,867 beds);  Florida and Massachusetts (430 and 378 beds, respectively); and New  York, Ohio and Pennsylvania (274, 261, and 332 beds respectively).
VA’s CHALENG report found that about 45,000 transitional housing beds  were needed in fiscal year 2005 to help homeless veterans become more  socially and economically independent. As shown in table 1, the report  identified over 35,000 transitional housing beds that were available  through various sources for this purpose—-including the GPD beds,  another 2,400 beds funded by VA through its other specialized homeless  programs, and additional beds funded by other sources. Still needed were  about 9,600 more transitional housing beds nationwide beyond the number  currently available to meet the demand in fiscal year 2005. To begin to  address the demand, VA officials told us that, as of May 2006, they have  negotiated an additional 2,200 beds for the GPD program that are expected  to be available in the near future.
Although VA reports the need for transitional housing beds is greater than  the capacity, the demand varies throughout the year and by location. Some  GPD programs we visited had vacancies and others had waiting lists at the  time of our visit. GPD providers and VA officials identified several reasons  that beds may go unfilled at any given time. Some beds are held for  veterans who are receiving medical treatment, while others may be  unfilled as a result of the normal transition when one veteran has left the  program and another veteran will soon be entering the program.
VA officials and GPD providers also told us they expect a change in the  demographics of homeless veterans that may require them to reconsider  the type of housing and services that they are providing with GPD funds.  Specifically, VA officials expect to see more homeless women veterans  and more veterans with dependents who are in need of transitional  housing. GPD providers told us that women veterans have 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. To meet the needs of homeless women  veterans, VA has provided additional funding in the form of special needs  grants to a few GPD programs.
section_title: GPD Providers Collaborate to Offer a Range of Services but Still Face Challenges in Helping Veterans
paragraphs: GPD providers often worked with public and nonprofit agencies to offer a  spectrum of services that may help veterans meet individual and GPD  program goals. While GPD providers were generally able to build  successful partnerships, most of them identified resource gaps that  presented challenges to helping veterans, particularly affordable  permanent housing. We also found that communication issues related to  program policies could prevent veterans from being offered care.  Providers did not always understand eligibility requirements such as  which veterans may be eligible for the program and the allowable number  and length of program stays. Further, providers were not always aware of  policy changes.
subsections: section_title: GPD Providers Create Partnerships to Help Veterans Meet Program Goals, but Resource Gaps Remain
paragraphs: GPD providers generally created partnerships to help prepare veterans to  obtain permanent housing and, ultimately, to live independently. VA’s  grant process encourages such collaboration by awarding points to GPD  program applicants that demonstrate they have relationships with other  organizations. GPD providers are to identify how they will provide  services to meet the program’s goals—residential stability, increased skill  level or income, and greater self-determination. For example, providers  may identify services such as substance abuse and mental health  treatment, financial counseling, employment assistance and training,  transportation to appointments and job interviews, and related services.  We found variation in the agencies that provided these services. According  to a VA survey, most GPD providers used their own on-site staff to offer  services like case management and transportation assistance. In contrast,  mental health assessments were mostly handled indirectly, with 79 percent  of the GPD providers using the staff of other agencies, often the VA. (More  information from the survey can be found in app. III.)
The GPD providers that we visited established partnerships with state and  local government agencies, other federal agencies, and local community  organizations. Further, several of the providers that we visited participated  in the local Continuum of Care funded by HUD or in other community  coalitions, taking advantage of community networks that serve homeless  individuals. While most providers offered a range of services, not all  veterans received each service. To identify the specific services a veteran  may need, providers typically worked with veterans to develop individual  treatment plans that identified the veteran’s needs on entering the  program. Table 2 lists examples of services and partners of GPD providers  we visited.
GPD programs often collaborated with VA and others to provide health  care-related services—such as mental health and substance abuse  treatment, and family and nutritional counseling—to help veterans  become more self-sufficient in their day-to-day activities. Several programs  hosted Alcoholics Anonymous meetings and other counseling services,  while some GPD programs expected veterans to attend regular meetings  elsewhere in the community. At least two GPD providers we visited  provided their own substance abuse treatment and did not rely on  community partners to provide such services. At least two other providers  that referred veterans to VA for substance abuse treatment expressed  concerns about waiting lists for that service, making it hard for veterans to  access care immediately. Typically, a VA local medical center provided  veterans with primary and specialized health care. However, GPD  providers sometimes expressed concerns about difficulties obtaining  dental care. To meet the needs of veterans who were not eligible for VA  health care, GPD providers made other arrangements. For example, a  program in the Boston area partnered with the local hospital which  provided free health care to homeless veterans who were in the GPD  program but were ineligible for VA health care. We also found that many  providers either used their own staff or used partners’ staff to provide  mental health services and family and nutritional counseling services.
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. For  example, a Wisconsin GPD provider worked with a county veterans’  service officer who reviewed veterans’ eligibility for state and federal  benefits. The provider also had a relationship with a county employment  representative who came to the GPD facility to discuss job searches,  training, and other employment issues with veterans. Several providers  were receiving DOL grants to provide employment training services,  worked with local colleges, or relied on other local programs to help  veterans to increase skills. However, a lack of available jobs in an area  may sometimes pose problems to finding employment for veterans.
Most of the GPD providers in the areas that we visited worked with  community partners to obtain permanent housing for veterans ready to  leave the GPD program, but indicated this was sometimes difficult  because of limited affordable permanent housing. Some providers had  established extensive partnerships with organizations that provide or find  affordable permanent housing. For instance, several of the providers  worked with the local HUD-funded Continuum of Care network to identify  permanent housing resources. Some providers had or were applying for  HUD funds to build single room occupancy housing units that could serve  as a transition to more permanent long-term housing. As at least one  provider mentioned, veterans sometimes become resourceful and agree to  share apartments. In some instances, providers have asked for an  extension to allow veterans to stay until housing becomes available.
GPD providers and VA staff coordinated with community resources to  help address other issues that they identified that might also present  obstacles for transitioning veterans out of homelessness. For example,  staff in some locations indicated that such legal issues as criminal records  or credit problems may preclude veterans from obtaining employment and  housing. To help overcome these issues, some GPD providers worked with  lawyers who provided services at no cost or other volunteer organizations.  Staff in some of the locations also reported that transportation issues  made it difficult for veterans to get to medical appointments or  employment-related activities. To help address potential transportation  difficulties, some providers received GPD grants to purchase vans. One  provider that we visited partnered with the local transit company that  provided subsidies to homeless veterans. This option is not always  available, however, and transportation remained an issue in areas not near  a medical center.
section_title: Communication of Program Polices May Affect Providers’ Ability to Serve Veterans
paragraphs: VA has five staff in the national program office who administer the GPD  program through a network of 21 regional homeless coordinators and   136 local VA liaisons. While program policies are developed at the national  level by the GPD program staff, the local VA liaisons designated by VA  medical centers have primary responsibility for communicating with GPD  providers in their area. Figure 6 depicts the flow of information about the  GPD program.
The VA liaisons may serve in a full-time or part-time capacity, in part  depending on the number of GPD beds in the area served by the VA  medical centers and the number of admissions per year. In fiscal year  2006, there were 60 full-time liaisons and another 76 individuals serving as  part-time liaisons in addition to their other VA duties. Liaisons sometimes  found it hard to readily assist providers, according to some staff we met,  because of the liaisons’ 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 help address this issue, VA has set aside additional funding for  more full-time liaisons.
The program office communicates with GPD providers and VA liaisons  through written guidance and teleconferences. VA provides liaisons with a  guidebook about their responsibilities and the program rules as well as a  manual prepared by NEPEC on the forms to be completed for all program  participants. To stay up-to-date on GPD program policies, liaisons  participated in monthly conference calls and also had the opportunity to  attend a conference conducted by the GPD program office in 2004. The  program office recently held a training seminar for new liaisons and also  offers training via phone. VA also gives GPD providers program  handbooks and holds monthly conference calls to discuss program rules.  In addition, some of the VA medical centers we visited held meetings with  local GPD program providers in their areas to share information.
Despite VA’s efforts, we found that some providers did not understand all  of the GPD program policies. Some misunderstandings could affect a  veteran’s ability to get—and a GPD provider’s ability to offer—care. For  instance, two providers said that VA staff told them that veterans eligible  to participate in the GPD program were also required to be eligible for VA  health care, but this is not the case. Similarly, in another location, the local  VA liaison and a provider both told us that they had received information  from the GPD program office indicating that the total lifetime length of  stay was 2 years, but the GPD program officials told us this interpretation  of the information that they provided is incorrect. Elsewhere several  providers understood the lifetime limit of three GPD stays but may not  have known or believed that waivers to this rule could be granted. They  argued that the limit could hinder a veteran’s ability to participate in the  GPD program if participation involved phased care offered by separate  GPD providers, each specializing in certain phases of treatment, such as  detoxification or job preparation. Since each phase of treatment is  counted as one GPD stay, veterans may exhaust their 3-stay limit before  they have received services vital to their improved functioning. Although  VA has the authority to waive the 3-stay limit in such cases, these  providers did not seem to understand that this option was available to  them. In addition, providers were not always aware of changes in the  GPD program in a timely fashion; sometimes not at all. For example, not  all GPD providers knew in 2006 that their program’s inspections would  include a review of whether they were meeting the objectives described in  their GPD grant documents.
VA recognizes that communication to providers and liaisons needs to be  improved. In its fiscal year 2005 report, the VA Advisory Committee on  Homeless Veterans recommended that VA hold an annual conference and  that each GPD provider have an opportunity to attend at least one such  conference. The purpose of the conference would be to improve  communications, program compliance, and treatment strategies. In the  spring of 2006 when the committee reconvened, VA had not yet accepted  the committee’s recommendation.
section_title: VA Data Show That the GPD Program Helps Veterans Get Housing and Income, but Data Are Limited on Veterans’ Circumstances after They Leave the Program
paragraphs: VA data show that in fiscal years 2000-2005 a steady or increasing  percentage of veterans had stable housing, income, and greater self- determination at the time they left the GPD program. These national  performance results are derived from standard forms filled out by VA staff  or by provider staff with VA’s review and sign-off for every veteran who  leaves the program for any reason. While the veterans’ success is VA’s  primary measure of program performance, in 2006 VA took steps to ensure  that the performance of individual GPD providers would also be reviewed,  in line with a recommendation of VA’s Office of Inspector General (OIG).  Some GPD providers we visited had stated in their grant documents that a  certain percentage of veterans they served would have permanent housing  or employment a year after they left the program. Also, VA recently  completed a onetime study looking at longer-term outcomes for homeless  veterans, including 520 who participated in the GPD program, and  preliminary results show that positive housing outcomes were maintained  1 year after veterans left the GPD program. However, VA does not  routinely collect follow-up information to determine the status of  participants at specified times after they leave the program and may not be  able to rely on the results of its study to determine the success of future  program participants.
subsections: section_title: Many Veterans Attain Stable Housing, Income, and Greater Self- Determination Immediately upon Leaving the Program, According to VA Data
paragraphs: The following sections compare VA’s GPD performance data from fiscal  year 2005 with data from fiscal years 2000 through 2004.
subsections: section_title: Stability in Independent and Secured Housing
paragraphs: VA reports that about 81 percent of veterans had arranged some form of  housing at the time they left the GPD program in fiscal year 2005, a  significant improvement over the 56 percent with housing in fiscal year  2000. VA considers the program successful if veterans have obtained either  independent or secured housing. Independent housing comprises  apartments, rooms, or houses, while secured housing includes transitional  housing programs, halfway houses, hospitals, nursing homes, or similar  facilities. Most of the improvement in housing outcomes has occurred in  independent housing. While independent housing may be a more desirable  outcome, for some veterans, including those with severe disabilities,  secured housing may be more appropriate. Figure 7 shows the percentages  of veterans who had arranged housing when they left the GPD program in  fiscal years 2000 through 2005.
In its annual reports, VA compares the housing arrangements of veterans  who successfully met provider requirements with those who did not. As  might be expected, proportionately more veterans who met requirements  had obtained independent housing in fiscal year 2005—-nearly   70 percent—compared to the 40 percent with independent housing who  had not met provider requirements. In terms of numbers, about half of the  15,000 veterans who left the program in fiscal year 2005 were considered  by the GPD providers to have met program requirements, an improvement  over earlier years. Of the approximately 7,500 veterans remaining, about  half dropped out and the other half violated program rules, such as rules  on maintaining sobriety, or they left for other reasons. VA derives this  information from discharge forms completed by VA or GPD staff for all  veterans at the time they leave the program. VA’s evaluation center  NEPEC aggregates this data and prepares annual reports on overall GPD  program performance. For more on this process, see appendix IV.
section_title: Income from Employment or Financial Benefits
paragraphs: The program goal of increased income can be achieved through  maintaining or obtaining employment or financial benefits such as VA  disability compensation or pensions, Supplemental Security Income, or  food stamps. From fiscal years 2000 to 2005, about one-third of veterans  had jobs, mostly on a full-time basis, when they left the GPD program. The  number of veterans with jobs more than tripled over the period, with  about 4,900 employed in fiscal year 2005 at the time they left the program.  The number of veterans receiving VA benefits when they left the GPD  program was about 3,800, while another 2,200 veterans had applied or  planned to apply for VA benefits. Table 3 shows the percentages and  numbers of those employed or receiving benefits for fiscal years 2000  through 2005, but VA did not have data on receipt of benefits until 2003.
To track greater self-determination, VA examines such goals as veterans’  progress in handling of alcohol, drug, mental health, and medical problems  and overcoming deficits in social or vocational skills. A greater  proportion of veterans leaving the program each year have met these  goals, with 57 to 69 percent showing improved functioning in fiscal year  2005, as shown in figure 8.
These improvements have occurred while the proportion of veterans who  entered the GPD program with a history of such problems remained  constant or increased. Specifically, the proportion entering with substance  abuse problems who left the program in fiscal years 2000 through 2005  remained relatively constant, while the proportion of veterans with a  history of mental or medical illness more than doubled, according to VA  data. See table 4.
In addition to assessing the program through the success of its veterans,  VA policy calls for all VA liaisons to review the performance of individual  GPD providers in meeting objectives that are identified in their grant  documents. Providers are required to establish specific measurable  objectives for each of the three program goals. To reach the housing goal,  for example, some providers we visited established savings objectives,  requiring veterans to set aside a portion of any income they receive so that  they can accumulate sufficient cash reserves to cover costs of renting a  room or apartment when they leave the program. Most providers we  visited also set outcome objectives for the percentage of veterans  expected to obtain independent housing when they left the program. For  the income goal, some providers set objectives requiring that a certain  percentage of veterans be offered or enrolled in vocational training,  develop résumés, interview for jobs, or apply for entitlement benefits.  Most providers also set objectives that a certain percentage of veterans  would find work. For the self-determination goal, some providers required  that a certain percentage of veterans maintain sobriety or attend weekly  Alcoholics or Narcotics Anonymous meetings.
In its 2006 examination of the GPD program, VA’s OIG found, however,  that many providers had not tracked their performance in achieving these  objectives and some VA liaisons had not reviewed the providers’  performance. The OIG recommended that VA liaisons ensure that the  providers’ performance be monitored. 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. The VA liaison will have the flexibility to determine the  method for reviewing and recording the providers’ performance, so long as  the results are documented. GPD providers who do not meet performance  objectives will be required to work with their local VA staff to create a  corrective action plan or resubmit their applications with new objectives.
section_title: VA Does Not Routinely Collect Data on Veterans’ Long-Term Success, but Recent Study May Provide Insights on How Veterans Fare a Year after Leaving the Program
paragraphs: VA does not require that veterans be contacted for purposes of program  evaluation after they leave the GPD program. With a view to the long-term  health of veterans, however, VA attempts to have its clinicians provide  GPD participants with a substance abuse or mental health assessment  within 2 months of leaving the program. In addition, the forms completed  when veterans leave the GPD program identify any follow-up that may  have been arranged to help them continue to cope with problems that they  have experienced. While follow-up is not required, about 80 percent of  GPD providers reported that they conduct some sort of follow-up with  veterans after they leave the GPD program. Providers may call veterans  who have left, obtain data on those who return for additional support  services, or arrange reunions or other gatherings. Some grant documents  also indicate that the providers planned to measure their performance, in  part by following up with veterans from 3 to 12 months after they left the  program. Some providers follow up to meet the requirements of non-VA  funding they receive. Several providers we interviewed had DOL grants  requiring them to report the employment status of veterans 3 and 6 months  after they left the DOL program. These providers were able to report  results for the veterans deemed employable who participated in both the  GPD and DOL programs. However, GPD participants who were deemed  unemployable because of their disabilities may not have been included in  the DOL program. While many providers attempt to follow up with  veterans, several told us that it is sometimes difficult to maintain contact,  especially with veterans lacking telephones or reliable mailing addresses  and with veterans who have moved away from the area.
While VA considers it important for veterans to achieve immediate success  on leaving the GPD program, homeless veterans may experience setbacks  later on that may negatively affect their housing arrangements,  employment and financial benefits, and self-determination. Furthermore,  veterans who were not immediately successful on leaving the program  nevertheless may have benefited from participating and may be able to  achieve success at a later time. To explore the long-term outcomes of  program participants, VA funded a onetime follow-up study in May 2001 to  examine the outcomes for a randomly selected sample of about   1,300 veterans spread across five geographic locations who were  participating in the GPD program and two other VA-sponsored homeless  programs. According to a VA official, the cost of the study was about   $1.5 million. Included in the sample were 520 veterans housed with   19 GPD providers. Proportionately more veterans in the GPD programs  were chronically homeless, while veterans in one of the other programs  had higher levels of serious medical and psychiatric problems and greater  impairments. At the time of selection, the veterans had various lengths of  stays in these programs.
For the study, university and RAND Corporation researchers interviewed  veterans to determine their status at 1, 3, 6, and 12 months after they left  the programs, with the last interviews conducted in October 2005. About  360 of the former GPD participants responded to the last interviews. VA  officials do not expect to release final results of the study until 2007, but  preliminary results show that just over 80 percent of the GPD participants  had housing 12 months after they left the program. Other outcomes that  are expected to be included in the report are the number of days that the  veterans have either been housed or homeless, their income and  employment situation, their use of drugs and alcohol, their physical and  mental health status, and quality of life.
section_title: Conclusions
paragraphs: Addressing homelessness is a daunting challenge, given the difficulties  associated with identifying those who need help and the broad spectrum  of services that need to be successfully tailored, coordinated, and  delivered in order to enable individuals and even families to secure  permanent housing and to live more independently. Limited resources— particularly the availability of affordable permanent housing—make this  job even more difficult. Moreover, the physical and emotional conditions  including substance abuse, and mental illness, prevalent in the homeless  veteran population further increase the difficulty.
VA has taken a number of steps to tackle this challenge by enhancing its  ability to estimate how many veterans need assistance, increasing the  number of GPD beds, instituting measures that help gauge the program’s  effectiveness, and through the GPD program, working proactively with  local and federal government agencies and nonprofits to provide the  assistance needed. However, more could be done to optimize VA’s  investment, particularly with respect to ensuring policies and criteria are  clearly understood and consistently applied and assessing longer-term  outcomes. In enhancing communications, VA will need to identify effective  ways of sharing information with the more than 100 agency liaisons in  addition to the 300 local GPD program providers—each with a potentially  different means of operating. In assessing longer-term outcomes, VA will  need to weigh the costs, benefits, and feasibility of implementing a variety  of analytical approaches. Clearly, these endeavors will not be easy, but  they are critical to better equipping VA to help homeless veterans.
section_title: Recommendations for Executive Action
paragraphs: We recommend that the Secretary of Veterans Affairs take the following  two steps to improve and evaluate the GPD program:  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. For example, VA could make more information, such  as issues discussed during conference calls, available in writing or  online, hold an annual conference, or provide training that may also  include local VA staff.  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. For example, VA could  review ways to use the data from its own follow-up health assessments  and from GPD providers who collect follow-up information on the  circumstances of veterans whom they have served.
section_title: Agency Comments and Our Evaluation
paragraphs: We provided a draft of this report to VA for review and comment. VA  agreed with our findings and concurred with our recommendations and  provided information on initiatives it has under way or planned that will  address issues raised in our report as well as other challenges the GPD  program faces.
VA concurred that there is an apparent lack of consistency in GPD  program implementation and stressed its commitment to further enhance  communications with VA liaisons and GPD providers, including providers  whose operations are still in the developmental stage.  For example, VA  plans to develop a comprehensive GPD implementation plan that will  address several operational issues, including training and certification  requirements.  As well, for the first time, the VA’s Veterans Health  Administration plans to host a conference or series of regional  conferences for GPD providers and VA liaisons to review program  requirements and expectations.  VA estimates these conferences will take  place in spring 2007.
VA also concurred with the need to better understand the circumstances  of veterans after they leave the GPD program and stated that it has plans  in place to address optional approaches for long-term study in this area  after it completes an analysis of its longitudinal outcome studies of VA’s  homeless program.  In the interim, VA said it would continue to explore  options for using existing data to evaluate program effectiveness.
However, the agency disagreed with the statement in our draft report that  VA officials attribute the decrease in the estimates of homeless veterans to  VA’s estimation process and better local data. VA believes that the recent  decrease in the estimates is a direct result of its progress in treating these  veterans through the GPD program.
Several factors may have contributed to the decrease in the estimates of  homeless veterans.  We did not intend to imply that the decrease was  solely attributable to changes in VA’s estimation process and better local  data, nor did we intend to downplay VA’s program successes. We have  revised the language in this report accordingly.
VA’s written comments appear in appendix V. VA also provided technical  comments, which have been incorporated into the report as appropriate.
We are sending copies of this report to the Secretary of Veterans Affairs.  We will also make copies available to others on request. In addition, the  report will be available at no charge on GAO’s Web site at  http://www.gao.gov. If you or your staff have any questions about this  report, please contact me at (202) 512-7215 or chaplainc@gao.gov. Contact  points for our Offices of Congressional Relations and Public Affairs can be  found on the last page of this report. GAO staff who made major  contributions to this report are listed in appendix VI.
section_title: Appendix I: Scope and Methodology
paragraphs: The objectives of this report were to review (1) Department of Veterans  Affairs (VA) estimates of the total number of homeless veterans and the  number of transitional beds available, (2) the extent of collaboration  involved in the provision of Homeless Providers Grant and Per Diem  (GPD) program and related services, and (3) VA’s assessment of GPD  program performance.
In conducting our review, we focused on the GPD providers that serve the  general homeless veteran population rather than those serving veterans  with special needs, although we visited some special needs grantees. We  interviewed officials at VA headquarters, the GPD program office, the  regional Veterans Integrated Service Networks, VA’s Northeast Program  Evaluation Center (NEPEC), and organizations knowledgeable about  homeless veterans’ issues, including the National Coalition for Homeless  Veterans. To gain an initial understanding of the GPD program in  operation, we spoke with staff and toured GPD facilities in Baltimore,  Maryland; Denver, Colorado; and Washington, D.C. To develop greater in- depth material for this report, we made more extensive visits to 13 GPD  providers that fall under the responsibility of VA’s medical centers in  Boston, Massachusetts; Los Angeles, California; Tampa, Florida; and  Tomah and Madison, Wisconsin. We selected these GPD providers to  obtain a range of geographic locations, size of programs, and proximity to  VA medical centers. (See table 5 for a listing of sites we visited and their  characteristics.) During our visits, we toured GPD facilities, interviewed  GPD providers, medical center staff, community agencies that partner  with the GPD providers, and current and former GPD program  participants. Additionally, we interviewed staff but did not tour facilities of  16 other GPD providers in the areas we visited. We also met with GPD and  other service providers at conferences sponsored by the Departments of  Labor and Health and Human Services.
Throughout our review, we worked with the VA’s Office of Inspector  General (OIG) to ensure that we complemented but did not duplicate a  review it was conducting on GPD program management. The OIG’s review  was designed to determine if records demonstrate that (1) homeless  veterans receive appropriate assessment and treatment, (2) GPD provider  performance is evaluated and actions are taken to improve conditions,   (3) GPD providers achieve their stated goals, (4) VA’s guidelines for the  inspection of GPD facilities are followed, (5) GPD operations are properly  monitored by VA, and (6) fiscal controls are adequate. Although the OIG’s  report was not available at the time we prepared our report, we were  briefed on results that were relevant to our work and incorporated the  information as appropriate. In addition, we discussed with the OIG’s team  our selection of sites to visit and chose sites that were not included in the  team’s review.
In reviewing VA estimates of the number of homeless veterans, we  reviewed the literature, read relevant reports, and interviewed VA officials,  particularly those involved in the federally mandated Community  Homelessness Assessment, Local Education and Networking Group for  Veterans (CHALENG). We interviewed experts in the subject area and  officials with the Bureau of the Census and the Department of Housing  and Urban Development (HUD). We used information from our site visits  to supplement our discussion on how local entities conduct counts of  homeless individuals. We did not review the validity of VA’s estimates. To  identify GPD program capacity, location, and number of admissions, we  analyzed data from a series of annual reports prepared by NEPEC,  updated where appropriate by information from the GPD program office  in May 2006.
To assess the overall extent to which GPD providers collaborated with  other agencies to offer services to homeless veterans, we analyzed NEPEC  survey data. The survey included responses from all GPD providers in  2003, when NEPEC first conducted the survey, and all programs that  became operational or were funded in subsequent years through  November 2005. For more information on the survey data, see appendix  III. We performed basic reasonableness tests on the survey data and  contacted NEPEC for any clarifications or discrepancies. We determined  these data to be sufficiently reliable for the purposes of this report. To get  an understanding of how collaboration was actually occurring at the local  level, we conducted site visits. During these visits we gathered information  on the types of services GPD providers offer, how providers partnered  with local agencies (including VA) to offer services, and how these  partnerships were working. To review how VA coordinates with other  federal agencies, we attended a meeting of VA’s Advisory Committee on  Homeless Veterans, talked with a representative from the Interagency  Council on Homelessness, and contacted other prominent federal  partners.
To identify how VA assesses the performance of the GPD program, we  reviewed GPD program goals, interviewed VA officials, including a team  with the OIG, and analyzed data obtained from VA’s national program  office and NEPEC. We reviewed the Grant and Per Diem Program  Evaluation Procedures Manual that NEPEC sends to each VA liaison that  describes the responsibilities of liaisons and GPD providers in completing,  reviewing, and submitting intake and discharge forms on individual  participants. We extracted data on outcomes from tables included in  NEPEC’s series of annual reports on the program and discussed the  reliability of these data with NEPEC officials. This information is briefly  summarized in appendix IV along with relevant findings from the OIG’s  review. We did not independently verify the NEPEC data. We reviewed  how VA collects and analyzes outcome data and found these data to be  sufficiently reliable for our purposes. Additionally, we reviewed grant  documents for the sites we visited to identify the specific objectives they  set to meet program goals and asked VA officials and providers about  various aspects of performance measurement during our site visits. We did  not conduct our own review of outcomes for homeless veterans served by  the GPD providers we visited.
At the time we conducted our analysis, VA’s follow-up study had not been  released; therefore, our discussion of the study is based on our review of  preliminary results that identified the numbers and characteristics of the  participants, the timetable and roles of the universities and researchers  involved, and the housing outcomes at the end of the year. Conducted  from 2001 through 2005, the study followed a total of 1,294 participants,  with approximately 260 participants from each of five medical center areas  serving California, the District of Columbia, Florida, Maryland, Ohio,  Pennsylvania, and West Virginia. Veterans were randomly selected from  lists of active participants that included recent admissions as well as  participants with longer stays in the program. Participants were drawn  from programs operated by 6 domiciliary care providers, 16 contracted  residential treatment providers, and 19 GPD providers. The study had an  overall response rate of 72 percent for all participants in the three  transitional housing programs, with a response rate of 69 percent for the  GPD participants, for the interviews conducted a year after they left the  program. Of the 520 GPD participants studied, 359 were interviewed a year  after leaving the program. Of those interviewed, 60 percent were in their  own independent housing, 23 percent were sharing with friends or family,  and 15 percent were in temporary housing, including shelters or in an  institution other than a jail.
We conducted our work between August 2005 and July 2006 in accordance  with generally accepted government auditing standards.
section_title: Appendix II: VA’s Programs for Homeless Veterans Other than the GPD Program
subsections: section_title: Veterans Health Administration Programs for Homeless Veterans
subsections: section_title: Health Care for Homeless Veterans (HCHV) including Contracted Residential Treatment
paragraphs: Under the HCHV umbrella program, VA provides outreach, health and  mental health assessments, treatment, and referrals for homeless veterans  with mental health and substance abuse problems. Veterans with limited  length of service or with other than a dishonorable discharge are eligible  for the HCHV program but may not necessarily be eligible for VA health  care, where the criteria are more restrictive. A veteran needing transitional  housing while undergoing treatment may be placed in one of the  approximately 300 contracted residential treatment beds that are funded  from the budgets of individual medical centers. In fiscal year 2005, there  were about 1,700 admissions for an average stay of 2 months at $36 per  day; the recommended maximum stay is 6 months. Where contracted  residential treatment is not available, veterans in need of transitional  housing may be referred to the more widely available GPD program or  domiciliary care. In fiscal year 2005, VA’s HCHV program provided  outreach, treatment, and referral services to about 61,000 homeless  veterans, with obligations of about $40 million.
section_title: Homeless Domiciliary Residential Rehabilitation and Treatment Program
paragraphs: This transitional housing program is designed for homeless veterans who  do not need hospital or nursing home services while their clinical status is  being stabilized. In this program, veterans receive various services,  including medical and mental health evaluations, treatment, and  community support. Domiciliary programs are generally located on the  grounds of VA medical centers, and unlike the GPD programs, they are  usually managed and staffed by the local VA medical center. In fiscal year  2005 about 5,000 homeless veterans stayed an average of 4 months in this  program. About 1,800 beds were available exclusively for homeless  veterans, with obligations of about $58 million. Additional funding was  awarded in 2005 to increase the number of beds available to about 2,200 in  fiscal year 2007, bringing total obligations up to a projected $73 million.
section_title: Homeless Compensated Work Therapy/Transitional Residence
paragraphs: This work therapy program provides veterans with job skills and income.  Through the program veterans produce items for sale or provide services  such as temporary staffing to a company. While participating in this  program, veterans may receive individual or group therapy and follow-up  medical care on an outpatient basis. At some locations, program  participants can stay in one of the about 500 beds available in transitional,  community-based group homes. Veterans participating in this program are  required to use a portion of their income from the work program to pay for  rent, utilities, and food. Obligations for this program in fiscal year 2005  were about $10 million.
section_title: Loan Guarantee for Multifamily Transitional Housing
paragraphs: This transitional housing program provides guaranteed loans to nonprofit  organizations to construct or rehabilitate multifamily transitional housing  for homeless veterans, including single room occupancy units. Supportive  services and counseling, including job counseling, must be provided with  the goal of encouraging self-determination among participating veterans.  Veterans must maintain sobriety, seek and maintain employment, and pay  a fee in order to live in these transitional units. Not more than 15 loans  with an aggregate total of $100 million may be guaranteed under this  program. In fiscal year 2005, the Vietnam Veterans of San Diego housing  project was under construction. Other programs have been conditionally  selected and are expected to be approved in fiscal years 2006 and 2007.  For information on the challenges encountered in implementing this  initiative, see Related GAO Products for GAO’s report on this program.
section_title: Housing and Urban Development-VA Supported Housing
paragraphs: This permanent, subsidized housing program provides HUD rental  assistance (Section 8) vouchers for use by homeless veterans with chronic  mental health or substance abuse disorders. Veterans are required to pay a  portion of their income for rent; those without income receive fully  subsidized housing. In general, veterans who do not exceed the maximum  allowable income can remain in the housing permanently, but must agree  to intensive case management services from VA staff and make a long- term commitment to treatment and rehabilitation. Local housing  authorities control access to the vouchers. Many of the 1,780 vouchers  allocated by HUD remain in use but no new vouchers have been made  available. As a result, in fiscal year 2005, only 142 veterans were admitted  to the program. VA’s obligations in support of this program in fiscal year  2005 were about $3 million.
section_title: Veterans Benefits Administration Programs for Homeless Veterans
subsections: section_title: Veterans Benefits Administration Outreach
paragraphs: According to VA, in 20 of its 57 regional offices VA has designated full-time  homeless veterans coordinators who work with HCHV and other VA staff  to conduct joint outreach, provide counseling, and offer other services to  homeless veterans, such as helping them apply for veterans benefits. In the  remaining regions, staff may be assigned collateral responsibility to work  with homeless veterans. One of the goals of this program is to expedite the  processing of benefit claims made by homeless veterans. According to VA,  in fiscal year 2005, VA received approximately 4,400 claims from homeless  veterans. Of these claims, 56 percent were for disability compensation and  44 percent were for pensions.  Of the compensation claims, 26 percent  were granted, 33 percent denied, and 41 percent pending an average of  about 4 months. Of the pension claims, 62 percent were granted,   18 percent denied, and 21 percent pending an average of about 3 months.
section_title: Acquired Property Sales for Homeless Providers
paragraphs: VA properties that are obtained through foreclosures on VA-insured  mortgages are available for sale at below fair market value to nonprofit  and public agencies that use the properties to shelter or house homeless  veterans. Since the inception of this program, more than  200 properties have been sold or leased.
section_title: Labor-VA Incarcerated Veterans’ Transition Program
paragraphs: Under this demonstration program, the Department of Labor (DOL) funds  community agencies to provide training and support services, and VA  contributes its services, to help veterans who are incarcerated and at risk  of homelessness make a successful transition back into the workforce.  According to DOL, services provided include career counseling,  employment training, job-search and job-placement assistance, life-skills  development, and follow-up. Local staff from both VA’s Health  Administration and Benefits Administration provide information about  available VA benefits and services. Grantees must report the number of  veterans who are still employed 6 months after job placement, whether  they are in the same or similar jobs, and the reasons why veterans who  were placed are no longer employed. DOL provided $2 million to seven  community agencies in 2006 for this purpose.
section_title: Appendix III: Range of Services Offered by GPD Programs Nationwide
paragraphs: We analyzed NEPEC’s Facility Survey data to identify the types of services  that programs provide and how they are provided. NEPEC conducted the  survey to capture information on the types of GPD programs funded.  According to NEPEC officials, the survey was used to capture information  such as program location, admissions criteria, services available, and  licensing. Because the survey was not intended to be used as a tool to  review how programs were performing, NEPEC does not conduct rigorous  internal reviews of the data collected. We conducted basic reasonableness  tests and contacted NEPEC for any clarifications or discrepancies. We  found the survey data sufficiently reliable for the purposes of this report.
The survey was first deployed in 2003 to all agencies that were receiving  funding that year. In subsequent years, NEPEC had newly funded agencies  complete this onetime survey. A total of 281 transitional housing facilities  were included in the survey data we analyzed—148 of the facilities were  surveyed in 2003, 94 in 2004, and 39 in 2005. According to NEPEC, this  represents all operational programs as of November 2005. While there  were about 300 agencies with GPD grants, some of the agencies have  multiple grants for one facility, resulting in one survey being completed for  that facility. The surveys were completed by the VA liaisons in  consultation with GPD provider staff. NEPEC officials were confident they  have achieved a 100 percent response rate. While we did not  independently verify the response rate for the survey, we concluded that it  would be at least 90 percent.
Table 6 shows the percentage of facilities that reportedly provide the  selected services and how the services were provided. Survey respondents  were asked to identify how, if at all, services were provided and were  directed to choose only one method. It may be the case, however, that as  in some locations we visited, services were provided by more than one  method. As can be seen, the majority of GPD programs provided a  spectrum of services for veterans. However, these programs varied in how  services were provided, with some services more likely to be provided  through partnerships and others more likely to be provided in-house  directly by staff. Some of the services that were more likely to be provided  through partnerships include those that require counseling or medical- related treatment. Services primarily provided directly by GPD providers  tended to be more related to case management type activities.
section_title: Appendix IV: Participant Outcomes for the Grant and Per Diem Program
paragraphs: Outcomes are reported on a standard Northeast Program Evaluation  Center discharge form that must be filled out by VA staff or by GPD staff  with VA’s review and sign-off when the participant leaves the program.  The form also captures information on the length and cost of stay in the  GPD, reasons the participant left the program, and any plans for follow-up  treatment for substance abuse or other problems. NEPEC officials told us  that they do not verify the data submitted to them, but they do perform  tests for completeness and internal consistency. VA’s Office of Inspector  General (OIG) found that not all outcomes shown on the discharge forms  were supported by additional information in the sample of case records  that the OIG reviewed. For example, 76 percent of records included  information supporting the veterans’ outcomes indicated on the form, but  about 24 percent of records lacked such support.
Outcomes for housing and income are shown as a percentage of all  participants who left the program for any reason. However, outcomes for  self-determination in terms of improved functioning are shown as a  percentage of those veterans who had an identified problem when they  entered the program. The determination that a participant has or has not  improved may be considered somewhat subjective. The problems are  described by participants themselves to VA staff in response to a series of  questions on a standard NEPEC intake form that also includes a section  for the VA clinical staff to record their observations of the substance abuse  or mental health problems that the participants face. The intake form also  captures other characteristics of the participants, such as their military,  financial and living circumstances. VA staff are expected to complete  these forms when they first contact homeless veterans but no later than  the veterans’ third day with a GPD provider and to forward the forms to  NEPEC. NEPEC reports that it does not receive intake forms for about   10 percent of participants in the GPD program each year.
section_title: Appendix V: Comments from the Department of Veterans Affairs
section_title: Appendix VI: GAO Contact and Staff Acknowledgments
subsections: section_title: Acknowledgments
paragraphs: Shelia Drake, Assistant Director; Patricia L. Elston; David Forgosh; and  Nyree M. Ryder made significant contributions to this report. In addition,  Roger Thomas provided legal assistance; Walter Vance and Lynn Milan  analyzed and assessed the reliability of data; Lily Chin, Jonathan  McMurray, and Charles Willson assisted in report development; and   Amy Sheller supported the team during its Los Angeles site visit.
section_title: Related GAO Products
paragraphs: Homeless Veterans: Job Retention Goal Under Development for DOL’s  Homeless Veterans’ Reintegration Program. GAO-05-654T. Washington,  D.C.: May 4, 2005.
Veterans Affairs Homeless Programs: Implementation of the  Transitional Housing Loan Guarantee Program. GAO-05-311R.  Washington, D.C.: March 16, 2005.
VA Health Care: VA Should Expedite the Implementation of  Recommendations Needed to Improve Post-Traumatic Stress Disorder  Services. GAO-05-287. Washington, D.C.: February 14, 2005.
Decennial Census: Methods for Collecting and Reporting Data on the  Homeless and Others without Conventional Housing Need Refinement.  GAO-03-227. Washington, D.C.: January 17, 2003.
Homelessness: Improving Program Coordination and Client Access to  Programs. GAO-02-485T. Washington, D.C.:  March 6, 2002.
Homeless Veterans: VA Expands Partnerships, but Effectiveness of  Homeless Programs Is Unclear. GAO/T-HEHS-99-150. Washington, D.C.:  June 24, 1999.
Homeless Veterans: VA Expands Partnerships, but Homeless Program  Effectiveness Is Unclear. GAO/HEHS-99-53. Washington, D.C.: April 1,  1999.
Homelessness: Overview of Current Issues and GAO Studies.   GAO/T-RCED-99-125. Washington, D.C.: March 23, 1999.
Homelessness: Demand for Services to Homeless Veterans Exceeds VA  Program Capacity. GAO/HEHS-94-98. Washington, D.C.: February 23,  1994.