Health Care for Homeless Veterans

The William Jennings Bryan Dorn Health Care for Homeless Veterans Program (HCHV) is part of a national VA program established in 1987 to address the needs of chronically mentally ill veterans who were homeless (Public Law 100-6). In 1993, these services were broadened to include a larger population of homeless veterans. In 1998, services to homeless veterans were designated as the “fifth mission of the VA” (Kizer, 1998). The Columbia, South Carolina Health Care for Homeless Veterans Program services the Richland county area and outlying clinic sites located in Greenville, Florence, and Rock Hill. HCHV Clinic administrative offices are located at the WJB Dorn VA Medical Center in Columbia.

The HCHV Program address the goal of ending homelessness among veterans by providing a continuum of services designed to help veterans achieve independent living, improved physical and mental health, employability, and an overall better quality of life. In addition, the HCHV Program develops community partnerships to develop resources needed by homeless or at risk for homelessness veterans, such as shelters, transitional housing, permanent housing, computer training, and employment opportunities.

Health Care for Homeless Veterans - Mission

The central goal for the Health Care for Homeless Veterans (HCHV) program is to end homelessness among veterans through outreach efforts and community partnerships. Veterans are engaged in treatment and rehabilitation programs to enable them to achieve a better quality of life

Health Care for Homeless Veterans - Vision

Our vision is to be the prototype homeless program for the next century, driven by the mastery of change, challenge, and purpose.

HBHV Core Values

TRUST: Is the basis of the veteran/case manager relationship and fundamental to all therapeutic treatment;

RESPECT: To honor and hold in high regard the dignity and worth of our veterans, their families, and our co-workers;

COMMITMENT: To assume a professional attitude and responsibility for the provision of services to our patients and their families;

EXCELLENCE: To be exceptionally good and of the highest quality in our delivery of patient care and advocacy.

The HCHV Program provides Outreach Brokering and Case Management services to veterans who are homeless or at risk for becoming homeless. Case Managers staff the HCHV clinic from 6:30 am to 7:00 pm on Monday through Thursday, and 8:00 am to 4:30pm on Friday. They also visit community sites or areas where homeless persons are located, such as shelters, Department of Corrections, hospitals and soup kitchens, to reach out to veterans. An interview is required to determine a person’s eligibility for VA services. At point of intake, case managers may determine that a veteran would be better served by other VA or community programs, such as Day Treatment Services, residential care or treatment programs, or vocational services, and will refer veterans to these programs as needed.

For eligible veterans, the HCHV Program provides case management services at multiple levels of care. All eligible interested veterans are enrolled in HCHV, referred to medical clinics for assessment of physical health. VA clinic referrals are also made for assistance with chemical dependency and mental health problems as well.

While the Health Care for Homeless Veterans program is primarily concerned with improving the lives and conditions of Midlands, Upstate and Pee Dee area at-risk veterans, it is also concerned with the community as a whole. Collaborative efforts and involvement with organizations like the Midlands Area Consortium for the Homeless and the Women's Shelter ensure the the HCHV program helps homeless veterans as well as underprivileged women, children and non-veterans.

Engage veterans in activities and provide them with services that will help them make a smooth transition.

Create employment opportunities through Compensation Work Therapy (CWT) and SC Employment Commission (One Stop).

Slightly more than half of homeless veterans suffer from some form of substance abuse...

Patient Responsibilities

In providing the patient’s care, the VA Medical Center has the right to expect reasonable and responsible behavior on the part of patients and visitors. Compliance with the following list of responsibilities is necessary to ensure the highest quality care (see attached handout “Patient Rights and Responsibilities In Their Care.”) Patient’s responsibilities include:

1. Ensure safety of patients and others by following all rules, regulations, and posted signs. Avoid interfering with the treatment of other patients, particularly in emergency situations and alerting staff if another patient is having difficulty or they observe an unsafe situation. Patients should act responsibly and keep their money, clothing or belongings in a safe manner.

2. Show respect and consideration toward staff, property, and other patients. This includes keeping all appointments on time or canceling with at least 24 hours’ notice. Patients should ask visitors to be considerate of other patients, medical center personnel and observe the visiting hours. Patients should try to understand when they encounter delays. They should promptly meet any financial obligations agreed to with the medical center.

3. Patients should be involved in and take responsibility for their care, which includes arriving sober and free of illegal drugs so they can optimally participate. This also includes providing complete and accurate information about past illnesses, hospitalizations, medications, symptoms, allergies, changes in their condition or anything else which might be relevant to their care. They should ask questions if they do not understand what they have been told or what they are expected to do and openly discuss any disagreements that they have with the plan. Patients and their families are expected to follow the instructions in their care plan, so it is important that they understand and agree. In order to ensure that the plan of care fits their needs, there must be ongoing, accurate and complete information about their needs, limitations and conditions. Patients should understand the medications and their use completely, including anticipated side effects and expected benefits, as well as instructions for proper use, including any food or drug interactions. They should be sure they understand the consequences of treatment alternatives and failure to follow the proposed course of care.

4. Help the medical center improve the environment by providing feedback about medical center service needs and expectations. Feedback can be provided through a number of mechanisms, including direct suggestions to providers or surveys, as well as voicing concerns to the Patient Representative.

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Staff Responsibilities

Service Line Director and Program Manager are responsible for ensuring that individual staff members assigned to his/her service line/service has access to this medical center memorandum and are familiar with its content. This should be documented on Line 11 of VA Form 5-4092, "Guide for Orientation of New Employees," which is maintained in Human Resources in the employee's official personnel folder. Additionally, these responsibilities should be discussed with employees annually as a part of their performance appraisal.

Patients will receive a copy of “Patient Rights and Responsibilities In Their Care” (attached) from Patient Operations staff upon enrollment in the VA Health Care system or at the time of admission through Acute Hospital Services staff.

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Compensated Work Therapy (CWT)

The Compensated Work Therapy (CWT) Program exists to “Serve Those Who have Served” by:

Ensuring that all homeless veterans who wish to improve the quality of their lives have access to psychosocial programs that can assist them in accomplishing their goals of becoming self-supporting.

Acting as an advocate for veterans, working to reduce societal stigma towards people with mental illness--especially those who are seriocomically disadvantaged.

Providing employment opportunities within the VA Medical Center and in the community, with the goal of competitive employment that pays at least minimum wage.

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Compensated Work Therapy Values

All homeless veterans have rehabilitation potential, such as a maximum degree of self-sufficiency that can be attained through psychosocial rehabilitation services that focus on strengths and functioning rather than on illness and symptoms. Self-sufficiency is determined by the veteran and not by the organization.

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Compensated Work Therapy Mission

To provide opportunities for homeless veterans to achieve and maintain their highest level of independent community integration accomplished through work-based psychosocial residential rehabilitation.

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Compensated Work Therapy Goal

The CWT goal is to provide holistic, community-based psychosocial rehabilitation, designed for improved functional status; enhanced quality of life; sustaining rehabilitation gains; disability management; and community employment which meets the needs, abilities, and desires of the veteran.

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Compensated Work Therapy Objectives

To assist veterans in identifying and addressing obstacles and choices which have prevented them from accomplishing goals of social integration and independent living.

To assist veterans in choosing, accessing, and utilizing support needed to be independent, self-supporting and successful in their individual recovery.

To facilitate the transition to safe, affordable, appropriate community housing.

To facilitate placement into community employment, an education or training
program, or vocational and vocational activities which meet the
needs, abilities, and desires of the veteran.

The Homeless Veterans Reintegration Program is a partnership between the HCHV/CWT Program and the SC Employment Security Commission. This Program is designed to provide outreach to identify homeless veterans who are interested in securing needed health care so that he/she can return to competitive employment in the local community. Last year 100 of these identified veterans were successful in obtaining desired employment. for referrals and placement will be reviewed with the veteran if found eligible for referral. Abstinence from use of alcohol or drugs is required in such residences as is compliance with all house rules and regulations.

WJB Dorn VAMC is adding a new program as a part of the Health Care for Homeless Veterans/Compensated Work Therapy Program for persons who have a desire to work and have been unable to do so, because of mental health issues. This is a Supported Employment Program that affords those with severe mental illness the opportunity for employment in viable and valid work scenarios with supportive assistance on-site and as needed. These services are tailored to the individual strengths and deficits of each person to facilitate learning and carrying out a chosen job. While the concept of supported employment has been in use for some years, recently it has received increased attention as an integral component of mental health recovery. This program affords better access for those with severe mental illness to significant and comprehensive work venues.

A veteran living with mental illness that has an aspiration and a desire to work may be entitled to supportive employment services if he or she needs support in order to find and sustain a job of their choice. Competitive employment is the goal, focusing on local full-time or part-time employment that pays at least minimum wage.

Outreach Services

Case Managers make visits to community sites where homeless or at risk persons go for help. These include, but are not limited to, shelters, soup kitchens, SCDC, social service agencies, and job services. Here, outreach workers talk with veterans to help them decide what services might be best for them personally. They educate veterans concerning services available and procedures for accessing them, both within the VA and other community services. They may also work with the veteran to develop a Service Plan to define the goals with which help is desired.

Veterans who are interested in linkage with VA or community vocational services and/or who are ready to work on recovery from homelessness may be referred to a transitional residence for up to four months (under VA contract) or to the grant and per diem program at Alston-Wilkes for a period not to exceed twenty-four months. Room and board is provided, as well as case management for linkage to needed community and employment services as well as social and recreational activities. The HCHV Case Manager will work with transitional residence staff to help participantes accomplish their identified service goals. Rules for referrals and placement will be reviewed with the veteran if found eligible for referral. Abstinence from use of alcohol or drugs is required in such residences as is compliance with all house rules and regulations.

Veterans who are ready for independent living and who have income to pay rent and cover personal expenses may be referred to Supported Housing sites, such as Providence Home, Oxford House, or the Columbia and South Carolina State Housing authorities, as well as public housing opportunities. HCHV Case Managers will provide case management services as needed for up to five years, dependent on which type of housing is selected and available. These programs also have rules, which will be explained before referrals are made and again by the in-house staff.

Based on the information provided to the Homeless Program Case Manager and needs that are identified, a veteran may be eligible for other VA services, such as Domiciliary Care, Substance Abuse rehabilitation, or Vocational Services. Although these services are separate from the HCHV Program, staff assists veterans by educating them to the available programs and the process by which services may be obtained. Case Managers assist veterans with transitions from one level of care or location to another as needed.

The case manager will describe the types of opportunities available to you based on the first interview and ongoing assessments, and will make referrals only with the veteran’s consent.