Almost one-quarter of Veterans live in rural areas compared to 18% of all Americans. More than three million rural Veterans use VHA healthcare and are more likely than their urban counterparts to be white, married, have lower education and income, and poorer health. Rural homelessness is often invisible, difficult to assess, and underestimated.
Rural Veteran Demographics
There are 4.7 million rural and highly rural Veterans with 2.8 million enrolled in VA.
- 58 percent of rural Veterans are enrolled in the VA health care system – significantly higher than the 37 percent enrollment rate of urban Veterans
- 18 percent of rural enrolled Veterans have at least one service-connected condition
- 6 percent of enrolled rural Veterans are women
- 15 percent of enrolled rural Veterans are minorities
- 52 percent earn less than $35,000 annually
- 27 percent do not access the internet at home
Rural Veterans enrolled in VA's health care system are also significantly older: 56 percent are over the age of 65.
- This older Veteran population is medically complex and more likely to be diagnosed with diabetes, obesity, high blood pressure and heart conditions that require more frequent, ongoing and costly care
The next generation of rural Veterans also has multiple medical and combat-related issues, which will require significant on-going access to care.
- Nearly 460,000 rural Veterans served in Iraq and Afghanistan
Rural Veteran Outreach Toolkit
Information describing the various rural housing programs offered to Veterans.
HERS Proceedings: Rural Veterans and Homelessness
Federal Rural Resources Guide
Rural Veteran Suicide Prevention (September 2019)
The Opioid Crisis in Rural America (January 2019)
HERS Symposium: Rural Veterans and Homelessness (June 22, 2017)
Office of Rural Health video. (January 2015)
Homelessness Among Rural Veterans (December 2016)
Utilization of Interactive Clinical Video Telemedicine by Rural and Urban Veterans in the Veterans Health Administration Health Care System. Scott V. Adams PhD, Michael J. Mader PhD, Mary J. Bollinger PhD, Edwin S. Wong PhD, Teresa J. Hudson PhD, Alyson J. Littman PhD
Rural and urban differences in undersupply of buprenorphine provider availability in the United States, 2018. Conway KP, Khoury D, Hilscher R, Aldridge AP, Parker SJ, Zarkin GA. Addict Sci Clin Pract. 2022 Jan 31;17(1):5. doi: 10.1186/s13722-021-00282-2.
Fewer potentially avoidable health care events in rural Veterans with self-directed care versus other personal care services. Yuan Y, Thomas KS, Van Houtven CH, Price ME, Pizer SD, Frakt AB, Garrido MM. J Am Geriatr Soc. 2022 Jan 13. doi: 10.1111/jgs.17656. Epub ahead of print. PMID: 35026056.
Self-Administration of Auricular Acupuncture in Rural Veterans with Chronic Pain: A Pilot Project. James BL, Welch J, Williamson C. Med Acupunct. 2021 Oct 1;33(5):349-352. doi: 10.1089/acu.2021.0007. Epub 2021 Oct 18. PMID: 35003503; PMCID: PMC8729899.
Above and Beyond the Call of Duty: Rural Home Care and Hospice Nurses' Experiences Caring for Veterans. McMillan LR, Elliott B, Chargualaf KA. Home Healthc Now. 2022 Jan-Feb 01;40(1):19-26. doi: 10.1097/NHH.0000000000001031. PMID: 34994717.
Mapping Rural and Urban Veterans' Spatial Access to Primary Care Following the MISSION Act. Sullivan E, Zahnd WE, Zhu JM, Kenzie E, Patzel M, Davis M. J Gen Intern Med. 2022 Jan 3. doi: 10.1007/s11606-021-07229-y. Epub ahead of print. PMID: 34981345.
The Role of Race in Rural-Urban Suicide Disparities. Peltzman T, Gottlieb DJ, Levis M, Shiner B. J Rural Health. 2021 Jun 15. doi: 10.1111/jrh.12603
Ending the Chase: Experiences of Rural Individuals with Opioid Use Disorder. Scorsone KL, Haozous EA, Hayes L, Cox KJ. Subst Use Misuse. 2021 Apr 19:1-8. doi: 10.1080/10826084.2021.1914109
Reducing Rural Veteran Suicides: Navigating Geospatial and Community Contexts for Scaling Up a National Veterans Affairs Program. Kreisel CJ, Wilson LK, Schneider AL, Mohatt NV, Spark TL. Suicide Life Threat Behav. 2021 Apr;51(2):344-351. doi: 10.1111/sltb.12710
Impact of Attitudes and Rurality on Veterans' Use of Veterans Health Administration Mental Health Services. Fischer EP, Curran GM, Fortney JC, McSweeney JC, Williams DK, Williams JS. Psychiatr Serv. 2021 Mar 11:appips201900275. doi: 10.1176/appi.ps.201900275
A Resource Building Virtual Care Programme: improving symptoms and social functioning among female and male rural Veterans. Bauer A, Amspoker AB, Fletcher TL, Jackson C, Jacobs A, Hogan J, Shammet R, Speicher S, Lindsay JA, Cloitre M. Eur J Psychotraumatol. 2021 Feb 4;12(1):1860357. doi: 10.1080/20008198.2020.186035
Flattening the Curve by Getting Ahead of It: How the VA Healthcare System Is Leveraging Telehealth to Provide Continued Access to Care for Rural Veterans. Myers US, Birks A, Grubaugh AL, Axon RN. J Rural Health. 2021 Jan;37(1):194-196. doi: 10.1111/jrh.12449
Taking the message to the rural patient: evidence-based PTSD care. Bernardy NC, Montano M, Cuccurullo LA, Breen K, Cole BF. J Behav Med. 2021 Jan 2. doi: 10.1007/s10865-020-00194-7
Serving Rural Veterans with Disabilities: A National Survey of Centers for Independent Living. Hale-Gallardo J, Kreider CM, Ni Y, Semeah LM, Ahonle ZJ, Cowper-Ripley DC, Mburu S, Delisle AT, Jia H. J Community Health. 2020 Nov 6. doi: 10.1007/s10900-020-00941-6
Combination outreach and wellness intervention for distressed rural veterans: results of a multimethod pilot study. Dindo L, Roddy MK, Boykin D, Woods K, Rodrigues M, Smith TL, Gonzalez RD, True G. J Behav Med. 2020 Sep 17. doi: 10.1007/s10865-020-00177-8
Recent trends in the rural-urban suicide disparity among veterans using VA health care. Shiner B, Peltzman T, Cornelius SL, Gui J, Forehand J, Watts BV. J Behav Med. 2020 Sep 11. doi: 10.1007/s10865-020-00176-9
Geographic differences in receipt of addictions treatment in a national sample of patients with alcohol use disorders from the U.S. Veterans Health Administration. Edmonds AT, Bensley KM, Hawkins EJ, Williams EC.Edmonds AT, et al. Subst Abus. 2020 Aug 21:1-10. doi: 10.1080/08897077.2020.1803176
The Impact of Co-occurring Anxiety and Alcohol Use Disorders on Video Telehealth Utilization Among Rural Veterans. Ecker AH, Amspoker AB, Hogan JB, Lindsay JA. J Technol Behav Sci. 2020 Aug 6:1-6. doi: 10.1007/s41347-020-00150-x
Relationship of neighborhood social determinants of health on racial/ethnic mortality disparities in US veterans-Mediation and moderating effects. Wong MS, Steers WN, Hoggatt KJ, Ziaeian B, Washington DL.Wong MS, et al. Health Serv Res. 2020 Aug 29. doi: 10.1111/1475-6773.13547
"We're Afraid to Say Suicide": Stigma as a Barrier to Implementing a Community-Based Suicide Prevention Program for Rural Veterans. Monteith LL, Smith NB, Holliday R, Dorsey Holliman BA, LoFaro CT, Mohatt NV. J Nerv Ment Dis. 2020 May;208(5):371-376. doi: 10.1097/NMD.0000000000001139.
Social Support Moderates the Association Between Posttraumatic Stress Disorder Treatment Duration and Treatment Outcomes in Telemedicine-Based Treatment Among Rural Veterans. Campbell SB, et al. J Trauma Stress. 2020. PMID: 32521100
Differences in Receipt of Alcohol-Related Care Across Rurality Among VA Patients Living with HIV with Unhealthy Alcohol Use. Kara M. Bensley PhD, John Fortney PhD, Gary Chan PhD et al.
Rural and Urban Differences in the Adoption of New Health Information and Medical Technologies. David A. Haggstrom MD, MAS, Joy L. Lee PhD, Stephanie L. Dickinson MS, Sina Kianersi DVM, Jamie L. Roberts, Evgenia Teal MS, Layla B. Baker MBChB, MPH, Susan M. Rawl PhD, RN
Rural, Rural Identity, and Cancer Control: Evidence from NCI's Population Health Assessment in Cancer Center Catchment Areas Initiative. Kelly D. Blake ScD, Robert T. Croyle PhD
What Characteristics Influence Whether Rural Beneficiaries Receiving Care from Urban Hospitals Return Home for Skilled Nursing Care? Abby F. Hoffman BA, George H. Pink PhD, Denise A. Kirk MS, Randy K. Randolph MRP, George M. Holmes PhD
The Association Between Neighborhood Socioeconomic and Housing Characteristics with Hospitalization: Results of a National Study of Veterans. Hatef E, Kharrazi H, Nelson K, Sylling P, Ma X, Lasser EC, Searle KM, Predmore Z, Batten AJ, Curtis I, Fihn S, Weiner JP. J Am Board Fam Med. 2019 Nov-Dec;32(6):890-903. doi: 10.3122/jabfm.2019.06.190138.
Justice Involvement and Treatment Use Among Rural Veterans. Finlay AK, Harris AHS, Rosenthal J, Blue-Howells J, Clark S, Flatley B, Timko C., Rural Ment Health. 2018 Jan;42(1):46-59. doi: 10.1037/rmh0000092.
Distance to Veterans Administration Medical Centers as a Barrier to Specialty Care for Homeless Women Veterans.Gawron LM, Pettey WBP, Redd AM, Suo Y, Gundlapalli AV., Stud Health Technol Inform. 2017;238:112-115.
Nelson, R. E., Gundlapalli, A., Carter, M., Brignone, E., Petty, W., Byrne, T. H., Montgomery, A. E., Rupper, R., Fargo, J. D. (2017). Rurality or Distance to Care and the Risk of Homelessness among Afghanistan and Iraq Veterans. Housing, Care and Support, 20(2): 45-49. (doi:10.1108/HCS-10-2016-0013)
Persistent Super-Utilization of Acute Care Services Among Subgroups of Veterans Experiencing Homelessness.Szymkowiak D, Montgomery AE, Johnson EE, Manning T, O'Toole TP., Med Care. 2017 Oct;55(10):893-900. doi: 10.1097/MLR.0000000000000796.
Rural Homelessness among Veterans – What do we Know? Metraux, S. & Szymkowiak, D. (October 2017).
A digital advocate? Reactions of rural people who experience homelessness to the idea of recording clinical encounters.Grande SW, Castaldo MG, Carpenter-Song E, Griesemer I, Elwyn G., Health Expect. 2017 Aug;20(4):618-625. doi: 10.1111/hex.12492. Epub 2016 Sep 7.
Homeless Liaisons' Perceptions of McKinney-Vento Act Implementation: Examining Geographical Trends and Differences.Mullins MH, Wilkins BT, Mahan A, Bouldin JB., Soc Work Public Health. 2016 Aug-Sep;31(5):358-68. doi: 10.1080/19371918.2015.1137516. Epub 2016 May 4.
Metraux, S., Treglia, D., O'Toole, T. (2016). Migration by Veterans Who Received Homeless Services from the Department of Veterans Affairs. Military Medicine, 181(10):1212-1217. (doi: 10.7205/MILMED-D-15-00504)
A Comparison of Homeless Male Veterans in Metropolitan and Micropolitan Areas in Nebraska: A Methodological Caveat.Tsai J, Ramaswamy S, Bhatia SC, Rosenheck RA.
Am J Community Psychol. 2015 Dec;56(3-4):357-67. doi: 10.1007/s10464-015-9746-7.
Remote, Home-Based Delivery of Cardiac Rehabilitation uses telehealth to eliminate the need for rural Veterans to travel multiple times a week to a rehabilitation facility and enables patients to tailor the location and schedule of their rehabilitation sessions for their home. (Specialty Care Services) (Lead: VRHRC Iowa City, Iowa)
Clinical Video Telehealth to Care for Rural Veterans with Multiple Sclerosis uses telehealth to deliver comprehensive rehabilitation care to rural Veterans with multiple sclerosis. (Specialty Care Services) (Lead: VRHRC Togus, Maine)
Telehealth Collaborative Care for Rural Veterans with HIV Infection links VA's specialty infectious disease clinicians with VA Community Based Outpatient Clinics to deliver HIV care to rural Veterans using telehealth technology. (Specialty Care Services) (Lead: VRHRC Iowa City, Iowa)
Geriatric Scholars Program addresses the shortage of specialized geriatric skills and knowledge in rural VA clinical settings by training VA general clinicians in the treatment of older rural Veterans. (Workforce Training and Education Services)(Lead: VRHRC Salt Lake City, Utah)
Geriatric Research Education and Clinical Centers (GRECC) Connect Project trains VA providers to manage medically complex cases through case-based conferences, electronic consultations, virtual meetings and clinical video telehealth. (Workforce Training and Education Services)
Community Clergy Training to Support Rural Veterans' Mental Health educates rural community clergy on available VA health care resources and trains rural clergy to recognize common symptoms of post-traumatic stress disorder, military sexual trauma and readjustment issues in Veterans returning to their rural communities upon separation from military service. (Mental Health Services) (Lead: VRHRC Togus, Maine
The Office of Rural Health also recommends these promising practices:
- Leveraging connectedness of rural communities
- Communicating with local rural health care providers and public health professionals
- Seeking out grass-roots organizations in rural communities
- Coordinating with County Veteran Services Officers and Veteran Service Organizations
- Providing education about VA services and resources
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