Factors associated with irregular discharges in the VA domiciliary care for homeless veterans (DCHV) program

ABSTRACT

The Domiciliary Care for Homeless Veterans (DCHV) programs provide time-limited residential treatment for veterans experiencing homelessness. Veterans prematurely leave DCHV programs for a variety of reasons, referred to as an “irregular discharge.” Our aim was to identify factors associated with irregular discharges from DCHV programs using multivariable logistic regressions on a national administrative dataset of 12,337 Veteran admitted to DCHV programs from 2018-2021. Irregular discharges were documented for 24.8% of the sample. Factors associated with increased risk of irregular discharges included prior incarceration (OR = 1.23, 95% CI [1.08, 1.39]), PTSD (OR = 1.13, 95% CI [1.02, 1.24]), psychoses (OR = 1.37, 95% CI [1.22, 1.53]), and drug use diagnosis (OR = 1.56, 95% CI [1.40, 1.74]). Understanding the risk factors for irregular discharge will allow for targeted interventions to Veterans most at risk. Further exploration into how to improve DCHV care for veterans with a history of incarceration, PTSD, and drug use diagnoses is warranted.

KEYWORDS:

• Homelessness
• veterans
• substance use
• mental health
• rehabilitation

Acknowledgments

This project was supported by the Department of Veterans Affairs Office of Academic Affiliations Advanced Fellowship Program in Health Services Research, the Center for Healthcare Organization and Implementation Research (CHOIR), Bedford VA Healthcare System.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

The author(s) reported there is no funding associated with the work featured in this article. .

Notes on contributors

Kimberlee Flike

Kimberlee Flike, PhD, RN is a health services research fellow at the Center for Healthcare Organization and Implementation Research at the VA Bedford Healthcare System. Her work focuses on improving the health and well-being of people experiencing homelessness. Her research interests include homelessness, substance use, and health services research.

Thomas H. Byrne

Thomas H. Byrne, PhD is an Investigator at the Center for Healthcare Organization and Implementation Research at the VA Bedford Healthcare System and an Associate Professor at the Boston University School of Social Work. His research focuses on the causes, consequences and policy solutions to housing insecurity and homelessness.

Justeen Hyde

Justeen Hyde, PhD is an Anthropologist and Health Services Researcher at the Center for Healthcare Organization and Implementation Research at the VA Bedford Healthcare System and Boston University School of Medicine. Her research focuses on person-centered care, with a special focus on factors contributing to the experience of health and health care among people who experience homelessness, face challenges with substance use, and live with medically unexplained symptoms.