    Homeless Veterans Programs: Improved Communications and Follow-up
    Could Further Enhance the Grant and Per Diem Program (11-SEP-06,
    GAO-06-859).

    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.
    -------------------------Indexing Terms-------------------------
    REPORTNUM:   GAO-06-859
        ACCNO:   A60605
      TITLE:     Homeless Veterans Programs: Improved Communications and
    Follow-up Could Further Enhance the Grant and Per Diem Program
         DATE:   09/11/2006
      SUBJECT:   Alcohol or drug abuse problems
    	     Homelessness
    	     Housing
    	     Housing programs
    	     Interagency relations
    	     Mental illnesses
    	     Performance appraisal
    	     Program evaluation
    	     Veterans
    	     Veterans benefits
    	     VA Homeless Providers Grant and Per Diem
    	     Program

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    GAO-06-859

         * Results in Brief
         * Background
              * GPD Transitional Housing Program for Homeless Veterans
              * Veteran Eligibility for the GPD Program
              * Characteristics of Veterans Eligible for the GPD Program
              * Roles of Various Agencies Serving Homeless Veterans
         * VA Estimates about 194,000 Veterans Are Homeless and Has Increased Its
           Capacity to Provide Transitional Housing
              * VA Considers Its Homeless Veterans Estimate to Be the Best
                Available
              * VA Expanded GPD Program Capacity and Plans Further Expansion to
                Help Meet Homeless Veterans' Needs
         * GPD Providers Collaborate to Offer a Range of Services but Still Face
           Challenges in Helping Veterans
              * GPD Providers Create Partnerships to Help Veterans Meet Program
                Goals, but Resource Gaps Remain
              * Communication of Program Polices May Affect Providers' Ability to
                Serve Veterans
         * 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
              * Many Veterans Attain Stable Housing, Income, and Greater
                Self-Determination Immediately upon Leaving the Program,
                According to VA Data
                   * Stability in Independent and Secured Housing
                   * Income from Employment or Financial Benefits
                   * Greater Self-Determination in Terms of Improved Functioning
                     in Several Areas
                   * In 2006 VA Took Steps to Help Ensure That VA Liaisons
                     Conduct Required Reviews of GPD Provider Performance
              * 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
         * Conclusions
         * Recommendations for Executive Action
         * Agency Comments and Our Evaluation
         * Veterans Health Administration Programs for Homeless Veterans
              * Health Care for Homeless Veterans (HCHV) including Contracted
                Residential Treatment
              * Homeless Domiciliary Residential Rehabilitation and Treatment
                Program
              * Homeless Compensated Work Therapy/Transitional Residence
              * Loan Guarantee for Multifamily Transitional Housing
              * Housing and Urban Development-VA Supported Housing
         * Veterans Benefits Administration Programs for Homeless Veterans
              * Veterans Benefits Administration Outreach
              * Acquired Property Sales for Homeless Providers
              * Labor-VA Incarcerated Veterans' Transition Program
         * GAO Contact
         * Acknowledgments
         * GAO's Mission
         * Obtaining Copies of GAO Reports and Testimony
              * Order by Mail or Phone
         * To Report Fraud, Waste, and Abuse in Federal Programs
         * Congressional Relations
         * Public Affairs

    Report to the Chairman, Committee on Veterans' Affairs, House of
    Representatives

    United States Government Accountability Office

    GAO

    September 2006

    HOMELESS VETERANS PROGRAMS

    Improved Communications and Follow-up Could Further Enhance the Grant and
    Per Diem Program

    GAO-06-859

    Contents

    Letter 1

    Results in Brief 2
    Background 4
    VA Estimates about 194,000 Veterans Are Homeless and Has Increased Its
    Capacity to Provide Transitional Housing 12
    GPD Providers Collaborate to Offer a Range of Services but Still Face
    Challenges in Helping Veterans 19
    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 26
    Conclusions 34
    Recommendations for Executive Action 34
    Agency Comments and Our Evaluation 35
    Appendix I Scope and Methodology 37
    Appendix II VA's Programs for Homeless Veterans Other than the GPD Program
    41
    Appendix III Range of Services Offered by GPD Programs Nationwide 44
    Appendix IV Participant Outcomes for the Grant and Per Diem Program 47
    Appendix V Comments from the Department of Veterans Affairs 49
    Appendix VI GAO Contact and Staff Acknowledgments 53
    Related GAO Products 54

    Tables

    Table 1: Available and Needed Transitional Beds for Homeless Veterans,
    Fiscal Year 2005 18
    Table 2: Examples of Services and Partners That Worked with GPD Providers
    We Visited 21
    Table 3: Numbers and Percentages of Veterans Leaving the GPD Program with
    Employment or Benefit Income, Fiscal Years 2000 through 2005 29
    Table 4: Number of Veterans Leaving GPD Program and Percentage with
    Specific Problems at Entry, Fiscal Years 2000 and 2005 31
    Table 5: Features of GPD Programs That GAO Visited 38
    Table 6: Percentage of GPD Facilities Reporting They Provided Selected
    Services by Method 45
    Table 7: Number Served by VA's Health Care for Homeless Veterans and Grant
    and Per Diem Program and Veterans' Outcomes, Fiscal years 2000 through
    2005 48

    Figures

    Figure 1: VA Services and Programs for Homeless Veterans 5
    Figure 2: Interiors and Exteriors of Selected GPD Buildings That GAO
    Toured 8
    Figure 3: VA Estimates of Homeless Veterans Nationwide, Fiscal Years 2000
    through 2005 14
    Figure 4: Number of GPD Beds Compared to Admissions of Homeless Veterans,
    Fiscal Years 2000 through 2005 16
    Figure 5: Distribution of the Beds Available under the GPD Program in May
    2006 17
    Figure 6: Flow of Policy and Program Information from VA to GPD Providers
    24
    Figure 7: Percentage of Veterans with Independent or Secured Housing upon
    Leaving GPD Program, Fiscal Years 2000 through 2005 28
    Figure 8: Percentage of Veterans Leaving the GPD Program with Greater
    Self-Determination, Fiscal Years 2000 through 2005 30

    Abbreviations

    CHALENG Community Homelessness Assessment, Local Education and Networking
    Group for Veterans

    DOL Department of Labor

    GPD Homeless Providers Grant and Per Diem

    HCHV Health Care for Homeless Veterans

    HHS Department of Health and Human Services

    HUD Department of Housing and Urban Development

    NEPEC Northeast Program Evaluation Center

    OIG Office of Inspector General

    VA Department of Veterans Affairs

    This is a work of the U.S. government and is not subject to copyright
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    separately.

    United States Government Accountability Office

    Washington, DC 20548

    September 11, 2006

    The Honorable Steve Buyer Chairman Committee on Veterans' Affairs House of
    Representatives

    Dear Chairman Buyer:

    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. 1 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.

    Results in Brief

    VA reports that about 194,000 veterans were homeless nationwide on a given
    night in fiscal year 2005-an estimate that VA officials consider the best
    available. VA changed its estimation process in 2004 to provide a snapshot
    of the number of homeless veterans at a given point in time, as opposed to
    an aggregate total of veterans who were homeless over the course of the
    year. Earlier estimates combined these aggregate totals with the snapshot
    data. While VA officials consider the current estimate to be more reliable
    than those for earlier years, the agency believes the estimate to be on
    the low side because some veterans cannot be located at the time the
    counts are taken. To accommodate veterans ready and willing to assume the
    responsibilities involved in transitional housing, VA reports that a total
    of 45,000 transitional beds are needed. VA has identified 35,400 beds that
    are available from various sources, including the GPD program, resulting
    in a shortfall of about 9,600 beds. In fiscal year 2005, the GPD program
    had about 8,000 beds available for homeless veterans. Because veterans
    only stayed in GPD beds on average about 4 months, the GPD program was
    able to admit over 16,000 veterans over this same period. VA officials
    told us that they have plans to expand the GPD program by 2,200 beds in
    the near future. As the GPD program continues to grow, VA also recognizes
    that it will have to accommodate the needs of the changing homeless
    veteran population, including increasing numbers of women and veterans
    with dependents.

    1 VA's Office of Inspector General reviewed the GPD program and planned to
    issue a report in September 2006 titled Evaluation of the Veterans Health
    Administration Homeless Grant and Per Diem Program that will be available
    on the Internet.

    2 Some medical centers continue to fund contracted residential treatment
    from their own budgets. For more on earlier VA programs serving homeless
    veterans, see GAO, Homeless Veterans: VA Expands Partnerships, but
    Homeless Program Effectiveness Is Unclear, GAO/HEHS-99-53 (Washington,
    D.C.: Apr. 1, 1999).

    3Throughout this report, we use the term "GPD provider" to refer to a
    locally run program. In some cases a single organization may have several
    GPD grants for housing at different locations, and we generally report
    this as multiple providers.

    4 VA granted extensions to about 1 percent of the veterans who left the
    program in fiscal year 2005. The rules allow extensions when permanent
    housing for the veteran has not been located or the veteran requires
    additional time to prepare for independent living.

    5 In contrast to the GPD program, veterans must meet the minimum length of
    service requirements of in 38 U.S.C. S:5303A in order to be eligible for
    VA health care. In certain cases veterans with dishonorable discharges may
    obtain an upgrade to their discharge status and thus become eligible for
    the GPD program or for VA medical care.

    6Veterans must constitute at least 75 percent of participants in
    facilities that have received GPD capital grants.

    7The definitions appear at 42 U.S.C. S: 11302 and 38 C.F.R. S: 61.1.

    8To assist Continuums in conducting counts of the homeless, HUD issued A
    Guide to Counting Unsheltered Homeless People, which is available on the
    Internet.

    9For the committee's recommendations and VA's responses, see Department of
    Veterans Affairs, 2005 Annual Report of the Advisory Committee on Homeless
    Veterans: Reaching Out to Homeless Veterans (Washington, D.C.: July 2005).

    10The chronic homeless are unaccompanied individuals with disabling
    conditions who have either been continuously homeless for a year or have
    had at least four episodes of homelessness in the past 3 years. An
    estimated 63,000 veterans were considered chronically homeless in 2005.

    11For the fiscal year 2005 report, see VA, Community Homelessness
    Assessment, Local Education and Networking Group (CHALENG) for Veterans:
    The Twelfth Annual Progress Report on Public Law105-114, Services for
    Homeless Veterans Assessment and Coordination, (Washington, D.C.: Apr. 15,
    2006).

    12 The estimate of homeless veterans is derived from the CHALENG survey of
    designated local VA officials who are asked to provide the highest number
    of homeless veterans estimated in their service area on one day of the
    official's choosing in fiscal year 2005.

    13The Bureau of the Census has had difficulty enumerating the overall
    homeless population, as we reported in GAO, Decennial Census: Methods for
    Collecting and Reporting Data on the Homeless and Others without
    Conventional Housing Need Refinement, GAO-03-227 (Washington, D.C.: Jan.
    17, 2003). A Census official we interviewed cautioned that the 2010 Census
    may not enumerate homeless veterans.

    14 VA issued a directive for a onetime dental care opportunity for
    homeless veterans (VHA Directive 2002-080) in line with 38 U.S.C. S: 101
    note. VA officials told us that funding was provided in 2006 to implement
    this directive.

    15 For more information on DOL programs, see GAO, Homeless Veterans: Job
    Retention Goal Under Development for DOL's Homeless Veterans'
    Reintegration Program, GAO-05-654T (Washington, D.C.: May 4, 2005).

    16Through the Continuum of Care, HUD contracts with public housing
    agencies for the rehabilitation of residential properties that provide
    multiple single room dwelling units. These agencies make Section 8 rental
    assistance payments generally covering the difference between a portion of
    the tenant's income (normally 30 percent) and the unit's rent to
    participating owners (i.e., landlords) on behalf of homeless individuals
    who rent the rehabilitated dwellings.

    17 According to VA, in fiscal years 2005 and 2006 it had allocated funding
    for a total of 97 full-time liaisons. As of the time of our review, some
    sites were still going through the recruitment and hiring processes to
    fill these positions.

    18 VA may waive the episode requirement if the services offered are
    different from those previously provided and may lead to a successful
    outcome. The VA liaisons must review and approve or deny the waiver based
    on their best clinical assessment of the individual case.

    19Since fiscal year 2002, VA's strategic plan has included a performance
    target to capture the housing status of veterans discharged from three of
    its transitional housing programs, including the GPD program. VA has
    gradually increased its target from 65 percent in fiscal year 2002 to 79
    percent in fiscal year 2005. VA estimates that it exceeded this target in
    fiscal year 2005.

    20 VA also asks participants for their evaluations after they have been in
    the program for 1 month. Nearly half of the participants completed the
    surveys in fiscal year 2005. Most reported satisfaction with the GPD,
    rating it at 3.2 on a scale where 4 is the highest possible score, and
    with their VA case managers, rating them at 4.6 on a scale where 6 is the
    highest possible score.

    21 This effort has been possible, according to VA, in part because
    increased funds have made it possible for more liaisons to work with the
    GPD program on a full-time rather than a part-time basis.

    22VA has also conducted other follow-up studies designed to test
    innovative approaches to serving homeless veterans, including ways to
    improve employment outcomes, ensure the safety and serve the needs of
    female veterans, and intervene on behalf of veterans dually diagnosed with
    both mental health and substance abuse problems.

    The GPD providers that we visited often collaborated with public and
    nonprofit agencies in helping veterans to recover from substance abuse or
    mental illness and obtain permanent housing, employment, financial
    stability, and services needed to enhance their ability to live
    independently. While GPD providers were generally able to build successful
    partnerships, most of them identified resource and communications gaps
    that presented challenges to delivering certain services. For example,
    providers reported difficulties in locating affordable permanent housing
    for veterans ready to leave the program because of shortages in their
    communities. In addition we found that those responsible for program
    implementation did not always understand the policies. Some GPD providers
    believed that homeless veterans were eligible for the GPD program only if
    they were eligible for VA health care. This assumption was incorrect and
    may have had the effect of erroneously turning away veterans seeking to
    enter the GPD program. There were also instances in which GPD providers
    did not understand that veterans may be able to exceed the 3-stay lifetime
    limit under certain conditions. This assumption, also incorrect, could
    keep veterans from obtaining needed care.

    VA assesses performance in two ways-the veterans' circumstances at the
    time they leave the program and the ability of individual GPD providers to
    meet their own objectives-but VA generally does not know how veterans are
    faring months or years later. When veterans leave the program for any
    reason, VA collects information on their immediate success in obtaining
    housing, income, and greater self-determination-the primary measures of
    overall GPD program performance. VA reports that of all veterans leaving
    the program in fiscal year 2005, half had successfully arranged
    independent housing, one-third had jobs, over one-third were receiving
    public benefits, and 57 to 69 percent showed progress with substance
    abuse, mental health or medical problems or demonstrated greater
    self-determination in other ways. In addition, in 2006 VA took steps to
    ensure that its local staff conduct annual reviews to determine if the GPD
    providers are meeting their objectives. VA does not require providers to
    collect data from veterans months or years after they leave the program,
    although many providers attempt to maintain contact with former
    participants. Some indication of how veterans are faring after they leave
    the program should be available from VA's recent follow-up study of 520
    program participants. Preliminary results of this study indicate that
    veterans maintained positive housing outcomes 1 year after leaving the GPD
    program.

    To further strengthen VA's ability to help homeless veterans, we are
    recommending that VA take steps to ensure that GPD policies and procedures
    are consistently understood and to explore feasible means of obtaining
    information about the circumstances of veterans after they leave the GPD
    program. In its comments on a draft of this report, VA concurred with our
    recommendations and described several initiatives planned or under way to
    address some issues raised in our report as well as other challenges the
    GPD program faces.

    Background

    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.)

    Figure 1: VA Services and Programs for Homeless Veterans

    aThis program is a joint initiative with VHA.

    bHUD provides the housing subsidy; VA provides case management services.

    GPD Transitional Housing Program for Homeless Veterans

    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. 2 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.

               o  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.

               o  Per diem grants support the operations of about 300 GPD
               providers 3 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.

    Figure 2: Interiors and Exteriors of Selected GPD Buildings That GAO
    Toured

    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. 4 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.

    Veteran Eligibility for the GPD Program

    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. 5 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. 6 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. 7 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.

    Characteristics of Veterans Eligible for the GPD Program

    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.

    Roles of Various Agencies Serving Homeless Veterans

    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. 8 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. 9

    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. 10 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. 11

    VA Estimates about 194,000 Veterans Are Homeless and Has Increased Its
    Capacity to Provide Transitional Housing

    VA estimates that on a given night in fiscal year 2005 about 194,000
    veterans were homeless. 12 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.

    VA Considers Its Homeless Veterans Estimate to Be the Best Available

    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.

    Figure 3: VA Estimates of Homeless Veterans Nationwide, Fiscal Years 2000
    through 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, 13 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.

    VA Expanded GPD Program Capacity and Plans Further Expansion to Help Meet
    Homeless Veterans' Needs

    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.

    Figure 4: Number of GPD Beds Compared to Admissions of Homeless Veterans,
    Fiscal Years 2000 through 2005

    Note: Not all beds shown were in operation for the full year; for example,
    only 7,800 beds were in operation at the end of fiscal year 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).

    Figure 5: Distribution of the Beds Available under the GPD Program in May
    2006

    Note: VA reports that grants have been awarded to providers in Alaska,
    Maine, and North Dakota to develop 20, 18 and 48 beds respectively in
    those states.

    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.

    Table 1: Available and Needed Transitional Beds for Homeless Veterans,
    Fiscal Year 2005

    Transitional beds needed            45,000
    VA transitional beds available      10,400

          o  GPD program                  (8,000)
          o  Non-GPD programsa
                                          (2,400)
    Other transitional beds available
                                           25,100
    Total transitional beds availableb  35,400
    Additional beds still neededb        9,600

    Source: GAO analysis of VA data.

    aBeds for VA's contracted residential treatment are not included, but VA
    officials estimate about 304 beds are available.

    bNumbers are CHALENG estimates rounded to nearest 100; subtotals included
    in these numbers may not add to numbers shown due to rounding.

    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.

    GPD Providers Collaborate to Offer a Range of Services but Still Face
    Challenges in Helping Veterans

    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.

    GPD Providers Create Partnerships to Help Veterans Meet Program Goals, but
    Resource Gaps Remain

    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.

    Table 2: Examples of Services and Partners That Worked with GPD Providers
    We Visited

    Veterans'   Select services  Partners that
    needs                        provided
                                    servicesa
    Case management and             o  VA liaison
    individual treatment plan       with GPD
                                       provider
    Health Care Mental health       o  VA
                   treatment           o  Local area
                                       hospitals
                                       o  Local
                                       organizations
                                    Substance abuse      o  VA
                                    treatment            o  Local area hospitals
                                                         o  Local organizations
                                    Counseling           o  VA
                                    (family,             o  Local organizations
                                    nutritional,
                                    etc.)
                                    Medical services     o  VA
                                                         o  Local area hospitals
    Employment  Financial           o  Local
    and Income  counseling          organizations
                                    Employment           o  Department of Labor
                                    assistance and
                                    training                     o  Disabled
                                                                 Veterans'
                                                                 Outreach
                                                                 Programb
                                                                 o  Homeless
                                                                 Veterans
                                                                 Reintegration
                                                                 Programc

                                                         o  VA

                                                                 o  Compensative
                                                                 Work Therapy
                                                                 o  Incentive
                                                                 Therapyd

                                                         o  State and local
                                                         training programs
                                                         o  Local organizations
                                                         and colleges
                                    Assistance with      o  VA
                                    getting benefits     o  Social Security
                                                         Administration
                                                         representative
                                                         o  State/county benefits
                                                         counselors
                                                         o  Veterans service
                                                         organizations
    After       Stable housing      o  State and
    leaving GPD                     local programs
    program                         o  HUD
                                    Follow-up care       o  VA
                                    and supportive       o  Local organizations
                                    servicese
    Other needs Legal assistance    o  Local
                                       organizations
                                       and law
                                       offices
                                       o  Local
                                       colleges
                                       o  Outreach to
                                       local jails
                   Transportation      o  VA GPD van
                                       grants
                                       o
                                       Relationship
                                       with local
                                       transit
                                       authority

    Source: GAO analysis of GPD provider partnerships.

    aGPD provider staff also may have been directly involved in providing
    services in any of these partnership examples.

    bProgram provides funding through state employment security agencies to
    support dedicated staff positions to develop and provide employment and
    job training opportunities for disabled and other qualified veterans.

    cProgram provides services to assist in reintegrating homeless veterans
    into meaningful employment within the labor force.

    dProgram helps veterans regain work habits and skills by participating in
    various work situations within VA as part of their treatment or
    rehabilitative programs.

    eSupportive services for veterans who leave the GPD program may include
    health care services rendered during a veteran's GPD program stay, as well
    as other services to help veterans maintain housing.

    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. 14 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. 15 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. 16 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.

    Communication of Program Polices May Affect Providers' Ability to Serve
    Veterans

    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.

    Figure 6: Flow of Policy and Program Information from VA to GPD Providers

    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. 17

    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. 18 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.

    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

    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.

    Many Veterans Attain Stable Housing, Income, and Greater
    Self-Determination Immediately upon Leaving the Program, According to VA
    Data

    The following sections compare VA's GPD performance data from fiscal year
    2005 with data from fiscal years 2000 through 2004.

    Stability in Independent and Secured Housing

    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. 19 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.

    Figure 7: Percentage of Veterans with Independent or Secured Housing upon
    Leaving GPD Program, 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.

    Income from Employment or Financial Benefits

    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.

    Table 3: Numbers and Percentages of Veterans Leaving the GPD Program with
    Employment or Benefit Income, Fiscal Years 2000 through 2005

    Number and             Fiscal   Fiscal   Fiscal   Fiscal   Fiscal   Fiscal
    percentage of       year 2000     year     year     year     year     year
    discharges from GPD               2001     2002     2003     2004     2005
    program with
          o  Total full-   1,404     2,803    3,579    3,735    4,108    4,920
          and part-time    (37%)     (33%)    (33%)    (33%)    (34%)    (33%)
          employment
          o  full-time     1,163     2,178    2,852    2,995    3,311    3,927
                           (30%)     (26%)    (26%)    (26%)    (27%)    (26%)
          o  part-time     241 (6%)  625 (7%) 727 (7%) 740 (7%) 797 (7%) 993 (7%)
          o  Total with                                3,594    4,400    5,840
          any benefits                                 (31%)    (36%)    (38%)
          o  VA benefits      NA        NA       NA    1,530    2,091    2,924
          only                                         (13%)    (17%)    (19%)
          o  other            NA        NA       NA    1,494    1,699    2,089
          benefits only                                (13%)    (14%)    (14%)
          o  both VA and      NA        NA       NA    570 (5%) 610 (5%) 827 (5%)
          other benefits

    Source: GAO analysis of VA data.

    Notes: Percentages may not add up to total shown due to rounding. NA =
    Data on receipt of VA and other benefits were not available for fiscal
    years 2000 through 2002.

    Greater Self-Determination in Terms of Improved Functioning in Several
    Areas

    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. 20 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.

    Figure 8: Percentage of Veterans Leaving the GPD Program with Greater
    Self-Determination, Fiscal Years 2000 through 2005

    Note: The percentage calculations are based on the number of veterans who
    showed the problem at admission.

    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.

    Table 4: Number of Veterans Leaving GPD Program and Percentage with
    Specific Problems at Entry, Fiscal Years 2000 and 2005

    Number of discharges from GPD program    Fiscal year 2000 Fiscal year 2005
                                                4,020            15,403
    Number of discharges for whom data are   3,826            15,048
    available
    Problems that discharged veterans showed
    on entering the program:
          o  Alcohol                                 2,789 (73%)     11,180 (74%)
          o  Drugs                                   2,579 (67%)     10,307 (68%)
          o  Mental illness                          1,205 (32%)      9,736 (65%)
          o  Medical illness                         1,255 (33%)     10,488 (70%)
          o  Social or vocational                    2,276 (60%)     10,864 (72%)

    Source: GAO analysis of data from NEPEC annual reports.

    In 2006 VA Took Steps to Help Ensure That VA Liaisons Conduct Required
    Reviews of GPD Provider Performance

    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 resumes, 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. 21 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.

    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

    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. 22 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.

    Conclusions

    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.

    Recommendations for Executive Action

    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.

    Agency Comments and Our Evaluation

    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.

    Sincerely yours,

    Cristina T. Chaplain Acting Director Education, Workforce, and Income
    Security Issues

    Appendix I: Scope and Methodology
    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.

    Table 5: Features of GPD Programs That GAO Visited

                                     Number of    Fiscal    Fiscal Year Location
                                      GPD beds  Year `05  `05Discharges Typea
                                                  Admits
    Massachusetts-Boston, Fitchburg, Leominster Veterans Integrated Service
    Network 1
    New England Shelter for              30       149            137 urban
    Homeless Veterans,
    Post-Detox Program (Boston)
    Veteran Hospice Homestead            12        19             21 rural
    (Fitchburg)
    The Armistice Homesteadb             15        NA             NA rural
    (Leominster)
    Florida-Tampa, Melbourne, Cocoa Veterans Integrated Service Network 8
    Agency for Community                 60        64             53 urban
    Treatment Services, (Tampa)
    Vietnam Veterans of Brevard          19        70             53 urban
    (Melbourne)
    Volunteers of                        80       100            100 urban
    America-Florida (Cocoa)c
    Wisconsin-Tomah, Madison, Fort McCoy Veterans Integrated Service Network
    12
    Veterans Assistance                  60       162            167 rural
    Foundation (Tomah)d
    Veterans Assistance                   7         9             10 urban
    Foundation, Step Up Program
    (Madison)
    Wisconsin Department of              14        23             18 rural
    Veterans Affairs  (Fort
    McCoy)
    California-Los Angeles Veterans Integrated Service Network 22
    P.A.T.H.c                            10        28             23 urban
    The Salvation Army, The              95       193            200 urban
    Haven d
    Volunteers of America-LAc           102       106             98 urban
    Weingart Center Association         100       107            113 urban

    Source: GAO review of VA data.

    aVA does not classify grantees as rural; however, we included this type of
    information for site selection purposes.

    bThe Armistice Homestead is part of a collaborative grant under
    Massachusetts Veterans Inc. The entire grant funds 43 beds, 15 of which
    are located at the Armistice. Specific admission and discharge data were
    not available for the Armistice program.

    cProgram also has funding for a service center.

    dProgram is located on VA medical center grounds.

    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.

    Appendix II: VA's Programs for Homeless Veterans Other than the GPD
    Program

    Veterans Health Administration Programs for Homeless Veterans

    Health Care for Homeless Veterans (HCHV) including Contracted Residential
    Treatment

    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.

    Homeless Domiciliary Residential Rehabilitation and Treatment Program

    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.

    Homeless Compensated Work Therapy/Transitional Residence

    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.

    Loan Guarantee for Multifamily Transitional Housing

    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.

    Housing and Urban Development-VA Supported Housing

    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.

    Veterans Benefits Administration Programs for Homeless Veterans

    Veterans Benefits Administration Outreach

    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.

    Acquired Property Sales for Homeless Providers

    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.

    Labor-VA Incarcerated Veterans' Transition Program

    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.

    Appendix III: Range of Services Offered by GPD Programs Nationwide

    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.

    Table 6: Percentage of GPD Facilities Reporting They Provided Selected
    Services by Method

                                        How services were provided by
                                                  programs
    Services (ordered by prevalence Indirectly Indirectly  Directly      Total
    of service being offered)          through  by staffb by staffc percentage
                                        linkagesa                              of
                                                                       facilities
                                                                        providing
                                                                          service
    Vocational/educational                48.0       11.5      39.8       99.3
    counseling
    Discharge planning                     8.2        2.5      88.6       99.3
    Assistance with obtaining             25.7        5.4      67.5       98.6
    social services (e.g.,
    Medicaid, Supplemental Security
    Income, Social Security
    Disability Insurance)
    Case management services              10.0        3.2      85.4       98.6
    Housing assistance                    20.8        4.3      73.1       98.2
    Assistance with spending money,       18.6        8.2      70.0       96.8
    banking or other financial
    matters
    Transportation or assistance          20.0        7.1      69.3       96.4
    using public transportation
    Relapse prevention groups             48.8        5.4      41.9       96.1
    Comprehensive mental health           70.4        8.6      16.8       95.7
    assessment/diagnosis
    Individual therapy                    47.9        5.4      42.5       95.7
    Referral to other transitional        13.9        3.2      78.2       95.4
    services
    Comprehensive substance abuse         47.7        8.6      38.7       95.0
    assessment/diagnosis
    Group therapy, not including          38.6        5.7      47.1       91.4
    relapse prevention
    Aftercare counseling                  48.2        5.4      37.5       91.1
    AIDS screening and counseling         75.0        7.5       6.8       89.3
    Nutritional counseling                54.6       11.4      23.2       89.3
    Legal advice or counseling            76.1        3.9       5.7       85.7
    Outcome follow-up (post               18.6        6.1      56.3       81.0
    discharge)
    Family counseling                     44.3        7.1      28.6       80.0
    Religious or spiritual                51.1        8.2      17.5       76.8
    counseling
    Domestic                              63.2        4.3       8.2       75.7
    violence-family/partner
    violence services
    Representative payee servicesd        51.4        3.6       8.6       63.6
    Child care                            17.1        3.2       1.8       22.1

    Source: GAO analysis of NEPEC GPD program facility survey.

    Note: Percentages were calculated for facilities that completed the survey
    question, either 279 or 280 facilities depending on the question.

    aIndirectly through linkages means treatment is provided indirectly
    through links with other agencies, including VA.

    bIndirectly by staff means treatment is provided indirectly by other staff
    of the organization.

    cDirectly by staff means treatment is provided directly by staff at this
    program.

    dRepresentative payees handle an individual's benefits if the individual
    is unable to. The benefits must be used to meet the needs of the
    beneficiary.

    Appendix IV: Participant Outcomes for the Grant and Per Diem Program

    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.

    Table 7: Number Served by VA's Health Care for Homeless Veterans and Grant
    and Per Diem Program and Veterans' Outcomes, Fiscal years 2000 through
    2005

    Participants served and  Federal fiscal year (October through September of
    outcomes                                    year shown)
                                    2000     2001    2002    2003    2004    2005
    Number of                  43,082   57,854  61,123  60,970  63,283  61,261

          o  veterans treated     34,206   46,862  44,296  42,380  42,485  41,111
          by VA's Health Care
          for Homeless             4,841   10,137  11,913  12,396  13,509  16,597
          Veterans' (HCHV)
          staff                    4,020    8,706  11,098  11,467  12,454  15,403
          o  intake assessments
          of homeless veterans
          by HCHV staffa
          o  admissions of
          veterans to GPDs
          o  discharges from
          GPDs
    Days a veteran stays at        91       85      93     110     126     127
    a GPD, on average
    Housing stability           1,163    2,187   3,073   4,590   6,597   8,186
    outcomes:
                                     991    2,162   2,731   2,882   3,127   4,003
    Number of discharges
    from GPDs with

          o  independent
          housing
          o  placement in
          halfway house or
          institution such as
          hospital. nursing
          home, or domiciliary
    Increased income or         1,404    2,803   3,579   3,735   4,108   4,920
    skills outcomes:
                                      NA       NA      NA   2,100   2,701   3,751
    Number of discharges
    from GPDs with                 NA       NA      NA   2,064   2,309   2,916

          o  full-time or
          part-time employment
          o  VA benefitsb
          o  Other public
          benefitsb
    Greater                     38-42    42-49   43-50   56-62   60-67   62-69
    self-determination
    outcomes:                   43-46    40-44   43-46   50-57   55-63   57-64

    Percentage of discharges       30       32      38      43      49      50
    from GPDs with

          o  improved alcohol,
          drug, mental healthc
          o  improved medical,
          social/vocational
          conditionc
          o  success in program

    Source: VA data.

    aIntake assessments are completed by HCHV staff when they first encounter
    a homeless veteran, unless the contact is casual and no services are
    offered or referrals made. After a year, new assessments are required if
    VA care or services are provided and VA staff have not been working with
    the veteran.

    bNumbers shown here include veterans who receive both types of benefits as
    well as those who receive only the designated benefits. For this reason,
    they differ from the numbers shown in table 3.

    cPercentages are ranges showing the highest and lowest of each of two or
    three outcome measures.

    Appendix V: Comments from the Department of Veterans Affairs

    Appendix VI: GAO Contact and Staff Acknowledgments

    GAO Contact

    Cristina T. Chaplain, Acting Director, (202) 512-7215, chaplainc@gao.gov

    Acknowledgments

    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.

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    (130513)

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    Highlights of GAO-06-859 , a report to the Chairman, Committee on
    Veterans' Affairs, House of Representatives

    September 2006

    HOMELESS VETERANS PROGRAMS

    Improved Communications and Follow-up Could Further Enhance the Grant and
    Per Diem Program

    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.

    Number of GPD Beds and Admissions from Fiscal Year 2000 through 2005

    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.

    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.

    What GAO Recommends

    To further strengthen VA's ability to help homeless veterans, GAO is
    recommending that VA take steps to ensure policies are understood by
    providers and staff who implement them. GAO also recommends that VA
    explore feasible and cost-effective means of obtaining information on
    long-term outcomes for veterans who leave the GPD programs. VA generally
    agreed with our findings and recommendations.
    *** End of document. ***