Evaluation of the low-demand model for serving unsheltered homeless Veterans in transitional housing
Abstract: OBJECTIVE: The U.S. Department of Veterans Affairs (VA) contracts with community-based agencies to operate its Grant and Per Diem (GPD) transitional housing programs, including a low-barrier model called low demand. This study aimed to compare characteristics and outcomes of unsheltered veterans served by the GPD Low Demand program with those of unsheltered veterans served by two other GPD programs (Clinical Treatment and Service Intensive). METHODS: National VA administrative data on 16,059 unique unsheltered veterans who participated in GPD programs in fiscal years 2019-2023 were analyzed. Outcomes examined included rates of positive program exit, returns to homelessness within 12 months, and use of VA health care services before and after program admission. RESULTS: The Low Demand program served a higher proportion of unsheltered veterans than the two comparison programs (36.8% vs. 24.0%-26.8%, respectively). Nearly half (46.4%) of unsheltered veterans in the Low Demand program had positive program exits, but they were significantly less likely to have positive program exits and exits to permanent housing, had a shorter length of stay, and were less likely to have reduced acute care use than unsheltered veterans in the two comparison programs. Veterans who were older, were non-Hispanic Black, and had a moderate VA service-connected disability rating were more likely to have a positive exit from the Low Demand program. CONCLUSIONS: These findings reflect challenges experienced in low-barrier programs serving unsheltered individuals, who often have high treatment needs. Unsheltered individuals with certain profiles may benefit more than others from low-barrier programs.