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entitled 'Homeless Veterans Programs: Improved Communications and 
Follow-up Could Further Enhance the Grant and Per Diem Program' which 
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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: 

Homeless Veterans Program: 

GAO-06-859: 

GAO Highlights: 

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

Why GAO Did This Study: 

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 Found: 

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. 

Figure: Number of GPD Beds and Admissions from Fiscal Year 200 through 
2005: 

[See PDF for Image] 

Source: GAO analysis of VA data rounded to the nearest 100th. 

[End of Figure] 

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. 

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. 

[Hyperlink, http://www.gao.gov/cgi-bin/getrpt?GAO-06-859]. 

To view the full product, including the scope and methodology, click on 
the link above. For more information, contact Cristina T. Chaplain at 
(202) 512-7215 or chaplainc@gao.gov. 

[End of Section] 

Contents: 

Letter: 

Results in Brief: 

Background: 

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

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

Conclusions: 

Recommendations for Executive Action: 

Agency Comments and Our Evaluation: 

Appendix I: Scope and Methodology: 

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

Appendix III: Range of Services Offered by GPD Programs Nationwide: 

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

Appendix V: Comments from the Department of Veterans Affairs: 

Appendix VI: GAO Contact and Staff Acknowledgments: 

Related GAO Products: 

Tables: 

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

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

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

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

Table 5: Features of GPD Programs That GAO Visited: 

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

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: 

Figures: 

Figure 1: VA Services and Programs for Homeless Veterans: 

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

Figure 3: VA Estimates of Homeless Veterans Nationwide, Fiscal Years 
2000 through 2005: 

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

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

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

Figure 7: Percentage of Veterans with Independent or Secured Housing 
upon Leaving GPD Program, Fiscal Years 2000 through 2005: 

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

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: 

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.[Footnote 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. 

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: 

[See PDF for image] 

Source: GAO analysis of VA data. 

[A] This program is a joint initiative with VHA. 

[B] HUD provides the housing subsidy; VA provides case management 
services. 

[End of figure] 

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.[Footnote 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. 

* 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. 

* Per diem grants support the operations of about 300 GPD 
providers[Footnote 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: 

[See PDF for image] 

Sources: GAO (bottom two); Maryland Center for Veterans Education and 
Training (top left); and Veterans Hospice Homestead, Inc. (top right). 

[End of figure] 

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.[Footnote 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.[Footnote 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.[Footnote 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.[Footnote 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.[Footnote 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.[Footnote 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.[Footnote 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.[Footnote 
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.[Footnote 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: 

[See PDF for image] 

Source: GAO analysis of VA data from CHALENG reports. 

[End of figure] 

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,[Footnote 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: 

[See PDF for image] 

Source: GAO analysis of VA data rounded to the nearest 100th. 

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. 

[End of figure] 

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: 

[See PDF for image] 

Source: GAO analysis of VA data. 

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. 

[End of figure] 

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. 

* GPD program; 
(8,000). 

* Non-GPD programs[A]; 
(2,400). 

* Other transitional beds available; 
25,100. 

Total transitional beds available[B]; 
35,400. 

Additional beds still needed[B]; 
9,600. 

Source: GAO analysis of VA data. 

[A] Beds for VA's contracted residential treatment are not included, 
but VA officials estimate about 304 beds are available. 

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

[End of table] 

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' needs: Case management and individual treatment plan; 
Partners that provided services[A]: 
* VA liaison with GPD provider. 

Veterans' needs: Health Care; 
Select services: Mental health treatment; 
Partners that provided services[A]: 
* VA; 
* Local area hospitals; 
* Local organizations. 

Veterans' needs: Health Care; 
Select services: Substance abuse treatment; 
Partners that provided services[A]: 
* VA; 
* Local area hospitals; 
* Local organizations. 

Veterans' needs: Health Care; 
Select services: Counseling (family, nutritional, etc.); 
Partners that provided services[A]: 
* VA; 
* Local organizations. 

Veterans' needs: Health Care; 
Select services: Medical services; 
Partners that provided services[A]: 
* VA; 
* Local area hospitals. 

Veterans' needs: Employment and Income; 
Select services: Financial counseling; 
Partners that provided services[A]: 
* Local organizations. 

Veterans' needs: Employment and Income; 
Select services: Employment assistance and training;
Partners that provided services[A]: 
* Department of Labor; 
* Disabled Veterans' Outreach Program[B]; 
* Homeless Veterans Reintegration Program[C]; 
* VA; 
* Compensative Work Therapy; 
* Incentive Therapy[D]; 
* State and local training programs; 
* Local organizations and colleges. 

Veterans' needs: Employment and Income; 
Select services: Assistance with getting benefits; 
Partners that provided services[A]: 
* VA; 
* Social Security Administration representative; 
* State/county benefits counselors; 
* Veterans service organizations. 

Veterans' needs: After leaving GPD program; 
Select services: Stable housing; 
Partners that provided services[A]: 
* State and local programs; 
* HUD. 

Veterans' needs: After leaving GPD program; Select services: Follow- up 
care and supportive services[E]; 
Partners that provided services[A]: 
* VA; 
* Local organizations. 

Veterans' needs: Other needs; 
Select services: Legal assistance; 
Partners that provided services[A]: 
* Local organizations and law offices; 
* Local colleges; 
* Outreach to local jails. 

Veterans' needs: Other needs; 
Select services: Transportation; 
Partners that provided services[A]: Partners that provided services[A]: 
* VA GPD van grants; 
* Relationship with local transit authority. 

Source: GAO analysis of GPD provider partnerships. 

[A] GPD provider staff also may have been directly involved in 
providing services in any of these partnership examples. 

[B] Program 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. 

[C] Program provides services to assist in reintegrating homeless 
veterans into meaningful employment within the labor force. 

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

[E] Supportive 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. 

[End of table] 

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.[Footnote 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.[Footnote 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.[Footnote 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: 

[See PDF for image] 

Source: GAO analysis of VA data. 

[End of figure] 

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.[Footnote 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.[Footnote 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.[Footnote 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: 

[See PDF for image] 

Source: GAO analysis of NEPEC data. 

[End of figure] 

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 percentage of discharges from GPD program with: 
* Total full-and part-time employment; 
Fiscal year 2000: 1,404 (37%); 
Fiscal year 2001: 2,803 (33%); 
Fiscal year 2002: 3,579 (33%); 
Fiscal year 2003: 3,735 (33%); 
Fiscal year 2004: 4,108 (34%); 
Fiscal year 2005: 4,920 (33%). 

Number and percentage of discharges from GPD program with: 
* full-time; 
Fiscal year 2000: 1,163 (30%); 
Fiscal year 2001: 2,178 (26%); 
Fiscal year 2002: 2,852 (26%); 
Fiscal year 2003: 2,995 (26%); 
Fiscal year 2004: 3,311 (27%); 
Fiscal year 2005: 3,927 (26%). 

Number and percentage of discharges from GPD program with: 
* part-time; 
Fiscal year 2000: 241 (6%); 
Fiscal year 2001: 625 (7%); 
Fiscal year 2002: 727 (7%); 
Fiscal year 2003: 740 (7%); 
Fiscal year 2004: 797 (7%); 
Fiscal year 2005: 993 (7%). 

Number and percentage of discharges from GPD program with: 
* Total with any benefits; 
Fiscal year 2000: [Empty]; 
Fiscal year 2001: [Empty]; 
Fiscal year 2002: [Empty]; 
Fiscal year 2003: 3,594 (31%); 
Fiscal year 2004: 4,400 (36%); 
Fiscal year 2005: 5,840 (38%). 

Number and percentage of discharges from GPD program with: 
* VA benefits only; 
Fiscal year 2000: NA; 
Fiscal year 2001: NA; 
Fiscal year 2002: NA; 
Fiscal year 2003: 1,530 (13%); 
Fiscal year 2004: 2,091 (17%); 
Fiscal year 2005: 2,924 (19%). 

Number and percentage of discharges from GPD program with: 
* other benefits only; 
Fiscal year 2000: NA; 
Fiscal year 2001: NA; 
Fiscal year 2002: NA; 
Fiscal year 2003: 1,494 (13%); 
Fiscal year 2004: 1,699 (14%); 
Fiscal year 2005: 2,089 (14%). 

Number and percentage of discharges from GPD program with: 
* both VA and other benefits; 
Fiscal year 2000: NA; 
Fiscal year 2001: NA; 
Fiscal year 2002: NA; 
Fiscal year 2003: 570 (5%); 
Fiscal year 2004: 610 (5%); 
Fiscal year 2005: 827 (5%). 

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. 

[End of table] 

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.[Footnote 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: 

[See PDF for image] 

Source: GAO analysis of VA data. 

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

[End of figure] 

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: 4,020; 
Fiscal year 2005: 15,403. 

Number of discharges for whom data are available; 
Fiscal year 2000: 3,826; 
Fiscal year 2005: 15,048. 

Problems that discharged veterans showed on entering the program: 
* Alcohol; 
Fiscal year 2000: 2,789 (73%); 
Fiscal year 2005: 11,180 (74%). 

Problems that discharged veterans showed on entering the program: 
* Drugs; 
Fiscal year 2000: 2,579 (67%); 
Fiscal year 2005: 10,307 (68%). 

Problems that discharged veterans showed on entering the program: 
* Mental illness; 
Fiscal year 2000: 1,205 (32%); 
Fiscal year 2005: 9,736 (65%). 

Problems that discharged veterans showed on entering the program: 
* Medical illness; 
Fiscal year 2000: 1,255 (33%); 
Fiscal year 2005: 10,488 (70%). 

Problems that discharged veterans showed on entering the program: 
* Social or vocational; 
Fiscal year 2000: 2,276 (60%); 
Fiscal year 2005: 10,864 (72%). 

Source: GAO analysis of data from NEPEC annual reports. 

[End of table] 

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 résumés, 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.[Footnote 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.[Footnote 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, 

Signed by: 

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

[End of section] 

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: 

Massachusetts--Boston, Fitchburg, Leominster Veterans Integrated 
Service Network 1: New England Shelter for Homeless Veterans, Post- 
Detox Program (Boston); 
Number of GPD beds: 30; 
Fiscal Year '05 Admits: 149; 
Fiscal Year '05 Discharges: 137; 
Location Type[A]: urban. 

Massachusetts--Boston, Fitchburg, Leominster Veterans Integrated 
Service Network 1: Veteran Hospice Homestead (Fitchburg); 
Number of GPD beds: 12; 
Fiscal Year '05 Admits: 19; 
Fiscal Year '05 Discharges: 21; 
Location Type[A]: rural. 

Massachusetts--Boston, Fitchburg, Leominster Veterans Integrated 
Service Network 1: The Armistice Homestead[B] (Leominster); 
Number of GPD beds: 15; 
Fiscal Year '05 Admits: NA; 
Fiscal Year '05 Discharges: NA; 
Location Type[A]: rural. 

Florida- Tampa, Melbourne, Cocoa: Veterans Integrated Service Network 
8: Agency for Community Treatment Services, (Tampa); 
Number of GPD beds: 60; 
Fiscal Year '05 Admits: 64; 
Fiscal Year '05 Discharges: 53; 
Location Type[A]: urban. 

Florida- Tampa, Melbourne, Cocoa: Veterans Integrated Service Network 
8: Vietnam Veterans of Brevard (Melbourne); 
Number of GPD beds: 19; 
Fiscal Year '05 Admits: 70; 
Fiscal Year '05 Discharges: 53; 
Location Type[A]: urban. 

Florida- Tampa, Melbourne, Cocoa: Veterans Integrated Service Network 
8: Volunteers of America--Florida (Cocoa)[C]; 
Number of GPD beds: 80; 
Fiscal Year '05 Admits: 100; 
Fiscal Year '05 Discharges: 100; 
Location Type[A]: urban. 

Wisconsin- Tomah, Madison, Fort McCoy: Veterans Integrated Network 12: 
Veterans Assistance Foundation (Tomah)[D]; 
Number of GPD beds: 60; 
Fiscal Year '05 Admits: 162; 
Fiscal Year '05 Discharges: 167; 
Location Type[A]: rural. 

Wisconsin- Tomah, Madison, Fort McCoy: Veterans Integrated Network 12: 
Veterans Assistance Foundation, Step Up Program(Madison); 
Number of GPD beds: 7; 
Fiscal Year '05 Admits: 9; 
Fiscal Year '05 Discharges: 10; 
Location Type[A]: urban. 

Wisconsin- Tomah, Madison, Fort McCoy: Veterans Integrated Network 12:  
Wisconsin Department of Veterans Affairs (Fort McCoy); 
Number of GPD beds: 14; 
Fiscal Year '05 Admits: 23; 
Fiscal Year '05 Discharges: 18; 
Location Type[A]: rural. 

California - Los Angeles: Veterans Integrated Service Network 22: 
P.A.T.H.[C]; 
Number of GPD beds: 10; 
Fiscal Year '05 Admits: 28; 
Fiscal Year '05 Discharges: 23; 
Location Type[A]: urban. 

California - Los Angeles: Veterans Integrated Service Network 22: The 
Salvation Army, The Haven[ D]; 
Number of GPD beds: 95; 
Fiscal Year '05 Admits: 193; 
Fiscal Year '05 Discharges: 200; 
Location Type[A]: urban. 

California - Los Angeles: Veterans Integrated Service Network 22: 
Volunteers of America--LA[C]; 
Number of GPD beds: 102; 
Fiscal Year '05 Admits: 106; 
Fiscal Year '05 Discharges: 98; 
Location Type[A]: urban. 

California - Los Angeles: Veterans Integrated Service Network 22: 
Weingart Center Association; 
Number of GPD beds: 100; 
Fiscal Year '05 Admits: 107; 
Fiscal Year '05 Discharges: 113; 
Location Type[A]: urban. 

Source: GAO review of VA data. 

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

[B] The 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. 

[C] Program also has funding for a service center. 

[D] Program is located on VA medical center grounds. 

[End of table] 

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. 

[End of section] 

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. 

[End of section] 

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: 

Services (ordered by prevalence of service being offered): Vocational/ 
educational counseling; 
How services were provided by programs: Indirectly through linkages[A]: 
48.0; 
How services were provided by programs: Indirectly by staff[B]: 11.5; 
How services were provided by programs: Directly by staff[C]: 39.8; 
How services were provided by programs: Total percentage of facilities 
providing service: 99.3. 

Services (ordered by prevalence of service being offered): Discharge 
planning; 
How services were provided by programs: Indirectly through linkages[A]: 
8.2; 
How services were provided by programs: Indirectly by staff[B]: 2.5; 
How services were provided by programs: Directly by staff[C]: 88.6; 
How services were provided by programs: Total percentage of facilities 
providing service: 99.3. 

Services (ordered by prevalence of service being offered): Assistance 
with obtaining social services (e.g., Medicaid, Supplemental Security 
Income, Social Security Disability Insurance); 
How services were provided by programs: Indirectly through linkages[A]: 
25.7; 
How services were provided by programs: Indirectly by staff[B]: 5.4; 
How services were provided by programs: Directly by staff[C]: 67.5; 
How services were provided by programs: Total percentage of facilities 
providing service: 98.6. 

Services (ordered by prevalence of service being offered): Case 
management services; 
How services were provided by programs: Indirectly through linkages[A]: 
10.0; 
How services were provided by programs: Indirectly by staff[B]: 3.2; 
How services were provided by programs: Directly by staff[C]: 85.4; 
How services were provided by programs: Total percentage of facilities 
providing service: 98.6. 

Services (ordered by prevalence of service being offered): Housing 
assistance; 
How services were provided by programs: Indirectly through linkages[A]: 
20.8; 
How services were provided by programs: Indirectly by staff[B]: 4.3; 
How services were provided by programs: Directly by staff[C]: 73.1; 
How services were provided by programs: Total percentage of facilities 
providing service: 98.2. 

Services (ordered by prevalence of service being offered): Assistance 
with spending money, banking or other financial matters; 
How services were provided by programs: Indirectly through linkages[A]: 
18.6; 
How services were provided by programs: Indirectly by staff[B]: 8.2; 
How services were provided by programs: Directly by staff[C]: 70.0; 
How services were provided by programs: Total percentage of facilities 
providing service: 96.8. 

Services (ordered by prevalence of service being offered): 
Transportation or assistance using public transportation; 
How services were provided by programs: Indirectly through linkages[A]: 
20.0; 
How services were provided by programs: Indirectly by staff[B]: 7.1; 
How services were provided by programs: Directly by staff[C]: 69.3; 
How services were provided by programs: Total percentage of facilities 
providing service: 96.4. 

Services (ordered by prevalence of service being offered): Relapse 
prevention groups; 
How services were provided by programs: Indirectly through linkages[A]: 
48.8; 
How services were provided by programs: Indirectly by staff[B]: 5.4; 
How services were provided by programs: Directly by staff[C]: 41.9; 
How services were provided by programs: Total percentage of facilities 
providing service: 96.1. 

Services (ordered by prevalence of service being offered): 
Comprehensive mental health assessment/diagnosis; 
How services were provided by programs: Indirectly through linkages[A]: 
70.4; 
How services were provided by programs: Indirectly by staff[B]: 8.6; 
How services were provided by programs: Directly by staff[C]: 16.8; 
How services were provided by programs: Total percentage of facilities 
providing service: 95.7. 

Services (ordered by prevalence of service being offered): Individual 
therapy; 
How services were provided by programs: Indirectly through linkages[A]: 
47.9; 
How services were provided by programs: Indirectly by staff[B]: 5.4; 
How services were provided by programs: Directly by staff[C]: 42.5; 
How services were provided by programs: Total percentage of facilities 
providing service: 95.7. 

Services (ordered by prevalence of service being offered): Referral to 
other transitional services; 
How services were provided by programs: Indirectly through linkages[A]: 
13.9; 
How services were provided by programs: Indirectly by staff[B]: 3.2; 
How services were provided by programs: Directly by staff[C]: 78.2; 
How services were provided by programs: Total percentage of facilities 
providing service: 95.4. 

Services (ordered by prevalence of service being offered): 
Comprehensive substance abuse assessment/diagnosis; 
How services were provided by programs: Indirectly through linkages[A]: 
47.7; 
How services were provided by programs: Indirectly by staff[B]: 8.6; 
How services were provided by programs: Directly by staff[C]: 38.7; 
How services were provided by programs: Total percentage of facilities 
providing service: 95.0. 

Services (ordered by prevalence of service being offered): Group 
therapy, not including relapse prevention; 
How services were provided by programs: Indirectly through linkages[A]: 
38.6; 
How services were provided by programs: Indirectly by staff[B]: 5.7; 
How services were provided by programs: Directly by staff[C]: 47.1; 
How services were provided by programs: Total percentage of facilities 
providing service: 91.4. 

Services (ordered by prevalence of service being offered): Aftercare 
counseling; 
How services were provided by programs: Indirectly through linkages[A]: 
48.2; 
How services were provided by programs: Indirectly by staff[B]: 5.4; 
How services were provided by programs: Directly by staff[C]: 37.5; 
How services were provided by programs: Total percentage of facilities 
providing service: 91.1. 

Services (ordered by prevalence of service being offered): AIDS 
screening and counseling; 
How services were provided by programs: Indirectly through linkages[A]: 
75.0; 
How services were provided by programs: Indirectly by staff[B]: 7.5; 
How services were provided by programs: Directly by staff[C]: 6.8; 
How services were provided by programs: Total percentage of facilities 
providing service: 89.3. 

Services (ordered by prevalence of service being offered): Nutritional 
counseling; 
How services were provided by programs: Indirectly through linkages[A]: 
54.6; 
How services were provided by programs: Indirectly by staff[B]: 11.4; 
How services were provided by programs: Directly by staff[C]: 23.2; 
How services were provided by programs: Total percentage of facilities 
providing service: 89.3. 

Services (ordered by prevalence of service being offered): Legal advice 
or counseling; 
How services were provided by programs: Indirectly through linkages[A]: 
76.1; 
How services were provided by programs: Indirectly by staff[B]: 3.9; 
How services were provided by programs: Directly by staff[C]: 5.7; 
How services were provided by programs: Total percentage of facilities 
providing service: 85.7. 

Services (ordered by prevalence of service being offered): Outcome 
follow-up (post discharge); 
How services were provided by programs: Indirectly through linkages[A]: 
18.6; 
How services were provided by programs: Indirectly by staff[B]: 6.1; 
How services were provided by programs: Directly by staff[C]: 56.3; 
How services were provided by programs: Total percentage of facilities 
providing service: 81.0. 

Services (ordered by prevalence of service being offered): Family 
counseling; 
How services were provided by programs: Indirectly through linkages[A]: 
44.3; 
How services were provided by programs: Indirectly by staff[B]: 7.1; 
How services were provided by programs: Directly by staff[C]: 28.6; 
How services were provided by programs: Total percentage of facilities 
providing service: 80.0. 

Services (ordered by prevalence of service being offered): Religious or 
spiritual counseling; 
How services were provided by programs: Indirectly through linkages[A]: 
51.1; 
How services were provided by programs: Indirectly by staff[B]: 8.2; 
How services were provided by programs: Directly by staff[C]: 17.5; 
How services were provided by programs: Total percentage of facilities 
providing service: 76.8. 

Services (ordered by prevalence of service being offered): Domestic 
violence--family/partner violence services; 
How services were provided by programs: Indirectly through linkages[A]: 
63.2; 
How services were provided by programs: Indirectly by staff[B]: 4.3; 
How services were provided by programs: Directly by staff[C]: 8.2; 
How services were provided by programs: Total percentage of facilities 
providing service: 75.7. 

Services (ordered by prevalence of service being offered): 
Representative payee services[D]; 
How services were provided by programs: Indirectly through linkages[A]: 
51.4; 
How services were provided by programs: Indirectly by staff[B]: 3.6; 
How services were provided by programs: Directly by staff[C]: 8.6; 
How services were provided by programs: Total percentage of facilities 
providing service: 63.6. 

Services (ordered by prevalence of service being offered): Child care; 
How services were provided by programs: Indirectly through linkages[A]: 
17.1; 
How services were provided by programs: Indirectly by staff[B]: 3.2; 
How services were provided by programs: Directly by staff[C]: 1.8; 
How services were provided by programs: Total percentage of facilities 
providing service: 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. 

[A] Indirectly through linkages means treatment is provided indirectly 
through links with other agencies, including VA. 

[B] Indirectly by staff means treatment is provided indirectly by other 
staff of the organization. 

[C] Directly by staff means treatment is provided directly by staff at 
this program. 

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

[End of table] 

[End of section] 

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 outcomes: Number of: veterans treated by VA's 
Health care for Homeless Veterans' (HCHV) staff; 
Federal Fiscal year (October through September of year shown): 2000: 
43,082; 
Federal Fiscal year (October through September of year shown): 2001: 
57,854; 
Federal Fiscal year (October through September of year shown): 2002: 
61,123; 
Federal Fiscal year (October through September of year shown): 2003: 
69,970; 
Federal Fiscal year (October through September of year shown): 2004: 
63,283; 
Federal Fiscal year (October through September of year shown): 2005: 
61,261. 

Participants served and outcomes: Number of: intake assessments of 
homeless veterans by HCHV staff[A]; 
Federal Fiscal year (October through September of year shown): 2000: 
34,206; 
Federal Fiscal year (October through September of year shown): 2001: 
46,862; 
Federal Fiscal year (October through September of year shown): 2002: 
44,296; 
Federal Fiscal year (October through September of year shown): 2003: 
42,380; 
Federal Fiscal year (October through September of year shown): 2004: 
42,485; 
Federal Fiscal year (October through September of year shown): 2005: 
41,111. 

Participants served and outcomes: Number of: admissions of veterans to 
GPDs; 
Federal Fiscal year (October through September of year shown): 2000: 
4,841; 
Federal Fiscal year (October through September of year shown): 2001: 
10,137; 
Federal Fiscal year (October through September of year shown): 2002: 
11,913; 
Federal Fiscal year (October through September of year shown): 2003: 
12,396; 
Federal Fiscal year (October through September of year shown): 2004: 
13,509; 
Federal Fiscal year (October through September of year shown): 2005: 
16,597. 

Participants served and outcomes: Number of: discharges from GPDs; 
Federal Fiscal year (October through September of year shown): 2000: 
4,020; 
Federal Fiscal year (October through September of year shown): 2001: 
8,706; 
Federal Fiscal year (October through September of year shown): 2002: 
11,098; 
Federal Fiscal year (October through September of year shown): 2003: 
11,427; 
Federal Fiscal year (October through September of year shown): 2004: 
12,454; 
Federal Fiscal year (October through September of year shown): 2005: 
15,403.

Participants served and outcomes: Days a veteran stays at a GPD, on 
average; 
Federal Fiscal year (October through September of year shown): 2000: 
91; 
Federal Fiscal year (October through September of year shown): 2001: 
85; 
Federal Fiscal year (October through September of year shown): 2002: 
93; 
Federal Fiscal year (October through September of year shown): 2003: 
110; 
Federal Fiscal year (October through September of year shown): 2004: 
126; 
Federal Fiscal year (October through September of year shown): 2005: 
127. 

Participants served and outcomes: Housing stability outcomes: Number of 
Discharges from GPDs with: full-time or part-time employment; 
Federal Fiscal year (October through September of year shown): 2000: 
1,404; 
Federal Fiscal year (October through September of year shown): 2001: 
2,803; 
Federal Fiscal year (October through September of year shown): 2002: 
3,579; 
Federal Fiscal year (October through September of year shown): 2003: 
3,735; 
Federal Fiscal year (October through September of year shown): 2004: 
4,108; 
Federal Fiscal year (October through September of year shown): 2005: 
4,920. 

Participants served and outcomes: Housing stability outcomes: Number of 
Discharges from GPDs with: VA benefits[B]; 
Federal Fiscal year (October through September of year shown): 2000: 
NA; 
Federal Fiscal year (October through September of year shown): 2001: 
NA; 
Federal Fiscal year (October through September of year shown): 2002: 
NA; 
Federal Fiscal year (October through September of year shown): 2003: 
2,100; 
Federal Fiscal year (October through September of year shown): 2004: 
2,701; 
Federal Fiscal year (October through September of year shown): 2005: 
3,751. 

Participants served and outcomes: Housing stability outcomes: Number of 
Discharges from GPDs with: Other public benefits[B]; 
Federal Fiscal year (October through September of year shown): 2000: 
NA; 
Federal Fiscal year (October through September of year shown): 2001: 
NA; 
Federal Fiscal year (October through September of year shown): 2002: 
NA; 
Federal Fiscal year (October through September of year shown): 2003: 
2,064; 
Federal Fiscal year (October through September of year shown): 2004: 
2,309; 
Federal Fiscal year (October through September of year shown): 2005: 
2,916. 

Participants served and outcomes: Greater self-determination outcomes: 
Percentage of discharges from GPDs with: improved alcohol, drug, mental 
health[C]; 
Federal Fiscal year (October through September of year shown): 2000: 38-
42; 
Federal Fiscal year (October through September of year shown): 2001: 42-
49; 
Federal Fiscal year (October through September of year shown): 2002: 43-
50; 
Federal Fiscal year (October through September of year shown): 2003: 52-
62; 
Federal Fiscal year (October through September of year shown): 2004: 60-
67; 
Federal Fiscal year (October through September of year shown): 2005: 62-
69. 

Participants served and outcomes: Greater self-determination outcomes: 
Percentage of discharges from GPDs with: improved medical, 
social/vocational condition[C]; 
Federal Fiscal year (October through September of year shown): 2000: 43-
46; 
Federal Fiscal year (October through September of year shown): 2001: 40-
44; 
Federal Fiscal year (October through September of year shown): 2002: 43-
46; 
Federal Fiscal year (October through September of year shown): 2003: 50-
57; 
Federal Fiscal year (October through September of year shown): 2004: 55-
63; 
Federal Fiscal year (October through September of year shown): 2005: 57-
64. 

Participants served and outcomes: Greater self-determination outcomes: 
Percentage of discharges from GPDs with: success in program; 
Federal Fiscal year (October through September of year shown): 2000: 
30; 
Federal Fiscal year (October through September of year shown): 2001: 
32; 
Federal Fiscal year (October through September of year shown): 2002: 
38; 
Federal Fiscal year (October through September of year shown): 2003: 
43; 
Federal Fiscal year (October through September of year shown): 2004: 
49; 
Federal Fiscal year (October through September of year shown): 2005: 
50.  

Source: VA data. 

[A] Intake 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. 

[B] Numbers 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. 

[C] Percentages are ranges showing the highest and lowest of each of 
two or three outcome measures. 

[End of table] 

[End of section] 

Appendix V: Comments from the Department of Veterans Affairs: 

The Secretary Of Veterans Affairs: 
Washington: 

August 25, 2006: 

Ms. Cristina Chaplain: 
Acting Director: 
Education, Workforce, and Income Security Team: 
U. S. Government Accountability Office: 
441 G Street, NW: 
Washington, DC 20548: 

Dear Ms. Chaplain: 

The Department of Veterans Affairs (VA) has reviewed the Government 
Accountability Office's (GAO) draft report, Homeless Veterans Programs: 
Improved Communications and Follow-up Could Further Enhance the Grant 
and Per Diem Program (GAO-06-859) and agrees with the findings and 
concurs with the recommendations. However, we disagree with the comment 
attributed to VA officials that VA's new estimation process and better 
local data are the reasons we are experiencing a decrease in the number 
of homeless veterans. VA believes the decrease is a direct result of 
our progress in treating these veterans through an effective needs- 
focused GPD health care program. 

The Department is proud of the wide array of services that its GPD 
program provides to homeless veterans through our partnership with many 
community provider organizations. GAO's findings favorably highlight 
the accomplishments of this rapidly expanding program. Nevertheless, we 
recognize opportunities for improvement exist. The Veterans Health 
Administration (VHA) is pursuing initiatives that actually reach well 
beyond issues GAO raises. As GAO reports, VA has almost quadrupled the 
number of beds and admissions to the GPD program since fiscal 2000. 
Such explosive growth has resulted in significant challenges. Although 
program oversight by VA field facilities is crucial in ensuring program 
effectiveness at the local level, it is also apparent that there is a 
lack of consistency in implementation of the program, as well as in 
national oversight. These have contributed to program gaps that VA is 
currently addressing. The Acting Under Secretary for Health has 
directed the Deputy Chief Patient Care Services Officer for Mental 
Health to convene a special field advisory group to develop a 
comprehensive GPD implementation plan that will address such issues as 
functional responsibilities at all organizational levels, staff roles 
and responsibilities, training/certification requirements, data 
collection, and standardization of reporting and oversight, including 
uniform management controls. Because planning for this advisory group 
is still in the early developmental stages, I am unable to provide 
established timeframes; however, we look forward to sharing progress 
with GAO in the coming months. 

In addition, VHA is finalizing a statement of work for solicitation of 
an expert consultant to evaluate the current GPD program/process- 
especially as it relates to financial oversight. The solicitation will 
include a requirement for the development of alternative options for 
program management. 

The enclosure details actions the Department has taken and has planned 
to implement GAO's recommendations. Technical corrections were passed 
separately. I appreciate the opportunity to comment on your draft 
report. 

Signed by: R. James Nicholson: 

Enclosure: 

Enclosure: 

Department of Veterans Affairs (VA) Comments on Government 
Accountability Office (GAO) Draft Report, Homeless Veterans Programs: 
Improved Communications and Follow-up Could Further Enhance the Grant 
and Per Diem Program (GAO-06-859): 

To improve and evaluate the Grant Per Diem (GPD) program, GAO 
recommends that the Secretary of Veterans Affairs take the following 
two steps: 

1. to help ensure that GPD providers' understand the GPD policies and 
procedures, GAO recommends that VA take steps to help ensure 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. 

Concur - During the past 9 months, the Veterans Health Administration's 
(VHA) GPD program office has conducted regional face-to-face training 
sessions for all newly hired and current liaison staff. These training 
sessions will continue to be scheduled for all new staff as they come 
onboard. The GPD program office has worked in close coordination with 
VA's Employee Education Service (EES) to design the training sessions, 
as well as an informative web-based training package that is widely 
accessed by both VA staff and GPD providers. The EES has also 
established a feedback mechanism whereby the liaison staff is contacted 
to determine the extent to which training tools are actually being 
implemented in practice. 

Avenues of communication with GPD liaisons and providers will be 
enhanced further. A recently-appointed national clinical manager serves 
as a resource expert on issues regarding veteran care and program 
design, as well as technical determinations involving eligibility, 
length of stay, episodes of care, etc. This individual also facilitates 
the regularly scheduled monthly conference calls for GPD liaisons, 
network homeless coordinators, and providers and will be available for 
consultative site visits as required. In addition, the new clinical 
manager will conduct an annual assessment of problematic areas and 
initiate follow-up corrective actions as indicated. 

All relevant policies and procedures related to the GPD program, 
including issues identified by GAO, are consolidated in the recently 
published VHA GPD Handbook (1162.01, March 2006). This easily accessed 
document is available on the GPD Intranet Web site. In addition, the 
GPD program office will soon provide a personal copy to each GPD 
liaison. 

The GPD national program office is also actively pursuing more open 
lines of communication with operational grantees and with those 
grantees whose programs are still in the developmental stage. As noted, 
the new national clinical manager will serve as a liaison for these 
organizations. Monthly conference calls with the grantees are already 
routinely scheduled, and minutes of these meetings are distributed to 
the attendees as well as posted on the Intranet Web site. For the first 
time, VHA is also planning to host a post-award conference or series of 
regional conferences, possibly in the spring of 2007 for all FY 2006 
grant awardees and their respective GPD liaisons. These face-to-face 
meetings will provide an opportunity to review program requirements and 
expectations and to gain valuable feedback from the providers about the 
status of project initiatives. 

2. To better understand the circumstances of veterans after they leave 
the GPD program, GAO recommends 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. 

Concur - Plans are in place to address optional approaches for long- 
term study in this area. VA's first priority is to complete an analysis 
of the data already generated from the nine longitudinal outcome 
studies of VA's homeless programs that the Northeast Program Evaluation 
Center (NEPEC) has conducted. We anticipate having the initial analyses 
by the end of December 2006 from the four completed projects. At that 
time, more information will be available to make evidence-based 
decisions about future directions. In the interim, VA will continue to 
explore the feasibility, limits, and utility of using existing health 
care performance measures and quality indicators to evaluate program 
effectiveness. 

[End of section] 

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. 

[End of section] 

Related GAO Products: 

Homeless Veterans: Job Retention Goal Under Development for DOL's 
Homeless Veterans' Reintegration Program. GAO-05-654T. Washington, 
D.C.: May 4, 2005. 

Veterans Affairs Homeless Programs: Implementation of the Transitional 
Housing Loan Guarantee Program. GAO-05-311R. Washington, D.C.: March 
16, 2005. 

VA Health Care: VA Should Expedite the Implementation of 
Recommendations Needed to Improve Post-Traumatic Stress Disorder 
Services. GAO-05-287. Washington, D.C.: February 14, 2005. 

Decennial Census: Methods for Collecting and Reporting Data on the 
Homeless and Others without Conventional Housing Need Refinement. GAO- 
03-227. Washington, D.C.: January 17, 2003. 

Homelessness: Improving Program Coordination and Client Access to 
Programs. GAO-02-485T. Washington, D.C.: March 6, 2002. 

Homeless Veterans: VA Expands Partnerships, but Effectiveness of 
Homeless Programs Is Unclear. GAO/T-HEHS-99-150. Washington, D.C.: June 
24, 1999. 

Homeless Veterans: VA Expands Partnerships, but Homeless Program 
Effectiveness Is Unclear. GAO/HEHS-99-53. Washington, D.C.: April 1, 
1999. 

Homelessness: Overview of Current Issues and GAO Studies. GAO/T-RCED- 
99-125. Washington, D.C.: March 23, 1999. 

Homelessness: Demand for Services to Homeless Veterans Exceeds VA 
Program Capacity. GAO/HEHS-94-98. Washington, D.C.: February 23, 1994. 

FOOTNOTES 

[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). 

[3] Throughout 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. §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. 

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

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

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

[9] For 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). 

[10] The 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. 

[11] For 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. 

[13] The 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. § 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). 

[16] Through 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. 

[19] Since 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. 

[22] VA 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. 

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