Pursuing the Mission: How Homeless Veterans Manage Chronic Disease
The purpose of this study was to describe and explain the process by which homeless veterans manage their chronic health problems. In the United States, over 550,000 people experience homelessness on any given night. Of these, over 11% are veterans of the military, many whom suffer from at least one chronic disease. Study participants included male homeless veterans with at least one chronic health problem recruited at a Veterans Affairs emergency department, a homeless shelter, and a soup kitchen. Semi-structured interviews with 32 veterans from the Vietnam/post-Vietnam era were audio-recorded, verified, and coded resulting in a theory entitled “pursuing the mission,” which describes and explains four ways (deferring, exploring, embarking, embracing) they manage their chronic health problems. The findings from this study provide insight from individuals living this experience and will help guide the future delivery of health care to homeless veterans.
In the United States, over half a million people are homeless on any given night (U.S. Department of Housing and Urban Development [HUD], 2015). Homelessness is associated with poorer health status due to the difficulty in maintaining health while attempting to satisfy the basic human needs such as food, shelter, and safety. Homeless individuals suffer from higher rates of communicable and noncommunicable diseases, higher mortality rates, and multiple comorbidities (Schanzer, Dominguez, Shrout, & Caton, 2007). They often overuse emergency services, underuse primary care services, and require longer lengths of stay as inpatients compared with the general population (Kushel, Vittinghoff, & Haas, 2001). Veterans of military service are overrepresented in the homeless population, accounting for 11% (or 48,000) of homeless adults (436,000) (HUD, 2015). Rates of homelessness have remained consistently higher in the veteran population, with male veterans 50% more likely to be homeless than male nonveterans (Fargo et al., 2012). Veterans have an increased risk of compromised health status because of their greater representation among this vulnerable population.
Homeless veterans suffer from higher rates of chronic disease and comorbidities than their nonveteran counterparts (Goldstein, Luther, Jacoby, & Haas, 2008) with over half suffering from at least one chronic health condition (Fargo et al., 2012). Physical and mental disorders experienced by homeless veterans are heterogeneous and do not necessarily fit any defined health framework. Their complex pattern of health contains components of both chronic medical and chronic psychiatric health problems. Common medical problems experienced by homeless veterans include diabetes, hypertension, cancer, chronic obstructive pulmonary disease, and heart disease (Goldstein, Luther, Haas, Appelt, & Gordon, 2010). Common psychiatric problems include depression, bipolar disorder, posttraumatic stress disorder (PTSD), schizophrenia, and substance abuse disorders (Goldstein et al., 2010). Other illnesses such as ulcers, frostbite, and malnutrition can be attributed to the general aspects of homelessness and exposure to the elements. Given the large number of homeless veterans, there is a significant challenge to health-care professionals, and the general public health domain to address the multidimensional and complex health needs of this population.