Homeless Veterans Research Articles

Ensuring Continuity of Transitional Housing for Homeless Veterans: Promoting Disaster Resilience among the Veterans Health Administration's Grant and Per Diem Providers.

The US Department of Veterans Affairs (VA) has committed significant resources toward eliminating homelessness among veterans as part of its health care mission. The VA Grant and Per Diem (GPD) program funds non-VA, community-based organizations to provide transitional housing and support services to veterans experiencing homelessness. During a disaster, GPD grantee organizations will be especially critical in ensuring the well-being of veterans residing in their programs. Recognizing the need to ensure continued access to this residential care, the VA GPD program implemented a disaster preparedness plan requirement for its grantee organizations in 2013. This study conducted semistructured interviews with leaders of 5 GPD grantee organizations, exploring their perceptions of the preparedness requirement, the assistance they would need to achieve desired preparedness outcomes, and their motivations toward preparedness. Organizations reported being extremely motivated toward improving their disaster preparedness, albeit often for reasons other than the new preparedness requirement, such as disaster risk or partnerships with local government. Two dominant themes in organizations’ identified needs were (1) the need to make preparedness seem as “easy and doable” as possible and (2) the desire to be more thoroughly integrated with partners. These themes suggest the need to develop materials specifically tailored to facilitate preparedness within the GPD nonprofit grantees, an effort currently being led by the VA’s Veterans Emergency Management Evaluation Center (VEMEC).

Evaluating the effect of a Participatory Music Program on the Quality of Life and Community Reintegration of Homeless Veterans in Indianapolis

Background: 
 Among Veterans, homelessness is a well-recognized, major problem. Approximately 20% of homeless persons in Indianapolis are Veterans. The Domiciliary Care for Homeless Veterans Program provides residential care for housing insecure Veterans with multiple needs. However, difficulty in combating issues of isolation and lack of avocation for members of the Program remains. Our goal and belief is that providing veterans with a participatory arts will significantly improve their quality of life and reintegration into the community. 
 Methods: 
 This prospective study will use mixed methods to compare intervention participants with usual care controls. Veterans will complete standardized measures including the 20-Item Short Form Health Survey, for quality of life, and Flow State Scale-2, for level of program engagement. Veterans who transition to community housing will complete the Military to Civilian Questionnaire. Veterans will also participate in semi-structured interviews for qualitative data. 
 Anticipated Results: 
 We anticipate that quality of life will improve among homeless Veterans who participate in the study compared to usual care controls. Further, that we will observe a higher level of community reintegration for participants who leave the Domiciliary. 
 Significance: 
 Offering an intervention that looks to change how Veterans see themselves in specific social roles and change how they structure their lives is vital in tackling issues contributing to homelessness. 
 Potential Impact: 
 This project will provide preliminary data about a participatory music program regarding improvement in quality of life for Veterans with housing insecurity. Findings can be used to build a larger implementation trial across VA domiciliaries nation-wide.

Costs Associated with Health Care Services Accessed through VA and in the Community through Medicare for Veterans Experiencing Homelessness.

To estimate health care utilization and costs incurred by homeless Veterans relative to nonhomeless Veterans and to examine the impact of a VA homelessness program on these outcomes. Combined Department of Veterans Affairs (VA) administrative and Medicare claims data. Observational study using longitudinal data from Veterans engaged with the VA system and enrolled in Medicare. Veterans with administrative evidence of homelessness at any point during 2006-2010 were matched on period of military service to Veterans with no evidence of homelessness. Experience of homelessness was associated with 1.37 (95 percent CI=1.34-1.40) and 0.16 (95 percent CI=0.14-0.17) more outpatient encounters per quarter in VA and non-VA settings, respectively, and 1.31 (95 percent CI=1.30-1.32) and 0.49 (95 percent CI=0.48-0.49) more inpatient days per quarter in VA and non-VA hospitals, respectively. These were associated with higher costs. Relative to stably housed Veterans less than 65years of age, those enrolled in a VA homelessness program had 94.4 percent (95 percent CI=90.7 percent-98.1 percent) more VA outpatient visits but 5.5 percent (95 percent CI=3.0 percent-7.9 percent) fewer Medicare outpatient visits. Homelessness was associated with an increase in VA and Medicare utilization and cost. A VA homelessness program decreased use of Medicare outpatient services.

Using the Humanism Pocket Tool for Patients With Challenging Behaviors.

How can clinicians stay humanistic—respectful, empathic, and compassionate—with patients with complex behavioral, social, or physical issues? In our interprofessional patient-centered medical home for homeless Veterans, we designed a compact set of techniques, summarized on a pocket card, and

Dual Use and Hospital Admissions among Veterans Enrolled in the VA's Homeless Patient Aligned Care Team

To examine the association between reliance on VA outpatient care and hospital admissions among Medicare-eligible Veterans enrolled in the Homeless Patient Aligned Care Team (H-PACT). Registry of H-PACT enrollees linked to VA and Medicare utilization data for 2013. After assigning Veterans to two groups according to whether they received >90 percent of outpatient care in VA (higher reliance) or <90 percent of outpatient care in VA (lower reliance), generalized linear models with inverse probability of treatment weights were used to estimate the association of reliance with Medicare and VA-financed hospital admissions. Compared with higher reliance Veterans, lower reliance Veterans had an equivalent number of annual VA hospitalizations (0.63 vs. 0.50; p=.14) but substantially greater Medicare hospitalizations (0.85 vs. 0.08; p<.001). Among Veterans in the highest tertile of outpatient visits, we observed statistically similar rates of VA hospital use but over 10-fold greater rates of Medicare-financed hospitalizations (1.31 for lower reliance vs. 0.15 for high reliance; p<.001). Among Veterans receiving integrated care in VA's H-PACT, dual use of Medicare and VA outpatient care is strongly associated with acute hospitalizations financed by Medicare. Linking VA and non-VA data may identify a subset of homeless Veterans with fragmented outpatient care who are at increased risk of poor outcomes.

VHA-Enrolled Homeless Veterans Are at Increased Risk for Eating Disorder Diagnoses.

Veterans are overrepresented in the U.S. homeless population, comprising 8.6% of the general U.S. population, but 14% of the homeless population. Homeless veterans have several risk factors for eating disorder diagnoses, but the association of homelessness and eating disorders in this population is understudied. Given limited access to adequate food given their diminished resources, it is critical to better understand risk for eating disorders as a function of homelessness. Administrative data on homelessness, eating disorder diagnoses, and related comorbidities occurring within the first 5 years of Veterans Health Administration (VHA) healthcare utilization between 2004 and 2014 in 265,806 Iraq/Afghanistan veterans were extracted from VHA medical records. Logistic regression analysis estimated the risk for eating disorders as a function of homelessness while accounting for demographic, military, and mental health covariates. Homelessness was observed in 11,876 veterans (4.5%), and of these, 71 (0.6%) had an eating disorder diagnosis. Odds of having an eating disorder diagnosis were 59% higher (adjusted odds ratio = 1.59, 95% confidence interval [1.21-2.09]) among homeless veterans relative to domiciled veterans. A diagnosis of eating disorders in veterans is rare at the VHA, however, the current study found that homelessness may increase risk for eating disorders in this population. Unique strategies to provide evidenced-based care while accounting for inadequate daily resources are needed to reduce the risk of eating disorders in this population.

Opioid use disorder and homelessness in the Veterans Health Administration: The challenge of multimorbidity.

The aim of this study is to estimate the prevalence and sociodemographic and clinical correlates of opioid use disorder (OUD), a major cause of morbidity and mortality in the United States, among homeless veterans nationally in the Veterans Health Administration (VHA). Administrative data on 256,404 veterans who were homeless and/or had OUD in fiscal year 2012 were analyzed to evaluate OUD as a risk factor for homelessness along with associated characteristics, comorbidities, and patterns of service use. Bivariate analyses and logistic regression were used to compare homeless veterans with OUD to veterans with OUD but no homelessness and homeless veterans with no OUD. Altogether 17.9 percent of homeless VHA users were diagnosed with OUD and 34.6 percent of veterans with OUD were homeless. The risk ratio (RR) for homelessness among veterans with OUD was 28.7. Homeless veterans with OUD, compared to nonhomeless veterans with OUD showed extensive multimorbidity with greater risk for HIV (RR = 1.57), schizophrenia (RR = 1.62), alcohol use disorder (RR = 1.67), and others. Homeless veterans with OUD also showed more multimorbidity and used more services than homeless veterans without OUD. Homeless and nonhomeless OUD veterans used opiate agonist therapy at similar, but very low rates (13 and 15 percent). OUD is a major risk factor for homelessness. Homeless veterans with OUD have high levels of multimorbidity and greater service use than veterans with either condition alone. Tailored, facilitated access to opioid agonist therapy may improve outcomes for these vulnerable veterans.

Differences in Experiences With Care Between Homeless and Nonhomeless Patients in Veterans Affairs Facilities With Tailored and Nontailored Primary Care Teams.

Homeless patients describe poor experiences with primary care. In 2012, the Veterans Health Administration (VHA) implemented homeless-tailored primary care teams (Homeless Patient Aligned Care Team, HPACTs) that could improve the primary care experience for homeless patients. To assess differences in primary care experiences between homeless and nonhomeless Veterans receiving care in VHA facilities that had HPACTs available (HPACT facilities) and in VHA facilities lacking HPACTs (non-HPACT facilities). We used multivariable multinomial regressions to estimate homeless versus nonhomeless patient differences in primary care experiences (categorized as negative/moderate/positive) reported on a national VHA survey. We compared the homeless versus nonhomeless risk differences (RDs) in reporting negative or positive experiences in 25 HPACT facilities versus 485 non-HPACT facilities. Survey respondents from non-HPACT facilities (homeless: n=10,148; nonhomeless: n=309,779) and HPACT facilities (homeless: n=2022; nonhomeless: n=20,941). Negative and positive experiences with access, communication, office staff, provider rating, comprehensiveness, coordination, shared decision-making, and self-management support. In non-HPACT facilities, homeless patients reported more negative and fewer positive experiences than nonhomeless patients. However, these patterns of homeless versus nonhomeless differences were reversed in HPACT facilities for the domains of communication (positive experience RDs in non-HPACT versus HPACT facilities=-2.0 and 2.0, respectively); comprehensiveness (negative RDs=2.1 and -2.3), shared decision-making (negative RDs=1.2 and -1.8), and self-management support (negative RDs=0.1 and -4.5; positive RDs=0.5 and 8.0). VHA facilities with HPACT programs appear to offer a better primary care experience for homeless versus nonhomeless Veterans, reversing the pattern of relatively poor primary care experiences often associated with homelessness.

Patient predictors and utilization of health services within a medical home for homeless persons

ABSTRACTBackground: The Veterans Health Administration (VHA) established a patient-centered medical home model of care for veterans experiencing homelessness called a Homeless Patient Aligned Care Team (HPACT) to improve engagement with primary care and reduce utilization of hospital-based services. To evaluate the impact of the HPACT model, this study compares the number and type of health care visits in the 12 months before and after enrollment in HPACT at one VHA facility, and explores patient characteristics associated with increases and decreases in visits. Methods: Chart reviews of VHA medical records were conducted for all patients enrolled in an HPACT in Pittsburgh, Pennsylvania, between May 2012 and December 2013 (N = 179). Multivariable mixed-effect logistic regressions estimated differences in having any visit in the 0–6 months and 7–12 months before and after HPACT enrollment, and multinomial logistic regressions predicted increases or decreases versus no change in number of visits over 12 months. Results: Compared with 0–6 months prior to HPACT, patients were more likely to visit primary care in the 0–6 months (adjusted odds ratio [aOR] = 4.91, 95% confidence interval [CI] = 2.94–8.20) and 7–12 months (aOR = 2.30, 95% CI = 1.42–3.72) following HPACT. Patients were less likely to visit the emergency department (ED) or to be hospitalized in the 0–6 months (aOR = 0.57, 95% CI = 0.34–0.94; and aOR = 0.55, 95% CI = 0.25–0.76) and 7–12 months (aOR = 0.43, 95% CI = 0.33–0.91; and aOR = 0.45, 95% CI = 0.26–0.80) following HPACT. Patients were less likely to visit mental health (aOR = 0.35, 95% CI = 0.20–0.60) and addiction specialists (aOR = 0.39, 95% CI = 0.18–0.84) in the 7–12 months following HPACT. Overall, 59% of patients had increases in primary care visits following HPACT. Female patients and those with self-housing were less likely to have increases versus no change in primary care visits (adjusted relative risk ratio [aRRR] = 0.15, 95% CI = 0.03–0.74; and aRRR = 0.35, 95% CI = 0.14–0.90). Conclusions: An integrated HPACT model was successful in engaging homeless veterans in primary care for 1 year, potentially contributing to reductions in ED use. More tailored approaches may be needed for vulnerable populations experiencing homelessness, including homeless women.

Integrating a mental health clinical pharmacy specialist into the Homeless Patient Aligned Care Teams.

Introduction:To address the complex needs of the homeless veteran population, the US Department of Veterans Affairs created the Homeless Patient Aligned Care Team (H-PACT) model. The South Texas Veterans Health Care System has an established H-PACT model, however it does not include a clinical pharmacy specialist in mental health (MH).Methods:An H-PACT MH pharmacy resident clinic was created and managed by a postgraduate year-2 psychiatric pharmacy resident. Improvements in access to MH care, Veterans Health Administration performance metrics, and estimated cost savings associated with resident interventions were reviewed to evaluate clinic utility.Results:Over the 6-month clinic time frame, there were a total of 40 patient encounters in which 21 veterans had MH medication evaluation on at least 1 occasion. The average wait time for Veterans previously followed by the H-PACT psychiatrist was approximately 8 weeks. The H-PACT MH pharmacy resident clinic enabled veterans to be evaluated every 4 to 6 weeks. Interventions made by the resident included identification of medication administration errors, medication adjustments, adherence education, reduction in polypharmacy, and referral to other services. Estimated cost savings from clinic interventions totaled $33 613.67.Discussion:The H-PACT MH pharmacy resident clinic allowed for an improvement in wait time for psychiatric pharmacotherapy follow-up for homeless veterans, with interventions that were associated with significant estimated cost savings.

"Meet Me Where I Am": Removing Barriers to End-of-Life Care for Homeless Veterans and Veterans Without Stable Housing.

To describe the barriers and facilitators of end-of-life (EOL) care for Veterans without stable housing (VWSH) as perceived by Veterans at 1 VA medical center and EOL care staff. Qualitative descriptive study. Secondary applied content analysis of data from interviews and focus groups in our parent study. VA Puget Sound Health Care System and VWSH. The core emergent theme in the words of Veterans and health-care workers was "meet me where I am," a statement of what many Veterans want most from their health care. Barriers and facilitators often reflected the presence or absence of important factors such as relationship and trust building, care coordination and flexibility, key individuals and services, and assistance in navigating change. These findings suggest that to improve health care for VWSH, interventions must be multifaceted, including a suite of support services, flexibility and creative problem-solving, and adaptations in communication approaches. The authors offer specific recommendations for improving EOL care for VWSH based on these findings.

History of co-occurring disorders and current mental health status among homeless veterans

BackgroundHomeless veterans are at high risk for co-occurring disorders (COD), defined as mental illnesses that include at least one alcohol or other drug use disorder and at least one non-drug related mental disorder. However, epidemiological studies examining the prevalence of COD and associated mental health status in this population are limited. The objectives of the study were: (1) to describe a history of diagnosed mental disorders among homeless veterans admitted to a transitional housing program, and (2) to examine the associations of the prior diagnosed COD and other mental disorders with current mental health status.MethodsStudy participants were male homeless veterans admitted to a transitional housing program from July 2015 to September 2017 in a large municipal area in Northeast Ohio, the United States. Cross-sectional, self-reported data from the admission assessment were included and analyzed. History of mental disorder diagnoses were aggregated into five categories for the purpose of this study: no mental disorders, only alcohol or other drug use disorder(s), one non-drug related mental disorder, two or more non-drug related mental disorders, and COD. Current mental status were measured as empowerment, mental component summary score (MCS) and physical component summary score (PCS) of health related quality of life (VR-12), and perceived overall well-being. Sample distribution of the five categories and their associations with current mental status were examined using Generalized Linear Model test.ResultsOf all participants, 76.7% had at least one prior diagnosed mental disorder, including 47.4% with any drug-related disorders. Over one-third (37.2%) reported having COD. Compared to those with no mental disorder history, those with COD scored significantly lower on MCS and empowerment scores; those with any prior diagnosed non-drug related mental disorders also scored significantly lower on MCS. No significant differences, however, were found in current mental health status between those with COD and those with mental disorders but not COD.ConclusionsCOD prevalence among homeless veterans was within the parameter of other literature reports. Veterans with COD compared to veterans with no history of mental disorders tended to have lower MCS and empowerment scores. Veterans with COD had the same mental health status as those with other mental disorders.

Shadowboxing with Integrity

In 1979, Pastoral Psychology published the author’s first autobiographical case study: the story of a near-fatal automobile accident, collateral damage of a high-speed police chase in downtown Chicago. Five other articles have relied on this type of narrative history, focusing directly on the threatened author as a subject for analysis. Such non-risk-free projects could be a fitting requirement for a DMin thesis in pastoral counseling. The author provides practical writing suggestions as a modus operandi. Theologically, the hub of these accounts often reveal evidence of Providence. The clustering of coincidences is an initial clue of high probability. For 40 years, the author has effectively used this type of research or detection to better understand events such as a homicide, a burglary, a flatline, the Ku Klux Klan, and the death of my best friend. The current piece collectively draws on several years of pastoral care for a homeless veteran, a personal injury lawsuit, and an encounter with the Devil.

Homeless Status, Postdischarge Health Care Utilization, and Readmission After Surgery.

Homeless Veterans are vulnerable to poor care transitions, yet little research has examined their risk of readmission following inpatient surgery. This study investigates the predictors of surgical readmission among homeless relative to housed Veteran patients. Inpatient general, vascular, and orthopedic surgeries occurring in the Veterans Health Administration from 2008 to 2014 were identified. Administrative International Classification of Diseases, Ninth Revision, Clinical Modification codes and Veterans Health Administration clinic stops were used to identify homeless patients. Bivariate analyses examined characteristics and predictors of readmission among homeless patients. Multivariate logistic models were used to estimate the association between homeless experience and housed patients with readmission following surgery. Our study included 232,373 surgeries: 43% orthopedic, 39% general, and 18% vascular with 5068 performed on homeless patients. Homeless individuals were younger (56 vs. 64 y, P<0.01), more likely to have a psychiatric comorbidities (51.3% vs. 19.4%, P<0.01) and less likely to have other medical comorbidities such as hypertension (57.1% vs. 70.8%, P<0.01). Homeless individuals were more likely to be readmitted [odds ratio (OR), 1.43; confidence interval (CI), 1.30-1.56; P<0.001]. Discharge destination other than community (OR, 0.57; CI, 0.44-0.74; P<0.001), recent alcohol abuse (OR, 1.45; CI, 1.15-1.84; P<0.01), and elevated American Society Anesthesiologists classification (OR, 1.86; CI, 1.30-2.68; P<0.01) were significant risk factors associated with readmissions within the homeless cohort. Readmissions are higher in homeless individuals discharged to the community after surgery. Judicious use of postoperative nursing or residential rehabilitation programs may be effective in reducing readmission and improving care transitions among these vulnerable Veterans. Relative costs and benefits of alternatives to community discharge merit investigation.

OI-165 - Norovirus Genotype II Outbreak in a Homeless Veterans' Residential Facility

OI-165 - Norovirus Genotype II Outbreak in a Homeless Veterans' Residential Facility

An evidence-based co-occurring disorder intervention in VA homeless programs: outcomes from a hybrid III trial

BackgroundEvidence-based treatment for co-occurring disorders is needed within programs that serve homeless Veterans to assist with increasing engagement in care and to prevent future housing loss. A specialized co-occurring disorders treatment engagement intervention called Maintaining Independence and Sobriety Through Systems Integration, Outreach and Networking - Veterans Edition (MISSION-Vet) was implemented within the Housing and Urban Development - Veterans Affairs Supportive Housing (HUD-VASH) Programs with and without an implementation strategy called Getting To Outcomes (GTO). While implementation was modest for the GTO group, no one adopted MISSION in the non-GTO group. This paper reports Veteran level outcome data on treatment engagement and select behavioral health outcomes for Veterans exposed to the MISSION-Vet model compared to Veterans without access to MISSION-Vet.MethodsThis hybrid Type III trial compared 81 Veterans in the GTO group to a similar group of 87 Veterans with mental health and substance use disorders from the caseload of staff in the non-GTO group. Comparisons were made on treatment engagement, negative housing exits, drug and alcohol abuse, inpatient hospitalizations, emergency department visits and income level over time, using mixed-effect or Cox regression models.ResultsTreatment engagement, as measured by the overall number of case manager contacts with Veterans and others (e.g. family members, health providers), was significantly higher among Veterans in the GTO group (B = 2.30, p = .04). Supplemental exploratory analyses between Veterans who received “higher” and “lower” intensity MISSION-Vet services in the GTO group failed to show differences in alcohol and drug use, inpatient hospitalization and emergency department use.ConclusionsDespite modest MISSION-Vet fidelity among staff treating Veterans in the GTO group, differences were found in treatment engagement. However, this study failed to show differences in alcohol use, drug use, mental health hospitalizations and negative housing exits over time among those Veterans receiving higher intensity MISSION-Vet services versus low intensity services. This project suggests that MISSION-Vet could be used in HUD-VASH to increase engagement among Veterans struggling with homelessness, a group often disconnected from care.Trial registrationClinicaltrials.gov, registration number: NCT01430741, registered July 26, 2011.

Needs of homeless veterans: 5 years of the CHALENG Survey 2012-16.

National surveys of homeless veterans have been conducted for over a decade, but there has been no examination of changes in the needs of homeless veterans. Annual surveys of convenience samples of homeless veterans conducted for Project Community Homelessness Assessment, Local Education and Networking Groups (CHALENG) from 2012 (n = 6859), 2013 (n = 7741), 2014 (n = 7126), 2015 (n = 3765) and 2016 (n = 3191) were analyzed. CHALENG surveys collected background information about respondents and their ratings of unmet needs of homeless veterans. Across years, the majority of respondents were males, white, 45-60 years old, Army veterans, lived in urban areas, had no dependent children, and were enrolled in VA healthcare. Over time, the proportion of respondents who were over 60, female, and white increased. There was little change in reported unmet needs with the highest rated unmet needs related to credit counseling, utility assistance, furniture and housewares, dental care and disability income. Among subsamples of veterans with specialized needs, the top three reported unmet needs were housing for registered sex offenders, legal assistance for evictions/foreclosures, and legal assistance for child support. Several intractable unmet needs of homeless veterans have persisted in contemporary time.

Body Image Perceptions of Women Veterans With Military Sexual Trauma

ABSTRACTThe researchers were invited to a transitional home for homeless women veterans to help veterans with body image issues. Convenience sampling was used to recruit 12 veterans who perceived they had a physical difference due to military service. Data were obtained in focus groups where the veterans were invited to share stories. Ricoeur's hermeneutic phenomenology guided the study. The research team learned early in the data collection stage that 11 of the 12 participants suffered military sexual trauma (MST). Three structures emerged in the data: (a) to speak up or not to speak, (b) from military pride to shameful anguish, and (c) invisible scars versus visible scars. A phenomenological interpretation of these invisible scars uncovered that viewing self in a mirror was depicted as viewing a stranger. Being with others, including family, was described as wearing a fake face. The phrase I am broken defined intimate relationships which were non-existent or strained. Shame permeated all body image structures. As the veterans listened to each other, they began to see themes in their stories. There was a shared sense of identity and a movement toward greater self-understanding and resolving. In addition to the recommendations the participants had regarding prevention of MST and recovery care of those with MST, implications for research and practice are provided.

National Shame/National Treasure: Narrating Homeless Veterans in Australia 1915–1930s

For twenty years after World War I veterans experiencing homelessness inspired narratives that left their mark on the politics of repatriation. Fear of the vagrant mob underpinned the establishment of the system itself. Once it was in place, those suffering homelessness became figures of pity, slowly and unevenly drawn into the Anzac legend by its attachment to the nobility of defeat. But the figure of the homeless digger remained deeply ambivalent. His street presence was a cause of scandal and once he dropped from sight, so did the needs of men and their families experiencing homelessness.

Clinical and cognitive correlates of unsheltered status in homeless persons with psychotic disorders

Homeless persons with psychosis are particularly susceptible to unsheltered homelessness, which includes living on the streets, in cars, and other places not meant for human habitation. Homeless persons with psychosis have distinct barriers to accessing care and comprise a high-need and hard-to-serve homeless subpopulation. Therefore, this study sought to understand unsheltered homelessness in persons with psychosis and its relationship to cognitive impairment, clinical symptoms, and community functioning, examined both categorically and dimensionally. This study included 76 homeless participants with a history of a psychotic diagnosis who were enrolled in a supported housing program but had not yet received housing. This study used two different housing stability thresholds (literally homeless at any point vs. literally homeless >20% of days) for comparing homeless Veterans with psychosis living in sheltered versus unsheltered situations on cognition, clinical symptoms, and community integration. Dimensional analyses also examined the relationship between percentage of days spent in unsheltered locations and cognition, clinical symptoms, and community integration. Sheltered and unsheltered Veterans with psychosis did not differ on clinical symptoms or community integration, but there was an inconsistent group difference on cognition depending on the threshold used for determining housing stability. In the unsheltered group, cognitive deficits in overall cognition, visual learning, and social cognition were related to more days spent in unsheltered locations. Rehabilitation efforts targeting specific cognitive deficits may be useful to facilitate greater access to care and successful interventions in this population.