Remarks by Secretary Eric K. Shinseki
Remarks by Secretary Shinseki
2014 National Coalition for Homeless Veterans Annual Meeting
May 30, 2014
Pat [Ryan, NCHV Board Chair]—thank you for that kind introduction and, more importantly, for your many years of advocacy on behalf of Veterans. Let me also acknowledge:
- John Driscoll, thank you for your leadership of NCHV and for inviting me here today;
- Gaven Gregory and Fred Wacker of the Home Depot Foundation, and Hala Farid, Citi Community Development: My thanks to you for your commitment to helping end Veterans’ homelessness in this country;
- Sheriff Pete Dougherty, a good friend to many here in this room, and my former VA colleague; he retired from VA but not from the fight against Veterans’ homelessness. Pete, glad you’re here;
- Laura Zeilinger, Executive Director, USICH, and my PIT count buddy;
- VA colleagues—especially our dedicated homelessness team, headed by Lisa Pape and Vince Kane;
- Distinguished guests, fellow Veterans, ladies and gentlemen:
The past few weeks have been challenging for everyone at VA—because we take caring for Veterans so seriously. We have done tremendous work together these past five years, and I wanted to acknowledge the hard work and very real accomplishments of all of the good people in this room. You give homeless Veterans hope, dignity, a home, and another chance at the future. That is the never-ending story here. It needs to be told, and told well.
Since 2009, VA has proven that it can fix problems—big problems—with the support and cooperation of our public and private partners. We learned to better focus our talents and resources.
Five years ago, I don’t think we really knew how many Veterans were homeless or what really caused homelessness. Since then, we have settled on annual point-in-time counts conducted by HUD—the Department of Housing and Urban Development—to peg our estimates. Today, we better understand what factors contribute to homelessness: depression, insomnia, pain, substance use disorder, and failed relationships. We can now begin to focus specific treatments to address each factor and, in the process, create a data base for substantive, predictive research.
In 2010, we established a National Registry of Homeless Veterans to capture facts and information on individual homeless Veterans. It has produced a trove of data, which we’ll use to support research efforts well into the future. The registry now includes over 750,000 Veterans who are or have been homeless or are at risk of being homeless. Also in 2010, we launched a Homeless Veterans Call Center, which has referred nearly 200,000 Veterans for help.
In 2012, we began screening Veterans seeking healthcare, asking if they have a home or if they are at risk of losing it. Last year, we screened over 4.3 million Veterans and identified about 36,000 as homeless and 42,000 as at-risk. Also in 2012, we established our first Community Resource and Referral Centers locating them downtown where homeless Veterans tend to congregate. CRRCs offer them a place to shower, launder their clothing, get access to healthcare, check on benefits and other services, and get something hot to eat or drink. Today, we have 27 CRRCs in operation.
In recent years, the number of courts dedicated to handling Veterans’ cases has increased dramatically. There were maybe four or five Veterans courts in January 2009, when I arrived at VA. Today, there are over 260 in operation throughout the country. Homelessness and involvement with the justice system go hand-in-hand. So, in 2009, we launched the Veterans Justice Outreach program, which now has 248 full-time specialists working directly with Veterans courts to see that Veterans get the care they need to keep them out of trouble, as well as off the streets.
We also recently created the Veterans Reentry Search Service to help corrections officials quickly identify inmate Veterans, especially those who may be scheduled for release. By uploading their list of inmates and running a comparison against our Veteran database, they can identify Veteran inmates. With this information, the 44 full-time specialists of our Health Care for Reentry Veterans program can connect soon-to-be-released Veterans with the services they need to help prevent both homelessness and re-incarceration.
Those are all examples of effective outreach—wrapping our arms around the problem by getting in touch with Veterans, finding out who needs help, and ensuring they receive it. In the process, we’ve learned a lot about homeless Veterans. We’ve learned that it’s not primarily a mental health problem as we thought five years ago, that substance-use issues are a major factor, and that VA treatment for substance abuse can make a big difference in a homeless Veteran’s life.
Three years ago, in this forum, I questioned whether we had the courage to ask if we were contributing to substance-use issues by over-medicating our patients. You gave me a towering response. I’ve gone on to ask the same question in other audiences, including DoD. Together, we have developed and implemented the joint DoD/VA pain management guideline that encourages the use of other medications and alternative therapies in lieu of opiates.
Among our healthcare facilities, our Minneapolis VA Medical Center went after this hard, cutting its use of high-dose opiates by more than 50 percent, and all but eliminating OxyContin prescriptions—down 99 percent. We are now reviewing opiates system-wide and seeking to reduce their distribution significantly across all 21 healthcare networks.
What else are we doing?
In the past five years, we have shifted to a “Housing First” approach, aimed at getting homeless Veterans into safe, permanent housing, and then meeting their clinical and other needs. Some results:
- Emergency room visits—down 27 percent
- Inpatient hospitalizations—down 33 percent
- Inpatient costs—down 54 percent
- Total VA healthcare costs—down 32 percent
The HUD-VASH voucher program, VA’s Grant and Per Diem program, and our Supportive Services for Veteran Families are the engines of the “Housing First” effort. We can’t end Veterans’ homelessness without them.
At the end of FY 2013, over 45,000 Veterans and their families had homes to live in, thanks to HUD-VASH vouchers. My thanks to Secretary Donovan and HUD for their generous partnership in that program.
Last fiscal year, community partners, supported by our Grant and Per Diem program, provided temporary housing to over 45,000 Veterans, and nearly 14,000 of them were spared further homelessness by moving straight to permanent housing elsewhere, some with the assistance of HUD-VASH vouchers.
SSVF assisted over 60,000 Veterans and family members last fiscal year, including more than 20,000 individuals under the age of 18; 79 percent of homeless Veterans’ families found permanent housing through SSVF, and 90 percent of at-risk Veterans’ families were spared eviction and kept in their homes.
VA’s benefits administration has a similar program to help Veterans who have defaulted on their VA-insured loans. Last year 74,000 Veterans who defaulted were kept from foreclosure and eviction because VBA worked things out with their lenders. That’s another 74,000 Veteran families who did not end up homeless.
So we’re not just rescuing Veterans already homeless—we are actively preventing Veterans and their families from becoming homeless, which is the next phase in our campaign.
This is the way forward for this coalition—melding our operations into efficient community-based systems of services, so that more cities can say, as Salt Lake City and Phoenix have, that they have ended chronic Veterans’ homelessness.
We have turned the tide. We have found a strategy that works, and we have reduced Veterans’ homelessness by 24 percent from 2010 to 2013—during a tough economy, when homelessness historically surges. Instead, we’ve bent that curve steadily downward.
Now is not the time to let up or get complacent. With our goals in sight in many communities across the country, we all need to work harder and smarter towards achieving them. This Coalition can end Veterans’ homelessness next year. So, let’s get on with it. Thank you for your hard work. It is the Lord’s work, many would say. I am honored to have been in this fight for justice with all of you. God bless you all.
Before I close, let me address the elephant in the room today.
After Wednesday’s release of an interim Inspector General report, we now know that VA has a systemic, totally unacceptable lack of integrity within some of our Veterans Health Administration facilities. That breach of trust involved the tracking of patient wait times for appointments.
The initial findings of our ongoing internal review of other large VA healthcare facilities also show that to be true. That breach of integrity is irresponsible, it is indefensible, and unacceptable to me.
I said when this situation began that the problem was limited and isolated because I believed that. I no longer believe it. It is systemic. I was too trusting of some, and I accepted, as accurate, reports that I now know to have been misleading with regard to patient wait times.
I can’t explain the lack of integrity amongst some of the leaders of our healthcare facilities. This is something I very rarely encountered during 38 years in uniform. I will not defend it because it is indefensible. But I can take responsibility for it, and I do.
Given the facts I now know, I apologize as the senior leader of the Department of Veterans Affairs. I extend that apology to the people whom I care about most deeply—the Veterans of this great country—and to their families and loved ones, whom I have been honored to serve for over five years now—the call of a lifetime.
I also offer that apology to Members of Congress who have supported me, to Veterans Service Organizations, and to the American people. All of them deserve better from their VA.
But I know this leadership and integrity problem can and must be fixed—now. So I am taking the following actions:
- I’ve initiated the process for the removal of the senior leaders at the Phoenix VA Medical Center.
- We will use all authority at our disposal to enforce accountability among senior leaders who are found to have instigated or tolerated dishonorable or irresponsible scheduling practices at VA healthcare facilities.
- I have also directed that no VHA senior executive will receive any type of performance award this year.
- I’ve directed that patient wait times be deleted from VHA employees’ evaluation reports as a measure of their success.
- We are contacting each of the 1,700 Veterans in Phoenix waiting for appointments to bring them the care they need and deserve—and we will continue to accelerate access to care for Veterans nationwide who need it, utilizing care both in and outside the VA system
- We’ll announce the results of our nationwide audit of all VA healthcare facilities in the coming days.
- I now ask Congress to support Senator Sanders’ proposed bill giving VA’s Secretary greater authority to remove senior leaders.
- I ask the support of Congress to fill existing VA leadership positions that are vacant.
Again, this situation can be fixed—with VA, VSOs, Congress, and all VA stakeholders working together, with the best interests of Veterans at heart, in the days ahead—just as we have done over the past five years on Veterans’ homelessness.
God bless our Veterans, especially those in greatest need of our prayers and our help. And may God continue to bless this great country of ours. Thank you.