Veteran Mark Fields relaxes while VA “street nurse” Janel Perez listens. Photo by Scott Hathaway/Greater Los Angeles VA.

The bad news: More than 6,000 Veterans are sleeping on the streets of Los Angeles, by some estimates.

The good news: The U.S. Department of Housing and Urban Development reports that between 2011 and 2012, the Department of Veterans Affairs Greater Los Angeles Healthcare System saw an estimated 22 percent decline in its homeless Veteran population.

“Since 2009 we’ve increased the number of beds in permanent or transitional housing by 60 percent,” noted Donna Beiter, director of the Greater Los Angeles VA. “We’re also hiring more nurses to help us care for the homeless Veteran population out here. The RN now has a major role to play in this effort. In all likelihood, the number of nurses working in our homeless programs will double within the next year.”

Beiter said the average homeless Veteran usually has any number of health issues going on at the same time, including physical, psychiatric, substance abuse, or post-traumatic stress disorder. “These patients are in need of nurses who are unique and highly trained,” she said. “We have this kind of nursing talent here at the VA, and we’re bringing more of this kind of talent on board.”

Janel Perez, a VA “street nurse” and a member of the Los Angeles VA’s Assertive Community Treatment Team, spends her time seeking out homeless Veterans in need of care.

“Our multidisciplinary team provides a variety of healthcare services to our chronically homeless Veterans,” she explained. “We find homeless Veterans in the community and offer them field-based services that include primary care, psychiatric care and social services. As time goes on, we try to build a relationship with them. Our goal is to gradually get them to accept continued care from us, as well as housing.”

Perez said the trust-building process can be painfully slow. “It can take two to three months before they even let you take their blood pressure,” she said. “They have to get to know you first. Life on the street is hard, and these Veterans are instinctively defensive. They don’t trust you right away. They have to protect themselves.”

Perez said that convincing a homeless Veteran to accept housing is a major step. “Once they agree to be housed, we determine the best kind of housing for them based on our evaluation of their healthcare needs,” she explained.

As soon as a Veteran is placed and residing independently, VA case management nurses like Gitta Patel begin visiting them to make sure they’re doing OK. “Once we have them in housing, the goal is to keep them there,” Patel said. “My role is to assess their needs and make sure their treatment plan is on track. The goal is to build a long-term trusting relationship that will enable the Veteran to feel safe in receiving care and treatment.”

– Tom Cramer, VA