Aging Veterans Are in Crisis. This New Program Aims to Help With Housing.

On a recent morning, four veterans who served in the 1960s and 1970s gathered at tables at the Jon W. Paulson Veterans Community in a common room that smelled of strong coffee. Eric Hill, an Army veteran with thinning gray hair, spent almost eight years living in his van, often staying the night in the San Francisco Veterans Affairs hospital’s parking lot.

“When I was younger, you know, get in the car, travel around the country, with or without anybody, and that was fine,” he says. “But when you’re in your 60s, it’s not as easy. And now I’m 75. I feel very fortunate that I have this place.”

In 2014, VA employees in San Francisco connected him to Swords to Plowshares, a nonprofit dedicated to supporting homeless veterans in the Bay Area—which was fortunate because his van broke down soon after. The Jon W. Paulson Veterans Community, one of six supportive housing sites Swords to Plowshares operates, opened in 2000 on land that once served as an Army post and is now a national park.

When residents look out their windows, the Golden Gate Bridge stands before them, cars spilling into San Francisco. If it’s a sunny day and the fog burns off, the bay sparkles and hosts swooping pelicans, gliding sailboats, and creeping cargo ships as massive as small islands. For the more than 100 veterans who live here, the view is a perk, but the apartments changed their lives.

Prior to coming here, they were homeless.

Paulson provided the first permanent supportive housing community for veterans in the country. Each unhoused veteran receives an apartment and a caseworker to help overcome whatever challenges arise. The community places no barriers on entry, including addiction.

But even with all that support, some veterans still lose their housing, and for older veterans, that loss can lead to costly, complex health consequences. Last year, to keep aging veterans housed, California began the Veterans Support to Self-Reliance pilot program, which includes extra manpower at supportive housing sites to try to keep formerly homeless veterans older than 50 aging in place. Though supportive housing sites typically have good retention rates, service providers say this program is desperately needed as predominantly Vietnam-era veterans age.

“They have higher acuity needs as they’re aging, and they have medical challenges that we’re faced with, or they need transportation, for example,” says Kim Cook, vice president of clinical services at U.S. Vets, a nonprofit housing provider. “So this allows us to do that.”

A little more than 200 high-needs, formerly homeless veterans from across the state are enrolled in the program. If the pilot proves successful, it could help shape how all homeless service providers approach housing older individuals—a demographic of particular concern. The 2023 Point-in-Time count, where volunteers scour the street for the unhoused for an estimate and a survey, found that almost 30% of unhoused people were 55 or older.

“The homeless population is aging,” says Roberto Herrera Jr., CalVet’s deputy secretary of Veterans Services. “That just presents itself with an explicit need for increased services in permanent supportive housing.”

Veterans tell The War Horse that while they once struggled with addiction, poverty, or mental health issues, the stability that comes with peer mentorship and coordinated care has allowed them to face the difficult realities of aging—such as heart disease, lost vision, or diabetes—and they say the programs have meant the difference between life and death.

‘It’s Not Enough to Give Them a Room and a Key’

Last year, veteran homelessness increased by 7.4%. The jump reversed a 12-year downward trend: VA had reported a decline of 55% in veteran homelessness. California has seen a 17.8% reduction in veteran homelessness over the last 10 years, though it, too, experienced a nearly 6% increase in 2023.

Experts credit two programs for the downward trend. The Supportive Services for Veteran Families has helped thousands of veterans and their families at risk of homelessness, and HUD-VA Supportive Housing—a collaborative program between the U.S. Department of Housing and Urban Development and VA that combines rental vouchers with VA case-management services—helps house tens of thousands of veterans every year. In January, VA announced it had placed 46,500 veterans in permanent housing in 2023, surpassing its goal of  38,000 veterans.

Retention rates for the first year in permanent supportive housing are high—generally between 85% and 96%. But as many as 25% of housed veterans once again lose their homes, according to some research. Veterans who frequent emergency or outpatient care have a higher risk of eviction, and for aging homeless veterans, who often have complex health needs, cycling in and out of housing can worsen their conditions.

The California Department of Veterans Affairs is administering the Veterans Support to Self-Reliance three-year pilot, and recently awarded four organizations, including Swords to Plowshares and U.S. Vets, $20 million in grants that will add mental health specialists, occupational therapists, and other support staff to existing housing sites.

In a state where encampments cluster beneath highways and along sidewalks, particularly in cities like Oakland and Los Angeles, it’s no surprise that California has the largest number of veterans experiencing homelessness at about 11,400 people. In fact, nearly a third of the nation’s homeless veteran population live in California, and 70% are unsheltered.

In 2012, VA adopted a permanent supportive housing model, saying housing should come first to provide stability before needs like addiction recovery or mental health support are met. Since 2012, Congress has appropriated funds to house nearly 170,000 veterans and their families.

Ben Henwood, a professor of social work at the University of Southern California, says permanent supportive housing models can look vastly different, with some having a medical clinic and mental health specialists on site, while others may have one caseworker assigned to up to 20 residents.

“Depending on who you’re housing, those supports may not meet the actual needs of the people,” he says.

Aging veterans often have chronic pain at higher rates than nonveterans, and if they also have post-traumatic stress, they’re more likely to experience a range of health issues, from cardiovascular disease to chronic fatigue syndrome. And older veterans are also likely to socially isolate.

This past summer, before the California Assembly’s Select Committee on California’s Mental Health Crisis, Amy Fairweather, director of policy at Swords to Plowshares, testified that when it comes to homeless veterans with behavioral health conditions, VA alone “cannot provide the level of care needed to support housing retention and well-being.”

Research has shown aging in place reduces long-term care expenditures from reliance on emergency care and preventable nursing facility placements that can cost as much as $98,000 per year, she said.

“Veterans who may have spent, you know, years on the streets—it’s not enough to give them a room and a key,” Fairweather tells The War Horse. “Even if it’s the most wonderful room in the world.”

With that in mind, the Veterans Support to Self-Reliance program will offer more intensive support than exists in many supporting housing sites, including transportation specialists who will help veterans make it to appointments and retrofit vehicles to make them more accessible. Cook, vice president of clinical services at U.S. Vets, says her organization plans to hire a geriatric social worker at one of the southern California housing sites participating in VSSR. This level of expertise is exactly what aging Vietnam veterans require, Cook says.

“Some of our other social workers, you know, they just have generalized disciplines or expertise,” she says. “We wanted to hire someone that had not just the background, but also the passion for it.”

‘How Are They Coordinating Care?’

The concept of permanent supportive housing with extra support isn’t totally new. The Colma Veterans Village outside San Francisco, for instance, is a collaboration between HUD-Veterans Affairs Supportive Housing and VA’s Office of Geriatrics and Extended Care. The 65-unit village houses dozens of veterans, some of whom are Gulf War-era or older veterans. Residents have an on-site nurse, social workers, art therapy, financial and employment assistance, and other programs.

And VA has employed more than 1,000 peer specialists to help support veterans who are housed and struggling with mental illness, an effort that research indicates keeps veterans in housing longer.

Outside VA, Henwood says, there are other permanent supportive housing projects, many with care configurations funded through several sources, which can put them at risk of lacking good care coordination.

“Which is the key to all of this,” he says. “It’s great if they have this extra staff, but I think the question then becomes, you know, how are they communicating and how are they coordinating care?”

Cook says that without good coordination, it can be easy to duplicate services, or, worse yet, create a situation where despite having a team of support, veterans are not “getting their needs met immediately,” she says. For example, if a medication change causes someone’s behavior to change but not everyone on the team understands how that medication can influence behavior, reaction to that unusual behavior could cause more harm than good.

U.S. Vets plans to enroll 100 veterans into the Veterans Support to Self-Reliance program, while Swords to Plowshares hopes to enroll 125. Because the pilot is voluntary and new, a spokesperson for Swords to Plowshares says it may take months before the most vulnerable vets trust this program enough to participate.

‘I Would Probably Be Dead by Now’

At the Jon W. Paulson Veteran Community, longtime residents can sometimes spot struggling newcomers. Jack Fong, who has lived there for more than 20 years and who was drafted into the Vietnam War in 1969, occasionally spots a man rifling through the garbage for food, while Hill notices new residents who avoid interaction with their neighbors. Hoarding is another common problem with formerly homeless veterans transitioning into housing.

Kenyon Wingo, who spent 10 years in the Army, serves as the peer specialist onsite, often reaching out to veterans who are having trouble adjusting to housing. His job frequently includes encouraging veterans who are making changes in their lives, such as toward sobriety or returning to school, to stick with it, he says.

“I tell all my vets, ‘If no one is proud of you, I’m proud of you,’” he says.

David Zielke, an Army veteran who has lived in the Jon W. Paulson apartments for about 20 years, knows how hard it can be to rebuild from rock bottom.

In the early 2000s, after losing three people he was close with, Zielke struggled with addiction. His low point hit on a sunny day in Golden Gate Park, he says. He had been sleeping in the park, and, on this day, he swore the sky cracked open, releasing music.

“It seemed like a very good idea to start taking off my clothes,” he recalls with a laugh. “And that’s the last thing I remember.” He ended up in a psychiatric facility, and, shortly thereafter, he found Swords to Plowshares.

Sitting across from Zielke, Robert Webb, who wears thick, amber-hued glasses, shares that he was homeless for almost 20 years.

“I got busted for possession of crack cocaine,” he says in his baritone voice. “And I had a record—petty crime, drunk in public, and stuff like that.”

Webb nearly landed in prison, but was instead diverted to a local rehab and, ultimately, moved into the Jon W. Paulson apartments in 2004. Webb and Zielke’s long tenure in housing is exactly what the Veterans Support to Self-Reliance program aims to replicate.

Since becoming housed, Webb says, he’s learned to “take care” of himself, but he’s also progressively lost his sight and now relies on a cane for the visually impaired to walk.

He sometimes thinks about how this turn in his health would’ve unfolded if he were still out on the street, and it’s in those moments that he feels especially grateful for where he’s at.

“I would probably be dead by now,” he says.

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This War Horse investigation was reported by Anne Marshall-Chalmers, edited by Kelly Kennedy, fact-checked by Jess Rohan, and copy-edited by Mitchell Hansen-Dewar. Abbie Bennett wrote the headlines.

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