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United States. Congress. House. Committee on Veter.

Viewpoints on Veterans Affairs and related issues : hearing before the Subcommittee on Oversight and Investigations of the Committee on Veterans' Affairs, House of Representatives, One Hundred Third Congress, second session, May 4, 1994 online

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half of which are scheduled drugs. Due to a lack of inter-linked computer communications, veterans are able to
acquire prescriptions in each VA hospital they visit. For example, there are 6 VA medical centers in the
Massachusetts/New England area. Some vets have been known to obtain prescriptions for powerful
medications from each of those 6 centers. This leads to not only personal substance abuse but also to the illicit
sale of these narcotics.

The VA needs to immediately begin a computer data base and communications system similar to those
of existing commercial drug stores that track an individual's prescription record.

A Weekend High

The VA utilizes methadone maintenance as a means of dealing with certain users of hard drugs. While
this group only comprises 6% to 8% of the homeless veterans, they comprise a major portion of the problem of
illicit drug sales. As with the prescription drugs, vets have the ability to acquire methadone at more than one
VA facility as well as to gain it at private, non-governmental methadone maintenance programs. Due to the fact
that VA methadone programs are closed on weekends, on Fridays vets are given their Saturday and Sunday
dosages. This makes it tempting to over-use or sell those drugs and then go to a private program on Saturday
and Sunday for their regular dosages.

The VA needs to do an immediate re-evaluation of its existing methadone program and determine (1) if
it needs to exist and (2) how its operations can be more realistically handled.

Taking Care of Our Own

While there are hundreds of thousands of veterans who are jobless, there is a substantial need within the
VA for medical aides and orderlies, particularly those who can relate well to veteran patients.

The VA should establish on-site training programs at VA medical centers to teach (through classroom
and 0|T) homeless veterans to become medical aides and orderlies. The vets would be given room, board and
a small stipend during the training.



142



Buy Vet

The VA is one of the largest purchasers of goods and services in the country.

We would like to see a high-level task force assembled and given the responsibility to develop new
ways to encourage the VA's use of goods and services provided by veteran-owned for-profit companies and
veteran-specific not-for-profit organizations. Special attention should be paid to the role the National Cemetery
System can play in this effort.

Death & Dying

There are few things more tragic than a veteran who dies alone on the streets or in a VA hospital.

We strongly urge the creation of a number of hospice pilot projects that would combine the assets of
our community-based non-profit homeless veteran programs with the existing services of a nationally
accredited local hospice and a local VA Medical Center.

VETS with AIDS

Across the country, we are finding more than ten percent of homeless veterans to be HIV Positive.

There needs to be a major effort by the VA to look into this crisis. Individuals from homeless veteran
CBOs should be a part of that team. Working with representatives of the AIDS community, there should be a
number of pilot, collaborative programs for homeless HIV positive vets. Furthermore, community based
organizations should have the ability to work with VA educational staff to Increase AIDS awareness and
prevention among homeless vets and veteran care-givers.

TV Training

The VA has very sophisticated in-service training programs for Its employees. Many are implemented
using satellite broadcasts and video tapes.

Community based organizations should be granted permission to monitor VA training broadcasts and
receive training materials so that our local, non-profit staffs can take advantage of the VA's major investment In
continuing education. Also, the resources of our programs' personnel could be utilized by the VA's training
staff to provide our unique Insight into ways to work with homeless veterans.

Once a veteran; always a veteran

The Delimiting Date for use of veteran's educational benefits effectively prohibits the substantial
majority of currently homeless veterans from utilizing their earned benefits. We believe that legislation should
be passed to allow veterans who are certified by the VA as being homeless to be able to access the full range of
benefits for college or vocational schools that they were previously due.

Federal Emergency Management Agency

Even though FEMA states that It makes special emphasis on the identification of and assistance to
veterans, our analysis of their recent budgets show that less than 1/10 of 1 per cent of their budget went to
veteran activities. We recommend that there be a designated veteran representative on FEMA's national and
local allocation boards.



143

Swords to Plowshares

a veterans' rights organization



995 Market Street, 3rd Floor Telephone; (415) 247-8777

San Francisco, CA 94103 Fax: (415) 227-0848



DELIVERING COST EFFECTIVE SERVICES TO HOMELESS VETERANS:

OPPORTUNITIES AND CHALLENGES PRESENTED BY

HEALTH CARE REFORM AND BASE CLOSURES

Testimony before the
House Committee on Veterans' Affairs
Oversight and Investigations Subcommittee

4 May 1994

Presented by
Michael Blecker

Executive Director



The Problem



There is a crisis of homelessness among veterans. Veterans make up over 30% of
the homeless population nationwide - 250,000 veterans are homeless on any given
night in urban, suburban and rural communities throughout the country.

Pressures from health care reform and the federal budget deficit will change the way
the VA delivers services. The GAG Report on Veterans Affairs Issues (December
1992) projects that employer mandated health insurance will lower the demand for
inpatient care at VA facilities by 20%, while universal coverage would reduce
demand by 50%.

The VA provides services to homeless veterans under its Division of Medicine and
Surgery. The VA's medical model for service delivery inflates the cost of personnel
and programs.

The VA has a resistance to contracting out for services. For example, earlier this
year Congress passed legislation in the form of Public Law 102-590, appropriating
funds for the VA to contract with CBOs for homeless services. The funds must be
spent by the end of the fiscal year, but as yet they have not been published in the
Federal Register for the initial public comment period.



The Solutions



Homeless veterans need residential treatment, transitional housing programs, and
affordable housing above all other services.

Community-based, veteran-specific agencies can play a vital role in helping the VA
meet its mission. As peers of the vets they serve, these providers are more
responsive, culturally sensitive and cost-effective than federal agencies. As
nonprofit agencies, CBOs can leverage an innovative array of public and private
resources, and thus a comprehensive range of services, not available to government



144



institutions. CBOs can offer aggressive, professional claims and discharge upgrade
assistance that the VA cannot, securing for veterans such exits from homelessness as
a meaningful monthly allowance or vocational rehabilitation.

On the federal level, the VA must actively develop a system for contracting with
CBOs, as DOL and HUD have successfully done. The key to cost-effective services
will be cooperation between the VA and local non-profits, rather than competition
or duplication of services. A mechanism must be put in place to monitor the VA's
progress in contracting out with CBOs and to hold them accountable for their
failure to do so.

The current downsizing of the military and resulting base closures represent a
unique resource for homeless vets. These closures present opportunities for new
programs and housing resources to be developed outside of the inner city.
Partnerships between the VA and CBOs will be essential to the success of these
programs. Federal agencies, such as the VA, have first priority in identifying
buildings on these facilities. The VA could provide medical care and oversight.
The CBOs can bring their flexibility, rapport with the veterans, and cost-effective
services to the projects.



Swords to Plowshares' Experience

Since 1 974, Swords to Plowshares has been providing a full range of services to
veterans in San Francisco, including employment and training, counseling, legal advocacy
and housing programs.

Twenty years ago. Swords was formed to meet the needs of the most disadvantaged
veterans: the urban underclass, minorities and others from the VietNam-era who were
particularly hurt by the deficiencies of veterans benefits, from the Gl bill to health care.
Today, we still serve this needy population, many of whom now find themselves homeless.

Recently Swords to Plowshares has been working closely with local VA staff,
focusing on the impending closure of several Bay Area military facilities. Both parties
recognize the special resource these bases represent, especially in terms of vital housing
stock. The work opportunities on the bases and their location away from the problems of
the inner city make these ideal settings for recovery.

After three successful StandDown encampments for homeless vets. Swords and the
local VA have learned that we are most cost effective when we each do what we do best.
At StandDown, that meant the VA providing medical and other services, with Swords
serving as the sponsoring agency, coordinating other public providers, supplying peer
counselors, and soliciting donations and volunteers from the private sector.

When developing programs and housing on military bases, doing what we each do
best will mean the VA providing access to the facilities, medical care, oversight and
contracting with CBOs for peer-oriented services. In turn, CBOs can work with a variety of
federal, state, and local founders to design innovative, comprehensive programs for
homeless vets. Swords has expanded on the StandDown model to design an Academy
program for homeless veterans, similar to the Job Corps program. The Academy is ideally
suited to be housed on a military base and to be funded by a range of public and private
resources, including the VA.

Swords is one of the few CBOs nationwide to have a contract with the VA for
transitional housing. Over the last five years this contract has enabled Swords to change



145



the lives of over 250 vets with a success rate of 65% who have gone on to live
independently. Our local HCHV program recognizes Swords' strengths and has been
meeting with us regularly in an effort to increase contract bed referrals to our program and
improve the quality of service to homeless veterans in our area; the extent of their ability to
contract with us is limited, however, by the VA's budget priorities.

Earlier this year, San Francisco was designated as a VA Comprehensive Care Center
for homeless vets. It is the hope of all of us serving veterans in need that these new
monies will mean a much needed increase in residential care and transitional housing, and
not a duplication of existing services.

Conclusions

The disadvantaged veterans served by CBOs will continue to be dependent on the
VA after health care reform is enacted. It is crucial that changes to the system not overlook
this deserving population of veterans in need.

The closure of military bases around the country presents a special opportunity to
provide what homeless veterans need most: residential care, transitional housing programs,
permanent housing and job opportunities.

The VA is charged with serving these veterans. But other federal agencies, such as
DOL and HUD also bear responsibility. CBOs can contract with a broad array of federal
agencies to provide a continuum of care in a cost-effective manner.

To make the best use of precious resources, especially military base facilities, the
VA should:

• contract and collaborate with community agencies who are already working with
homeless veterans, especially residential programs;

• not duplicate existing services, nor neglect regional responsibility to under-served
areas;

• be monitored and held accountable for their performance in these areas.

A new approach to service delivery must accompany changes to the VA health care
system. Community-based, residential care programs are the most cost-effective means
to transition homeless veterans to self-sufficiency.



146

Swords To Plowshares

Q veterans' righrs orgonizorion _



995 Market Street. 3rd Floor Telephone. (4 1 5) 247- 8777

San Francisco, CA 94 1 03 ABOUT SWORDS TO PLOWSHARES ^^ ("» ' 5) 227- 0848

Background

Swords to Plowshares has been serving veterans since 1974. Bom out of the pain and dislocation of the
Vietnam war, services have focused on the unmet needs of veterans. Swords has a well-deserved reputation
for effective advocacy, for expertise and compassion in working with a hard-to-serve population, and for
dedication to serving the truly needy.

Program Services

Swords to Plowshares provides a full continuum of services to veterans: emergency referrals; one-on-one
counseling, intervention and referral for PTSD, alcohol and drug abuse, relapse prevention, coping and life
management skills; benefits advocacy; coordinated referrals to VA and community social service and
treatment programs; job preparation and placement; legal services relating to military discharge and VA
benefits problems, and in some cases, direct legal representation before the VA and Review Boards; and
transitional housing in the only veteran-specific community-based program in the San Francisco Bay Area.
Over 1 ,000 veterans receive services each year.

What makes Swords unique is the continuum of services, the vets-helping-vets approach to providing
services, and the fact that services are provided in a community setting.

Swords' principal office is located at Sixth and Market Streets in San Francisco, at the crossroads of the
Tenderloin and South of Market areas where homeless people "live" and congregate. This initial outreach
presence in one of the worst parts of the city is balanced by Swords' new transitional housing facility in a
stable residential area of town, far removed from the Tenderloin.

Housing — Current and Future

Homelessness was not the main problems when Swords opened its doors in 1974, however, now 85% of the
clientele is homeless. Homelessness is time-consuming and debilitating, making it nearly impossible to
address problems of physical and mental health, substance abuse, and employment. Healing, rehabilitation
and reintegration are more likely to occur in a stable and supportive residential environment.

Swords has operated Northern California's only veteran-specific housing since 1989, in the form of a
transitional housing program for homeless veterans who are being released from residential drug, alcohol,
and or PTSD treatment programs. This short-term program is funded through fees from the Veterans
Administration. On Veterans Day, Swords will dedicate two new residences purchased with a grant from
HUD. and matching funds from the City and County of San Francisco. This transitional program allows
veterans who are discharged from the short-term program and from other residential treatment to benefit
from up to two years of supportive residential services.

Beyond Stand Down

Swords has held three successful Stand Downs since 1991, and it is clearly time to move beyond a three-day
event to more permanent solutions to homelessness. Swords is actively pursuing the creation of a Veterans
Academy at one of the local military bases being closed. Utilizing the clarity, focus, and comraderie of the
military model, the Academy will build on the pride and common experience of the veterans to reintegrate
them to the community.

For further information, contact: Michael Blecker, Executive Director, (415) 247-8777



147



STATEMENT OF



ENLISTED MOriEN VETERANS GROUP



Presented By



INGRID E. SAREMBE



Be+ore The



HOUSE SUBCOMMITTEE ON VETERANS AFFAIRS FOR OVERSIGHT AND INVESTIGATION



H.R. 30i;



A CENTER FOR WOMEN VETERANS IN DEPARTMENT OF VETERANS AFFAIRS



MAY 4, lt;94



148



Mr. Chairinan, members of the House Subcommittee on Veterans Affairs for
Oversight and Investigation. We welcome this opportunity to support H.R. 3013
which creates In the Departinent a Center for Women Veterans, and a Director
as head of the Center for Women Veterans.

I am speaking on behalf of a group of Enlisted Women Veterans who have been
together for one year. Most of us have not spoken about our experience as
members of the Armed Forces. We do not identify ourselves as veterans because
we ar s made to feel invisible as members of an all male dominated veterans
community. We feel the Department of Veterans Affairs has created a condition
of defacto segregation. The DVA has created a climate that is hostile to
women veterans and it has the effect of denying us our rights.

We are seeking our rights' We are seeking full emancipation as women who
served our country in time of war. We are proud to have ser/ed' It is now
19 94 and still there is no one woman inside the DVA, nor one Center that has
authority to respond to Women Veterans Affairs. We are asked to deal with a
male dominated institution that is very often hostile and unsympathetic to
our experiences in the military.



We are met with obstruction to our request for benefits. What is more
damaging, however, is the open hostility we encounter as women vets who are
suffering from the effects of se:;ual trauma injuries'' This segregates us
from other vets and allows the DVA to continue the Policy of an Invisible
Force begun in the Armed Forces. For s:;ample injuries incurred while on
acti/e duty are further aggravated b/ the service. The behavior towards women
who bring such injury to the unit commander's attention makes women the Prime
Suspect'' Women ar s the object of interrogation, psychiatric e.; ami nat i on , or



149



termination from active duty with other than honorable discharge. This blatant

harassment aggravates a very serious traumatic injury. There is a process ai

collusion here, the Armed Forces makes a determination about the active duty

woman and the DVA makes the same determination without regard to the evidence
submitted on behal-f o-f the woman veteran.

This can and must be changed. A very important step in that change is to
include women in all areas of the DVA. To begin this process women need a
permanent Women Veterans Center in the DVA and a Director who will have hands
on policy and implementation authority. This climate cannot be changed by the
stroke oi a pen alone. Policy can and will be changed with vets helping vets,
not as enablers, perpetuating a sense o-f helplessness a;iiong women veterans,
but by the empowerment of women vets helping other women vets.

Untreated sexual trauma injuries be they physical, spiritual, emotional
and/or mental worsen the aftermath of military service for wDiT;en who now feel
a deep sense of hopelessness and despair. Adjustment to civilian life becomes
a life threatening force. Women dissolve into isolation as they seek refuge
from the ongoing dreams, illusions, fantasies, flashbacks and depressions that
are a part of PTSD - Post Traumatic Stress Disorder.



The last 27 years of mv life have been a tragedy for my family and me. The
aftermath of my service life left me and my injury to the stressful forces of
everyday living, eventually leading me down the path of homeless n ess and many
times near homel essness. PTSD is a major cause of homel essness among veterans.
Substance abuse is a common problem, but problems related to women specifically
are not being considered, for e;i ample eating disorders, sexual dysfunction,
suicide, depressions or a wor k ahol i c /perfect i oni st attitude as a defense
against the terrors of being alone and invisible. Just as our brother vets.



150



women vets do not trust the DVA. The realization that PTSD among women veterans
IS not being addressed su-f -f i c i ent 1 y and access to care is limited to having a
diagnosis o-f service connected PTSD, leaves women questioning the process.

Question; how do women get diagnosed with PTSD if they are not seen by any
DVA medical facility'' This is the responsibility o-f the government'' Providing
diagnosis and treatment is the job o^ the DVA, not women veterans'' Even so
women vets must work together with the DVA to get care and bene-fits -for all
women veterans. Because o-f the very special nature o-f these traumas and
injuries, women veterans who have gone through the terror o-f being se;;ually
assaulted and abused in the military are m a special needs category.

These injuries go undetected by a VA reluctant to look -for them. Wo!T\en on
active duty do not report them. I-f a woman reports this, she can e-ipect to be
injured again. Suppose a soldier goes to a -field hospital with gunshot wounds,
and is treated for this injury with another gunshot wound, the outrage would
be immediate and overpowering. Yet women are brutally subject to this type of
re-injury in the military. If this condition is not treated, the effects
become permanently disabling. Add to this condition the obstruction by the DVA
and the possibility o-f recurrence o-f the trauma and the cycle goes on without
interruption. The treatment format the DVA has consists o-f two items women must
go through. One: PROVE YOU WERE INJURED. Two: PROVE IT WAS ON ACTIVE DUTY.

The e-ffects o-f PTSD are well known inside the VA so it shouldn't be hard
to diagnose, further the issue ai service connection shouldn't be di-f4icult to
show if the burden o-f proo-f were li-fted. This is gender biased' Male veterans
must show a presunption o< service connection, such as POW internment or unit
history and campaign medals. The DVA has to look at this issue o-f proof in
light of the history o-f women in the Armed Forces as detailed in the report to



151



Congress on the Tailhook AHair. In its deliberations on PL 102-585 Title One
the Congress stated its concern about women who are not afforded legal
protection because there did not exist a ■forinal reporting mechanism, or a
reluctance to use reporting mechani sois when they existed lor women in the
military.

We are asked to individually prove a hostile climate existed. This is a
large population of veterans with special needs that goes unidentified by a
male dominated DVS. There e:<ists now an institutional bias in claims and
benefits. Treatment has been withheld and compensation not considered. It is
time for the DVA to grant claims on evidence provided by Vet Centers and non
VA treatment centers. The DVA has no established claims process in the area of
Sexual Trauma in the Military. Where is the burden of proof the DVA has in this
area. Can the DVA prove the documentation it asks for ever existed. Can it
prove that the Armed Forces have any such records available for review. The
D'.'A has a duty to assist the veteran. Can it show that any documentation
about this population exists or ever existed, this is not the same reporting
as in conbat injuries for example.



Women must be given a seat at the table, fully emancipated and, equal in
all respects to their brother vets. To begin this healing process there must
be in the DVA a Women Veterans Center and a Director permanently established
as part of the DVA. A strong woman veteran advocate is needed in the DVA to
direct the Women Veterans Center. This is a strong first step in bringing
services to women vets. Vets helping vets and vets working with the DVA can
change the outlook for all veterans. We are seeking our rights. We are seeking
our full partnership alongside our brother vets, for we have also served the
nation and we are proud to have served.



152



The Enlisted Wonen Veterans Group has no membership dues or -fees. We are a
volunteer group who have been together •for one year. We are informal and reach
our decisions by consensus. We ire in support o-f Women Veterans. Women's issues
must be given a voice within the DVA. A major area o* activity is our support
0^ the passage o^ H.R. 3013.

Included in this testimony are written statements -from women veterans. A
biographical statement is included.



Ingrid E. Sarembe Medical Corpsman USWAC 1966-67
General Discharge under Honorable Conditions,
Diagnosed with a severe personality disorder no help
ever given. First contact with VA was in 1992 due to
severe health crisis. Am now being seen at SF Vet Ctr



Patricia A. (Northrop) Ahlstrand USAF 29 Aug. 69
23 Sept. 76 066-44-3657 Honorable Discharge SSgt/E-5
Admin. Specialist, Photographic Dark Room Tech.


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Online LibraryUnited States. Congress. House. Committee on VeterViewpoints on Veterans Affairs and related issues : hearing before the Subcommittee on Oversight and Investigations of the Committee on Veterans' Affairs, House of Representatives, One Hundred Third Congress, second session, May 4, 1994 → online text (page 18 of 23)