If officials want to help veterans with heart disease stay out of the hospital, they should consider getting them a stable place to stay, and doing it quickly. 

That’s the finding of a new study published in the Journal of General Internal Medicine by LDI Senior Fellows Sameed Khatana, Peter Groeneveld, Vincent Reina, Eric T. Roberts, and colleagues. Permanent supportive housing (PSH), a type of assistance that gives veterans housing and social support, was significantly linked to fewer emergency department (ED) visits and hospitalizations for veterans with cardiovascular disease. 

“These findings reinforce that housing is not just a social need, but a critical component of health care,” Khatana said. “We must continue working to ensure access for those who need it most.”

Homelessness remains a huge concern for veterans. On one night in 2024, more than 32,000 veterans were without a stable place to stay, the government’s Point-in-Time count found, and this population is aging. 

Cardiovascular disease is the leading cause of death among this group. 

Research has linked Housing and Urban Development-Veterans Affairs Supportive Housing (HUD-VASH) – the largest permanent supportive housing (PSH) program for veterans – to lower inpatient health care costs. The HUD-VASH program combines case management support and rental assistance for this group. But its impact on heart health outcomes is unknown. 

The Waiting Time for Permanent Housing may be Critical

The team leveraged differences in the time it took to move veterans into permanent supportive housing after receiving a HUD-VASH voucher. Thus, veterans with heart disease who experienced homelessness and moved into PSH within one month of receiving the voucher were compared to those who moved into permanent supportive housing six to 12 months after receiving the voucher.

Moving Into PSH Early Linked to Lower Risk of Hospitalization for Heart Events

Veterans with heart disease who moved into PSH after getting a HUD-VASH voucher were about 9 percentage points less likely to have a heart-related ED visit or hospitalization within six months, compared to those who didn’t move into PSH. 

Also, those veterans who moved into PSH were about 14 percentage points less likely to go to the ED or be hospitalized for any cause.

Study Limitations

The model may not have captured other psychosocial factors that could affect ED visits and hospitalizations, such as stress from being unable to find housing even after receiving a voucher.

However, specific reasons why some veterans took longer to move into permanent supportive housing after receiving the voucher could not be found.

Furthermore, “pre-intervention trends did not differ significantly between the two groups, suggesting that the difference-in-differences design helped isolate changes in outcomes linked to the immediate receipt of PSH,” said Khatana.

Implications for Veterans Experiencing Homelessness

This is the first study to examine the relationship between HUD-VASH and changes in CVD outcomes using contemporary, national data. The findings suggest PSH may play a role in improving health outcomes for veterans with heart disease experiencing homelessness.

“I think it is important we conduct rigorous research on the effects of policies that can improve housing and health outcomes among Veterans experiencing homelessness to inform solutions,” Khatana said.

As the VA seeks to expand their PSH programs, more studies of policies that expand access to PSH are needed to evaluate their long-term impact on the health of housing insecure veterans with heart disease.

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The study, “Permanent Supportive Housing and Cardiovascular Outcomes Among Veterans Experiencing Homelessness: A Difference-in-Differences Analysis” was published in the Journal of General Internal Medicine. Authors include Sameed Ahmed M. Khatana, Jingyi Wu, Peter W. Groeneveld, Vincent J. Reina, Jack Tsai, and Eric T. Roberts. 

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