Association of statewide stay-at-home orders with utilization of case management and supportive services for veterans experiencing housing insecurity

Abstract

The US Department of Housing and Urban Development-Department of Veterans Affairs (VA) Supportive Housing (HUD-VASH) program provides Veterans with a subsidy for rent and case management. In response to the Coronavirus 2019 pandemic, many states enacted stay-at-home orders that may have limited access to case managers. Therefore, we examined the association between statewide stay-at-home orders and utilization of HUD-VASH case management. We linked data on whether a state implemented a statewide stay-at-home order between March 1, 2020 and April 30, 2020 with VA medical records. Analysis time was centered on the date of a state’s stay-at-home order (exposed states). For Veterans in states without a stay-at home-order (unexposed states), we used the average date exposed states implemented an order (March 27, 2020). We used a difference-in-difference design and adjusted linear regression models to compare total, in-person, telephone, and video case management encounters per Veteran in the 60 days after a stay-at-home order relative to the prior year. There was no significant difference in utilization of case management between Veterans who lived in states that did and did not issue a stay-at-home order. Across all states and in the 60 days after the index date relative to the prior year, Veterans had more total, telephone and video, and fewer in-person encounters. Statewide stay-at-home orders did not differentially affect utilization of case management. Virtual case management in HUD-VASH can increase program reach; however, the effect of virtual case management on outcomes such as quality of life and Veteran satisfaction is unknown.