Reasons for Job Loss Among Homeless Veterans in Supported Employment
Abstract: Individual Placement and Support (IPS) improves competitive employment rates for those with serious mental illness (SMI) and is available through the Veterans Healthcare Administration (VHA). IPS clients often have difficulty maintaining jobs, and various reasons for job loss have been identified for those with SMI. No study has yet investigated IPS job loss in a homeless and largely substance-using population. An analysis of data from a quasi-experimental demonstration examined the association of various reasons for job loss with the duration of the first IPS job and with veteran characteristics. This study also examined the relationship of job duration and reasons for job loss with subsequent employment. Veterans’ most commonly identified reason for termination was drug/alcohol use; mental and/or physical health problems were uncommonly cited as reason for job loss. Those whose jobs ended due to drugs/alcohol were less likely to find subsequent employment. They also had greater scores on alcohol (but not drug) use measures and were more likely to have alcohol (but not drug) use diagnoses, highlighting a potentially unique role of alcohol in job loss in veterans who were homeless. These analyses reveal distinctive work-related challenges among homeless IPS participants. Suggestions to improve vocational services for homeless individuals are provided.
Abstract: Objectives: Increasing numbers of older adults are reentering community following incarceration (i.e., reentry), yet risk of incident neurodegenerative disorders associated with reentry is unknown. Our objective was to determine association between reentry status (reentry vs never-incarcerated) and mild cognitive impairment (MCI) and/or dementia. Methods: This nationwide, longitudinal cohort study used linked Centers for Medicare & Medicaid Services and Veterans Health Administration data. Participants were aged 65 years or older who experienced reentry between October 1, 2012, and December 31, 2018, with no preincarceration MCI/dementia, compared with age-matched/sex-matched never-incarcerated veterans. MCI/dementia was defined by diagnostic codes. Fine-Gray proportional hazards models were used to examine association. Results: This study included 35,520 veterans, mean age of 70 years, and approximately 1% women. The reentry group (N = 5,920) had higher incidence of MCI/dementia compared with the never-incarcerated group (N = 29,600; 10.2% vs 7.2%; fully adjusted hazard ratio [aHR] 1.12; 95% CI 1.00-1.25). On further investigation, reentry was associated with increased risk of dementia with or without prior MCI diagnosis (aHR 1.21; 95% CI 1.06-1.39) but not MCI only. Discussion: Transition from incarceration to community increased risk of neurocognitive diagnosis. Findings indicate health/social services to identify and address significant cognitive deficits on late-life reentry. Limitations include generalizability to nonveterans.