1) Rapid Population Growth, Demographic Changes: The number of women Veterans is growing rapidly, with increasing demands for health care as well as an influx of younger Veterans. VA is equally committed to and equipped to serve the health care needs of older women Veterans—the largest subpopulation of female VA health care users.

Today, women comprise approximately:

• 14.5% of all active duty military
• 18% of all National Guard and Reserves
• 6% of VA health care users

Since 2000, the number of female Veterans using VA health care has more than doubled, from nearly 160,000 (FY00) to more than 337,000 (FY11). This growth has outpaced that of the male Veteran population.

Among women Veterans returning from the current conflicts, Operation Enduring Freedom, Operation Iraqi Freedom and Operation New Dawn (OEF/OIF/OND):

• 79.4% are age 40 or below
• 51% are 30 or younger

55% of female OEF/OIF/OND Veterans have received VA health care. Of this group, 89% have used VA health care services more than once; 52.4% have used VA health care 11 or more times.

Average age of VA users in FY09 was:

• Female Veteran = 48
• Male Veteran = 63

In FY09, more than half of women Veteran VHA patients had some level of disability that was caused or exacerbated by their military service (service-connected disability status). About a quarter of the women had a service-connected disability rating of 50% or higher.

VA is committed to serving the needs of older women Veterans.

• Women Veterans aged 45 to 64, many of whom are Vietnam- or Gulf War 1-era Veterans, are the largest subpopulation of women VA health care users, comprising 44%.

• Growth of this age group has outpaced that of younger women Veterans.
• These Veterans may require more intensive healthcare services as they grow older.

· Women aged 65 and older make up 14% of women VA health care users.

VA is stepping up to meet the needs of a growing women Veteran population and enhancing primary care to meet their needs. This is a major undertaking for VA.

2) Leadership in Women’s Health: VA strives to be a national leader in the provision of health care for women, thereby raising the standard of care for all women.

• Women Veterans are entitled to the same benefits male Veterans receive.
• VA performance evaluation indicates high quality care delivery (averaging better than the private sector), but a persistent gap exists by gender, including gaps in clinical prevention measures and mental health screenings.
• Gender disparities in clinical performance are not unique to VA, but in striving to be the national leader in the provision of care for women, one goal is to eliminate gender health disparities.

3) Comprehensive Primary Care: Women Veterans deserve health care provided with privacy, safety, dignity, and sensitivity to gender-specific needs. VA understands the needs of women Veterans and is best equipped to meet their needs. VA is evolving toward a comprehensive primary care model of delivery for women.

Comprehensive primary care for women Veterans ensures that any woman Veteran seeking VA care will receive complete primary care from one primary care provider at one site, including:

• Care for acute and chronic illness
• Gender-specific primary care
• Preventive health services
• Mental Health services (see below)
• Coordination of care

The emphasis goes further:

• More accessible and flexible clinic hours as well as technology access — for working women who may have childcare/eldercare responsibilities and difficulty getting time off for appointments
• Tele-health for users in rural areas
• Emergency services
• Seriously wounded women and women with disabilities
• Providers who recognize and can address:

• Homelessness and special issues for homeless women
• Age-related health effects: Cardiac, obesity, diabetes, cancers (breast, cervical, lung, colorectal, etc.), osteoporosis, and more.

Implementing comprehensive primary care is part of the Women’s Health Transformation Initiative, one of VA’s T21 Transformation Initiatives created by Secretary Shinseki to transform VA into a 21st Century organization. Other initiatives focus on:

• Women Veterans Call Center (see below)
• Privacy and Environment of Care
• Homelessness (see below)
• Improved care coordination

Patient Centered Care

Through Patient Aligned Care Teams (PACTs), VA is implementing patient-centered care. PACTs provide accessible, coordinated, comprehensive care, and encourage patients to have an active role in their health care. Women’s comprehensive health care — complete primary care from one designated Women’s Health Primary Care Provider at one site — serves as a model for VA’s PACT initiative.

Women’s Health Education

VA is recruiting and training providers interested and proficient in women’s health. Developed by the Women Veterans Health Strategic Health Care Group, a 2.5-day national mini-residency program has been delivered across the country since 2008. More than 1,200 Primary Care providers have been educated in Basic and Advanced Women’s Health Care through this Mini-Residency training. This is a flagship education model for VA.

VA Mental Health Services for Women

VA has responded to the growing number of women Veterans by developing a wide range of mental health services to meet their unique needs. Available services include psychological assessment and evaluation, outpatient individual and group psychotherapy, acute inpatient care and residential-based psychosocial rehabilitation. Specialty services target problems such as posttraumatic stress disorder, substance use problems, depression, and homelessness.

VA also has outpatient, inpatient, and residential specialty services for Veterans who experienced military sexual trauma (MST), and provides free care for all mental and physical health conditions related to a Veteran’s experiences of MST. Veterans may be able to receive this free MST-related care even if they are not eligible for other VA care. For MST specialty services, many of VA’s standard requirements are waived. For example, a VA service-connected disability rating is not required. Neither is the Veteran required to have reported the incident when it happened, nor to have other documentation that it occurred.

To accommodate female Veterans who do not feel comfortable in mixed-gender treatment settings, many facilities throughout VA have women-only programs or have established specialized women’s treatment teams. Nationally, VA also has over a dozen women-only residential and inpatient programs.

Standards for Mental Health Services for Women

VA policy states:

• All VA facilities must accommodate and support women with safety, privacy, dignity and respect.
• Mental health services need to be provided in a manner that recognizes that gender-specific issues can be important components of care.
• Facilities are strongly encouraged to give Veterans treated for other mental health conditions the option of a consultation from a same-sex provider regarding gender-specific issues.
• Facilities are strongly encouraged to give Veterans being treated for conditions related to military sexual trauma (MST) the option of being assigned a same-sex mental health provider or opposite-sex provider if the trauma involved a same-sex perpetrator.
• All inpatient and residential care facilities must provide separate and secured sleeping accommodations for women. Mixed-gender units must ensure safe and secure sleeping and bathroom arrangements, including but not limited to, door locks and proximity to staff.

Available Services for Women Veterans Who Are Homeless

VA offers an array of special programs and initiatives specifically designed to help homeless Veterans live as self-sufficiently and independently as possible. VA’s continuum of care includes services for special populations, such as women and families, who may be at greater risk for homelessness. Programs incorporate outreach and prevention, temporary and transitional housing, and permanent housing with supportive services.

• The Health Care for Homeless Veterans (HCHV) program is an essential and critical part of providing a gateway to VA and community supportive services for eligible Veterans who are homeless.
• VA’s Homeless Providers Grant and Per Diem Program (GPD) funds projects that offer communities a way to help homeless Veterans with housing and supportive services. GPD-funded services include Special Needs Grants for segments of the homeless population, including women as well as women with children.
• The Department of Housing and Urban Development – VA Supportive Housing (HUD-VASH) Program combines case management and clinical services provided by VA with HUD “Housing Choice” voucher rental assistance for homeless Veterans and their families to obtain and maintain permanent housing.
• VA’s Supportive Services for Veteran Families (SSVF) Program will award grants to private non-profit organizations and consumer cooperatives who will provide supportive services to very low-income Veterans and their families residing in or transitioning to permanent housing. The grantees will provide a range of supportive services designed to promote housing stability.
• Homeless Veteran Supported Employment Program (HVSEP) provides a preventive and reparative approach to ending homelessness, offering Veterans improved quality of life, increased self-confidence and independence, and decreased reliance on institutional care. HVSEP provides vocational assistance, job development and placement, and ongoing supports to homeless Veterans and those at-risk of becoming homeless each year to improve employment outcomes. These supportive vocational services will result in increased residential and personal stability, affording Veterans the opportunity to return to healthy productive lifestyles within their own communities.

Veterans can also contact the National Call Center for Homeless Veterans (1-877-424-3838) or the VA Homeless Coordinator at their nearest VA Medical Center for information or assistance with homeless issues. For more information about VA Homeless programs and services, visit the web at: http://www.va.gov/HOMELESS/index.asp

4) Culture change: Women Veterans Health Care is working to enhance the language, practice and culture of the VA to be more inclusive of women Veterans. A key piece of this is outreach.

Women Veterans Call Center

Women Veterans Health Care has launched an unprecedented effort to contact women Veterans nationwide in order to enhance its health care services. Representatives at VA’s Health Resource Center (HRC) are calling women Veterans to increase their knowledge of VA services and benefits, to ask them to share their experiences with VA, and to suggest potential enhancements that will further VA’s mission to provide the best care anywhere.

The HRC aims to reach every woman Veteran and expects to generate 40,000 calls per quarter once fully operational. Veterans who are contacted and referred to VHA or VBA responders will receive a 30 day follow up call from the contact representative to ensure their needs are met.

The goals of the call center are to:

• Increase women Veterans’ knowledge of VA services and benefits;
• Increase enrollment of women Veterans in VHA; and
• Increase utilization of VHA health care services by women Veterans.

Other ongoing outreach initiatives include:

• Convening a National Women Veterans Communications Work Group to advise on communications and outreach strategies;
• Initiating proactive, regular media calls to connect with the press and inform them about how VA is enhancing access and services for women Veterans;
• Collaborating with the Health Eligibility Center (HEC) to increase enrollment and VA health care use by women Veterans;
• Undertaking a Web redesign complete with a fully-qualified URL to make health care information for women Veterans easier to find online at www.womenshealth.va.gov.

from the Department of Veterans Affairs, Previously Cleared Fact Sheet Updated 2/2012