VA turns attention from war injuries to social problems Spared cuts in budget, vet centers shift roles

February 04, 1996|By NEW YORK TIMES NEWS SERVICE

PERRY POINT, Md. -- At a time when the federal government is squeezing many social programs, the veterans medical center here, on a serene 400-acre campus on the Chesapeake Bay, has opened a new refuge for people like Stanford Avant.

After his discharge from the Marine Corps, with which he served in Vietnam, Mr. Avant spent 25 tortured years "drinking and drugging," as he puts it, on the streets of Wilmington, Del.

Now he is 46, and he has been at Perry Point since a sanctuary for homeless veterans opened here in September.

He gets free health care, three meals a day and a room with a desk, a chair, a chest of drawers and, on the bed, a bright fluffy quilt. He also receives psychiatric and job-preparation counseling. "I'm feeling like I'm worth something," he said.

The Department of Veterans Affairs is best known for its network of hospitals. But now the department's insulation from the fiscal and political pressures confronting the rest of the government has helped give it an important new role as an agency that cares for the poor.

"If you're a vet," said Martha Burt, director of social service research at the Urban Institute, a Washington-based research organization, "you have a resource that a lot of other people don't have."

With the drop in the number of war-maimed veterans treated at the agency's 173 hospitals, the VA has been turning more of its attention to veterans who are drug-addicted or indigent, mentally ill or physically disabled.

To qualify, most need only have put in some time in the service, in combat or not, in wartime or peacetime.

"If you serve 180 days on active duty," said one Republican congressional aide who specializes in veterans issues, "and if for whatever reason you do not succeed in life, you get this complete safety net."

As a result, a department that is the nation's largest employer of doctors and nurses has also become the largest employer of social workers, with 4,241 on the payroll last year.

The cost of programs for homeless veterans, though still a minuscule part of all Veterans Affairs spending, has more than doubled in three years, from $32 million to $75 million, and much of that is used to support 94 centers like the one here.

As for total spending, while many federal agencies face cuts, Veterans Affairs, supported as strongly as ever by a politically potent phalanx of veterans organizations, appears assured at least a small increase from the $37.7 billion of the last fiscal year. President Clinton has proposed adding $1.7 billion.

Given Washington's tight-budget environment, Veterans Affairs Secretary Jesse Brown, a Vietnam veteran whose right arm was disabled in combat, has had to contend with a new skepticism from congressional Republicans and the White House Office of Management and Budget toward a VA spending request that once would have gone unchallenged.

Mr. Brown notes that the agency is mandated to provide free health care to only about 10 million veterans, about 40 percent of the nation's total of 26 million.

The others whom the VA must serve are defined as poor, those whose annual incomes are less than $20,469, about the average earnings of an American worker.

Many members of both groups are covered by private health insurance or Medicare, however, and so those who actually enter a Veterans Affairs center for free care are often very poor.

Twenty-seven percent of all new VA hospital patients are homeless, Mr. Brown says, and so the agency is becoming more attentive to their other needs.

In addition to free medical care, many veterans receive monthly benefit checks. An indigent veteran who has a disability wholly unrelated to his years in the service can collect $650 a month.

Perry Point specializes in psychiatric care but has added care for homeless veterans in "domiciliaries," a uniquely VA institution that once provided just meals and shelter for indigent veterans but now treats various conditions that they bring in from the street.

The room, board and counseling in domiciliaries accommodate just 6,000 a year of the 250,000 former servicemen the agency estimates are homeless.

But through hospitals and clinics, alcohol- and drug-treatment centers, job training and rehabilitation, subsidized care for the house-bound and outreach offices in cities, Veterans Affairs reaches hundreds of thousands of other poor veterans.

Phyllis Osbun, acting chief of the domiciliary care program here, opened Perry Point's first domiciliary for the homeless in September and will add another this year, so that in all she will be able to serve 50 clients. To be admitted, a veteran may have an income of no more than $1,100 a month.

The common denominators among Ms. Osbun's clients are alcoholism, drug addiction and the mental disorders that can arise from either.

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