Center of Innovation on Disability & Rehab Research (CINDRR)

Two articles by CINDRR investigators discuss special difficulties impacting Veteran health: disruptive behavior during health care and rental housing for Veterans with disabilities.

Veterans have special concerns that affect their health both within VA medical centers (VAMCs) and in community life, and both are difficult to address following usual health care practices:

• Display of behavior considered disruptive during health care.
• Difficulties obtaining rental housing due to disabilities.

Dr. Luz Semeah, a CINDRR post-doctoral fellow (Gainesville) since September 2018, is lead author on articles exploring these issues. The papers describe the causes and effects and the potential solutions to these problems as part of the VA effort to improve the health and quality of life of all Veterans.  

Occupational Hazard: Disruptive Behavior in Patients

Semeah L, Cowper-Ripley D, Freytes M, Jia H, Uphold C, Hart D, Campbell C. Occupational Hazard: Disruptive behavior in patients. Fed Pract. 2019 Apr;36(4):158-163. PMID: 31138967; PMCID: PMC6503907.  Abstract at PubMed.

Recently, risks to healthcare providers from patients has been in the news as reported in this NPR story.

While other health care organizations can refuse to care for patients who display disruptive behavior, the VA is required by law to care for all Veterans, even if they engage in such behavior. According to the VHA, behavior that is disruptive is “intimidating, threatening, or dangerous or has, or could, jeopardize the health or safety of patients, VHA staff, or others.” As has happened in other areas of health care, because the VA is at the forefront of solving problems, it can lead to changes that are helpful outside the VA as well.  The VA has created a system of reporting disruptive behavior so that safety measures can be taken, such as requiring extra staff to be present when care is provided to Veterans with a history of disruptive behavior. Ironically, some healthcare providers believe that reporting such incidents may be against the ethical principal of never harming the patient. Dr. Semeah’s article and research may help VA healthcare providers understand that this reporting system will not lead to actions that could be directly or indirectly punitive but will ensure quality patient care and safety for the patient displaying the behavior as well as for other patients and for healthcare providers. Care for the patient displaying disruptive behavior is improved because such behavior can be a symptom of numerous health problems and needs to be addressed as a part of health care.  Currently, Dr. Semeah is developing research to further help improve the VA system for reporting disruptive behavior.

Rental Housing Needs and Barriers from the Perspective of Veterans with Disabilities

Semeah LM, Ahrentzen S, Cowper-Ripley D, Santos-Roman LM, Beamish JO, Farley K. Home modification and health services utilization by rural and urban Veterans with disabilities.  Housing Policy Debate 31(6):862-874.  Abstract available here.

Housing is considered a social determinant of health, that is, poor housing conditions are linked to poor health. Veterans with disabilities who have had combat duty are more likely to experience problems with housing, often because of employment instability.  In seeking to identify facilitators and barriers to finding and maintaining rental housing, Veterans with military-related disabilities were interviewed and asked about barriers to rental housing from their perspectives.  Examples of problems identified by these Veterans were:

• Poor quality of housing
• Lack of affordable rental options
• Lack of information about housing programs and assistance
• Policies such as no pets for Veterans who need service dogs
• Resistance by housing providers to provide disability-related accommodations and modifications mandated by the Fair Housing Amendment Act.

Programs are being created to help Veterans overcome such barriers, such as a VA partnership with the U.S. Department of Housing and Urban Development.