The State of the American Veteran: The Los Angeles County Veterans Study
Summary: The United States has been at war for more than a decade, with the conflicts in Iraq and Afghanistan representing the longest in our nation’s history. This post-9/11 veteran population has been making its way back to civilian communities. California is home to over 1.8 million former service members, making it the largest veteran population of any state in the United States, and Los Angeles County is the most populous. Each year, approximately 12,000 military veterans will settle in Los Angeles County as they transition out of the military, joining the 325,000 veterans who currently reside here. For the most part, veterans in California and Los Angeles County reflect the larger national demographics, with the exception that the local population has more Hispanic and Asian veterans than the national average. Notwithstanding these minor demographic differences, the data from this study will be applicable to local communities, states and national agencies developing strategies to assist veterans transitioning home. The timing of this study could not be more critical. The Los Angeles County Veterans Study, conducted by the USC School of Social Work Center for Innovation and Research on Veterans & Military Families, is an effort to provide data-driven recommendations for serving the large population of veterans residing is Los Angeles County. This study found a number of veterans have and are continuing to transition well into their civilian population. This report, however, focuses on those who are facing challenges so that targeted programs and policies can ensure that all veterans are successful, not just a lucky few. Service members encounter a series of needs as they transition out of the military. These include securing employment and housing, addressing physical or mental health issues and adjusting to civilian culture. The ease through which this transition is made has a profound impact on post-service well-being. In an effort to examine how Los Angeles County veterans have managed this transition as well as the current state of their overall needs, the Los Angeles County Veterans Study surveyed 1,300 veterans living in Los Angeles County. In addition focused group interviews were conducted to supplement the findings from the survey. From this effort, the following findings and specific recommendations were developed.
Abstract: Context: In response to the opioid crisis, federal guidelines were implemented, including the Veterans Health Administration's (VA) Opioid Safety Initiative in 2013. The impact of policies on patients near the end of life is unknown. Objective: Examine temporal trends in opioid prescribing, pain, and opioid overdoses among Veterans near the end of life. Methods: Retrospective, time series analysis of VA decedents between October 2009 and September 2018 whose next-of-kin participated in VA's Bereaved Family Survey (BFS). Using multivariate regression to adjust for sociodemographic and clinical covariates, we examined temporal trends in outpatient opioid prescribing, uncontrolled pain based on BFS report, and opioid overdose-related hospitalizations, in the last month of life, overall and by clinical diagnosis (cancer versus non-cancer). Results: Among 79,409 decedents, mean daily outpatient opioid dose in morphine milligram equivalents in the last month of life decreased from 4.6 mg in 2010 to 2.1 mg in 2018 (adjusted change -0.20 mg/year; P