Supporting Veterans in Massachusetts

Massachusetts is home to approximately 380,000 of the more than 21 million individuals who formerly served in the U.S. armed forces, along with 27,580 active-duty personnel, National Guard members, and reservists. Although there have been many studies of the unique needs of the nation's military and veteran populations, there has been less research on the characteristics and needs of veterans at the local and state levels. To help inform and guide future investment in initiatives targeting Massachusetts veterans, service members, and their families, The Klarman Family Foundation commissioned the RAND Corporation to assess the needs of these populations and the services, benefits, and other programs that are available to support them.

To complement this study, we have collected all the data and analyses presented here, along with the catalog of available resources, in an online tool at www.rand.org/t/TL228 (Fischer, Kraus, and Hoch, 2017). The tool allows users to explore the data by region, service era, and other characteristics of Massachusetts veterans. More information about the tool is available on the project website, www.rand.org/mavets.

Methods and Data Sources

We sought to understand the needs of Massachusetts veterans, current members of the National Guard and reserves (NG/R), and, to the extent possible, their families. As part of this assessment, we analyzed national data sets, fielded a survey of Massachusetts veterans and NG/R members, held focus groups at events targeting veterans, and conducted interviews with key stakeholders who administer programs for veterans and service members in Massachusetts, including employees at veteran service organizations and government officials. All methods employed in this study were reviewed and approved by RAND's Institutional Review Board.

To describe how Massachusetts veterans compare with their counterparts in other states and with nonveterans in Massachusetts, we analyzed data from the American Community Survey (ACS, U.S. Census Bureau) and the Behavioral Risk Factor Surveillance System (Centers for Disease Control and Prevention). We also drew on fiscal year (FY) 2014 (the latest available) data from the National Center for Veterans Analysis and Statistics in the U.S. Department of Veterans Affairs (VA).

To supplement this research, we fielded an anonymous web-based survey to more than 900 veterans and NG/R members.¹ The survey, which also collected demographic information, asked participants about various aspects of their education, employment, health, social support, housing, and finances and included questions about their use and perceptions of services targeting Massachusetts veteran and service members.² Because the survey relied on a convenience sample of participants, we reweighted the survey data using the ACS so that our final sample better reflected the age, gender, and regional composition of veterans and NG/R members living in Massachusetts (according to national-level data). While our weighting approach helped us adjust the sample to better reflect the characteristics of the larger population in Massachusetts, it does not eliminate the potential for bias in results drawn from a convenience sample.

We also collected qualitative data from 29 Massachusetts veterans through focus groups and individual interviews, during which we asked participants to provide their perspectives on the challenges and needs of veterans and their families, available programs and resources, the quality of these programs and resources, and facilitators and barriers to seeking available services.

To supplement the information collected through our survey and in our focus groups and interviews, we conducted discussions with policymakers, veteran service organizations, and other stakeholders in the commonwealth about their perceptions of the needs of and available resources for veterans. We also collaborated with the Massachusetts Inter-Service Family Assistance Committee to convene a meeting of more than 50 stakeholders in February 2016. At the meeting, we organized additional focus groups that discussed the needs of veterans, service members, and their families; barriers to accessing services; and services available. We also collected information through a brief questionnaire, completed by 49 stakeholders, that asked about the organizations they represented; their perceptions of the needs of veterans, service members, and their families; available programs and resources; and their perceptions of the barriers to using available programs and resources.

There are several strengths to our approach. Our study drew on multiple data sources across several areas of interest, and we collected new data from more than 900 Massachusetts veterans and NG/R members. However, this study was not without limitations. For example, we relied on pooled data across years at the national level for some of our analyses. In other cases, data were available only at the state level, so we were not able to examine variations by region in Massachusetts. We made survey questions available in paper format for those who could not access the online survey and developed weights to more closely align our sample with the characteristics of the population of veterans and service members in Massachusetts. However, some of the most vulnerable populations, including homeless veterans and those without Internet access, may not have been able to access the survey. Finally, we did not gather data directly from veterans' and NG/R members' family members. While military and veteran families represent an important population and have their own unique needs, we did not have the resources to explore them directly and instead relied on veterans and NG/R members to report on the characteristics and needs of their families. Thus, an assessment of the needs of family members would benefit from more detailed data collected from this population directly, and this topic warrants future, dedicated study.

The findings in this study provide a comprehensive view of how well veterans in Massachusetts are faring across multiple domains and describe their perceived needs and current use of services. These findings can help inform investments to improve and expand support programs and resources aimed at improving their well-being.

Characteristics of Massachusetts Veterans

Similar to overall population patterns for Massachusetts residents, the metro Boston region is home to more veterans than other areas of the commonwealth (see Figure 1). The number and proportion of veterans varies by service era, with Vietnam War–era veterans representing the largest cohort. Post-9/11 veterans currently make up less than 9 percent of the overall veteran population in the commonwealth, but their numbers are growing.

We examined the needs of Massachusetts veterans and NG/R members in the domains of education and employment, health and health care (both physical and mental health), social support and family well-being, and housing, financial, and legal needs. To provide additional context for our findings, we also show how these populations' needs compare with those of veterans in other states and with those of nonveterans in Massachusetts.

Massachusetts veterans are slightly older, on average, than veterans in other states and are less racially diverse. Compared with veterans in other states, Massachusetts veterans are also less likely to be married and more likely to live alone.

Within Massachusetts, veterans are older and more likely to be male than nonveteran residents. After accounting for these differences in age and sex, veterans were more likely to be white and more likely to be married than nonveterans.

Resources Available to Veterans and Service Members in Massachusetts

A wide array of government agencies and nonprofit and private-sector organizations serve Massachusetts veterans, service members, and their families at the national, state, and local levels. While some programs, services, and benefits serve all veterans and service members, others have specific eligibility criteria. For many potential beneficiaries, navigating the landscape of available resources and requirements can be challenging.

Government Programs and Services

At the national level, VA provides a range of benefits and services to eligible veterans, including education benefits, vocational rehabilitation, disability compensation, and financial assistance. VA also provides health care to veterans enrolled in its health care system. Massachusetts is home to four VA hospitals, 17 community-based outpatient clinics, and 24 VA-affiliated clinics and centers. Massachusetts also has a regional Veterans Benefits Administration office. Of the nearly 380,000 veterans in Massachusetts, not all are eligible to receive VA benefits. However, data from the VA indicate that 137,592 (roughly 36 percent of veterans in the commonwealth) were enrolled in the VA health care system in FY 2014, with around 84,000 of these veterans (or 61 percent of those enrolled) receiving care through VA. The rates of enrollment and health care use at the Veterans Health Administration are slightly lower than national rates (where approximately 41 percent of veterans are enrolled and 75 percent of those enrolled use VA health care).

The Massachusetts Department of Veterans' Services serves as the state-based liaison office for benefits, services, and programs that specifically target veterans, including financial assistance, education benefits, employment services and training, housing loans, and residential nursing home care. The office also facilitates access to federal programs and benefits for which Massachusetts veterans may be eligible. A network of 222 veterans' service officers based in 351 cities and towns across Massachusetts is available to help veterans access and navigate eligibility requirements for federal, state, and local programs.

The Massachusetts Department of Veterans' Services has also collaborated with the Massachusetts Broadband Institute and the Red Sox Foundation to create MassVetsAdvisor.org, a web-based directory of government and nongovernmental resources for veterans and military families residing in Massachusetts.

The Massachusetts National Guard offers a number of programs and resources to support the more than 8,000 Guard members and their families in the commonwealth, including access to state-funded education and family programs. Through the Inter-Service Family Assistance Committee, a voluntary military-community cooperative, service providers work with their counterparts in the U.S. Department of Defense and the community to coordinate services and programs for service members and their families.

Other Resources

Throughout Massachusetts, a host of nongovernmental organizations offer resources and services to veterans as part of national networks or independently at the local level. Using MassVetsAdvisor.org, a web-based directory of government and nongovernmental resources for veterans and military families residing in Massachusetts operated by the Department of Veterans Services, and additional Internet searches, we identified 212 unique resources and organizations. (This includes offerings from veteran service organizations, government programs, academic institutions, military programs, health care delivery organizations, and private organizations.) Table 1 shows the numbers of resources and organizations providing support for the higher education, employment, housing, financial, legal, and physical and mental health care needs of veterans, as well as the region of Massachusetts in which these resources are offered. All types of services were more commonly available in the metro Boston area, which also has the largest number of veterans.

Region	Education	Employment	Housing	Financial	Legal	Health	Total
Southeast	29	33	25	29	15	41	112
Metro Boston	39	37	32	32	25	55	147
Central	26	31	21	28	16	41	107
Western	25	33	23	30	17	41	111
Total	45	43	42	38	31	61	166

NOTE: Forty-six of the 212 resources and organizations we identified did not fall into the domains addressed in this study and are not included in this table. Because some organizations provide services that fall under multiple domains, the totals represent the total number of resources and organizations in each domain or region and are not summations of the rows and columns.

Across domains, Massachusetts veterans and NG/R members reported difficulty learning about available services and understanding how to access them. In our focus groups, veterans highlighted the value of events targeting veterans and other opportunities to connect with peers as venues for learning more about available resources. Although resource directories and other initiatives designed to facilitate navigation of the resource landscape can be valuable in determining availability and eligibility, stakeholders cautioned that these tools can contribute to information overload as veterans struggle to determine which options are best for them.

Well-Being of Massachusetts Veterans and NG/R Members

Education

Massachusetts veterans were more likely than veterans in other states to have earned a college degree (30 percent versus 26 percent). However, in Massachusetts, veterans had lower levels of educational attainment than their nonveteran counterparts, 37 percent of whom had a college degree. Overall, 10 percent of veterans and NG/R members who responded to the survey reported that they were currently enrolled in a higher education program, with the highest enrollment rates among post-9/11 veterans (20 percent) (see Figure 2). Among survey respondents who were enrolled in a course of study, the majority reported that their school understood the challenges veterans face and offered services to help them succeed, including job placement assistance. More veterans and NG/R members also reported using educational services (such as financial aid and help applying for schools) than reported unmet needs. Among those who reported having an unmet need for education services, most cited not knowing how to access services and not knowing that they were eligible for services as primary barriers to access. Although survey respondents indicated satisfaction with their education experience, some program representatives felt that educational institutions were not always well prepared to serve veterans, service members, and their families.

Employment

We found few differences in employment rates between Massachusetts veterans and veterans in other states, except in terms of salaries: Massachusetts veterans earned an average of $2,000 more per year than veterans in other states. When we accounted for statistical differences in age and sex, these veterans' salaries were more than $5,000 higher. This may reflect the higher overall wages in Massachusetts compared with other states (Bureau of Labor Statistics, 2016).

When comparing veterans to their nonveteran counterparts in Massachusetts, we found that veterans' unemployment rates were similar to nonveterans, after accounting for statistical differences in age and sex. However, among those employed, veteran salaries were considerably lower (average $28,000 per year for veterans versus almost $36,000 for nonveterans). This suggests a potential gap in financial well-being for veterans in Massachusetts.

Among survey respondents, many veterans and NG/R members who worked part-time cited problems finding full-time work or having health limitations that prevented them from working full-time. Older veterans were more likely to cite a preference for working part-time.

Among unemployed respondents, the most commonly cited barriers to finding a job were not having the right experience, skills, or education and being constrained by health limitations, child care responsibilities, or transportation. Many also reported that the available jobs did not pay enough or provide opportunities to do meaningful work.

Many veterans and NG/R members reported being in need of or using employment services (e.g., job training, job placement, resume writing, help starting a business) in the prior 12 months. Twelve percent of survey respondents reported that they would have benefited from, but did not use, employment services, with the highest levels of unmet need among NG/R members (23 percent needed employment services but did not use any; see Figure 3).

Health and Social Well-Being

The health and social support needs of veterans and service members have been the subject of great study at the national level. Concerns about service-connected health, disability, and social support needs have also driven a proliferation of benefits, services, and programs across the government and nongovernmental sectors.

Within Massachusetts, veterans tended to have worse health status than nonveterans but were more likely to have insurance (with the most common source being VA, at 47 percent) and had slightly higher rates of health care use. They were also more likely to be overweight or obese and to report having a chronic health problem, such as diabetes, heart disease, or arthritis. Massachusetts veterans were more likely to have health insurance than veterans in other states, but we did not find a significant difference in health status or health behaviors.

Among veterans and NG/R members who responded to the survey, we observed high rates of behavioral health–related problems, including binge drinking and having symptoms of depression and posttraumatic stress disorder (PTSD) (see Figure 4). These rates were particularly high among post-9/11 veterans and NG/R members. Survey respondents also noted some health-related physical limitations in their daily lives and accomplishing less than they would like due to physical health problems and emotional problems. However, survey respondents also reported high levels of social support and access to someone who could care for them if needed.

In general, veterans and NG/R members reported a positive family environment, but survey respondents reported unmet needs in the areas of family services and community services. A small number of veterans reported having unmet health care needs and identified lack of knowledge about eligibility, lack of information about access, and geographic distance from service providers as barriers to service utilization.

Housing, Financial, and Legal

The well-being of veterans, current NG/R members, and their families depends on having essential needs met: a stable place to live and sufficient financial resources to pay for necessary expenses. The majority of survey respondents reported having stable housing arrangements. Massachusetts veterans also had similar rates of home ownership as veterans in other states, and, among Massachusetts residents, they were more likely than nonveterans to own a home outright (no mortgage). This is likely explained by the fact that Massachusetts veterans are older, on average, and may have paid off any home loans. Less than 20 percent of our survey respondents reported using housing services in the past year; the majority of these users were current NG/R members and reported that their needs were mostly or completely met.

Most survey respondents reported having some type of debt (e.g., home or auto loans, credit card) but perceived their financial situation to be the same as or better than that of others their age. Most (77 percent) believed that their income was enough to cover basic expenses, but NG/R members reported greater difficulty in meeting their needs (Figure 5), as well as less financial discipline (delaying retirement contributions, difficulty remembering to pay bills on time). Just over half of respondents were confident that they had enough savings to cover basic necessary expenses in case of an unexpected financial shock (57 percent) and that they would have enough money to live comfortably through their retirement years (52 percent). However, post-9/11 veterans and NG/R members were less confident in their ability to weather financial shocks and have enough money for retirement.

While a third (31 percent) of current NG/R members and veterans had used financial services, such as tax preparation, retirement planning, or debt management, over the past year, 16 percent reported that they needed these services but did not receive them. Unmet need was highest current NG/R members, 35 percent of whom reported needing but not receiving financial services. Those with unmet needs reported that they did not know how to access financial services or did not think they were eligible.

Approximately one-fifth of respondents reported using legal services in the past year (e.g., benefit appeals, landlord disputes, creating wills), and 76 percent of those who used these services reported that their needs were completely or mostly met. Another 13 percent reported having an unmet need for legal help. The most common barrier was not knowing how to access the service.

Conclusions and Recommendations

Our analyses of existing data sets, survey data, and focus group responses highlighted potentially unmet needs of the veteran and NG/R populations in Massachusetts across several domains. As the makeup of the population changes (for example, as veterans age and their overall numbers decline) or as the support landscape shifts (as programs are created or discontinued), specific areas of need and the level of unmet need among the population may shift.

Understanding the characteristics of Massachusetts veterans and service members and the issues they face is important for ensuring that sufficient resources are available to meet potential demand across the commonwealth. Our survey data and focus groups with veterans, NG/R members, and service providers and organizational representatives in the region highlighted challenges associated with mental health problems and employment support. Many service providers and organizational representatives noted that the resources available could be hard to find and navigate, particularly for the most vulnerable veterans. Focus group participants also noted that even when services were available and used, they may not sufficiently address their concerns. Thus, future efforts should examine whether existing resources for these populations successfully identify veteran affiliation and provide adequate support. We offer five recommendations to address the issues and concerns identified in our assessment.

Implement Strategies to Connect Veterans to Existing Resources

Our survey respondents and the individuals with whom we spoke noted several barriers to connecting to available services and benefits. Although there are numerous pathways by which individuals may find out about resources and services, the majority of Massachusetts veterans rely on existing connections to services or resources and must understand often-complex eligibility requirements. Greater coordination across stakeholders and service providers may improve the efficiency and effectiveness of efforts to link veterans and NG/R members with the full range of resources available to them. Veterans' service officers in each community are responsible for helping veterans learn about and apply for benefits for which they are eligible; additional training could increase their familiarity with local, statewide, and federal resources for veterans so they can help veterans connect with these resources.

MassVetsAdvisor is a platform designed to provide information about potential services to interested veterans regardless of eligibility status; however, only a quarter (26 percent) of our survey respondents had used it and service providers and organizational representatives reported that the information is out of date and, when updated, needs greater visibility. While the Massachusetts government website does provide a list of resources and includes links to many service providers, use of these options may be restricted to those who qualify under specific scenarios, making the site hard to navigate. Services specifically designed for those serving in the National Guard or reserves may be especially difficult to locate.

Awareness of potential services can also be affected by whether information is made available to veterans at critical time points, such as during their transition from military to civilian life or as they reach out for other sources of support (e.g., employment opportunities, housing support). Sustained efforts to disseminate information and raise awareness of available services are also essential. It may be particularly challenging to reach veterans who are several years post-military transition and not otherwise connected to services.

Improve Employment Transition Opportunities

Many veterans and NG/R members reported needing or using employment services, and, among those who had used services, nearly a quarter reported that their needs were not met. A number of focus group participants and service providers and organizational representatives also expressed concern about existing employment services. They noted that the emphasis on hiring by employers at job fairs did not always seem sincere, and that there was a not enough efforts designed to help train or retrain veterans for work in the civilian sector. While we did note that some of these programs are available in Massachusetts, veterans, service providers, and organizational representatives were concerned that there was not enough emphasis on helping veterans find meaningful careers versus just finding jobs. To fill this gap, those who oversee programs designed to facilitate employment transitions (a veteran's transition from military service to civilian life or from one civilian career to another) should reevaluate the extent to which their efforts are helping veterans pursue career paths.

Train Community-Based Health Care Providers

Given the high rates of physical and mental health problems among the Massachusetts veteran population, continued efforts to ensure the appropriate capacity for providing health care services for service members and veterans will be critical. There are opportunities to promote military cultural competence among existing and future mental health providers in Massachusetts and to create registries of available mental health resources. One promising initiative by Massachusetts General Hospital is addressing this gap through its Psychiatry Academy and in partnership with the Boston Red Sox Home Base Program's Training Institute, but more effort is likely needed to raise awareness of the challenges service members and veterans face among providers in the community.

Promote Networks Among Veterans

In our focus groups, veterans said they appreciated opportunities to connect with other veterans. They noted a sense of connection and familiarity, which contributes to relationship building. These connections may also help veterans learn how others have navigated and overcome challenges. The use of social media (such as Facebook groups) was mentioned as a way to connect veterans with each other, but this still requires that veterans know about the groups and join them. Many veterans in our focus groups had a continued interest in opportunities for face-to-face meetings, information sharing, and socialization, such as through the VetTogether gatherings in the metro Boston area or the regular veteran lunches, golf tournaments, and other events throughout Massachusetts.

Anticipate Future Needs

Our study provides a snapshot of the current size, characteristics, and needs of the veteran and NG/R member population in Massachusetts. While the veteran population is expected to change in the next decade—shrinking in size, increasing in age, and shifting geographically for older veterans—it is unclear whether there will also be any shifts in the landscape of support resources or whether the level of interest in supporting veterans, service members, and their families will wane. If so, there will be an increased reliance on government (federal, state, and local) programs to support the unique needs of this population. To ensure strategic investment over time, it will be important to repeat assessments of the population to track progress and understand how areas of need may change in the future. There are several options for maintaining awareness of the needs and any trends among the state's veteran and NG/R member populations, including repeated cross-sectional studies. In particular, longitudinal studies of a representative population of veterans in Massachusetts would help ensure that support resources are sensitive to such changes and sustainable in the long term.