This winter, much like last, is a hard one on the East Coast. Record snowfall and low temperatures are inconvenient for the general populace, and dangerous, if not deadly, for the homeless.

One of the first stories that I worked on when coming to U.S. MEDICINE 8 years ago was a profile of VA’s work to get homeless veterans off the street. I spoke with VA leaders at the national level; hospital administrators tackling the homeless problems of an entire city; and social workers whose jobs were to go out and identify veterans among the homeless population.

At that point, VA was exceptionally good at identifying those veterans and getting them hooked up with healthcare, housing and educational opportunities, and other social services.  I was particularly struck by one outreach worker who explained that he could differentiate a homeless veteran from a homeless non-veteran by the way he or she had their belongings packed. Veterans, he said, had been trained to live rough, and knew how to pack and carry equipment.

But at the time, VA was struggling with the concept of prevention. Not only was it difficult to identify veterans who were at-risk for being homeless, but there were no set methods for keeping those men and women from falling over the edge into homelessness.

Now, the paradigm has shifted. VA Secretary Shinseki has pledged to attempt to end veteran homelessness within the next 5 (now less than 4) years. And much of VA’s effort will be targeted at prevention. According to VA, any serious attempt to end veteran homelessness has to find a way to keep that population from growing any further.

In our February issue, I write about the recent VA summit on homelessness held in DC, where Shinseki outlined what VA is doing, both in treating the currently homeless and in identifying those veterans on the edge. Also, you can read about what one hospital has been doing for 15 years to bring the veterans in its city in from the cold.