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Addressing Health Issues of the Homeless

Introduction
A. Addressing The Health Issues Of Chronically Homeless Individuals In Ottawa
i. The Ottawa Inner City Health Project
ii. Sustainability
iii. Contacts

B. Services For Homeless People In The City Of Toronto (Backgrounder)
Toronto's Extreme Weather Response Plan for People at Risk
Homeless Health Reference Group

INTRODUCTION

In early February 2001, the OHPE Bulletin editor received a job posting for the Ottawa Inner City Health Project Director position, and a description of the Inner City Health Project. We invited Bonnie Dinning, the Service System Manager for Homelessness-Health to expand the information piece into a feature article, as the topic is one that needs attention. A few months later, we were pleased to receive the following short article on health issues of chronically homeless people in Ottawa.
As it is our practice at OHPE Bulletin to have resources of organizations, print and websites to complement and expand upon a feature article, we went back to earlier issues of the Bulletin (#74 and #89) that covered homelessness and looked to update the resources and contacts. Most of the resources in OHPE Bulletins 74 and 89 were Toronto based. As a result, contacts were made with a number of Toronto organizations to ask if they could suggest new initiatives, programs, reports and resources on the topic of the health of the homeless. It was a busy summer - very few responses came back, other than names and offers to pass on the request. With the heat wave and smog alerts in late July and early August, the issues around the health of vulnerable people, especially the homeless, became front page news. A little research into the services that are available for addressing the health of homeless people in Toronto indicated that there are a number of good services, working groups and commitments to collaboration and coordination, and resources being focused on shelter, support and healthcare. However, unlike Ottawa, there is not a funded two year project to coordinate health services for the chronically homeless. As Toronto Public Health spokeswoman, Liz Janzen stated: "It is short term emergency response to a serious social problem. It in no way makes up for the desperate need for long term solutions to the increasing problem of homelessness in our city."
Let us continue to keep the health concerns of vulnerable people as a health promotion priority. We welcome your comments, ideas, and submissions.
Alison Stirling for the OHPE Bulletin editorial team

Addressing The Health Issues Of Chronically Homeless Individuals In Ottawa

Recent surveys undertaken in Ottawa indicate that chronic shelter users and street dwellers within the larger, relatively more temporary homeless population experience multiple mental and physical health problems, including mental illness and addictions. In addition, local statistics reflect the reality of a community struggling to address increased rates of infectious diseases like Hepatitis and HIV among people who are homeless.

Typically, individuals who are chronically homeless frequent several emergency rooms and community health centres and have regular contact with police, fire and ambulance services each week or, in some cases, each day. Complex health and behaviour issues make it difficult to accommodate these individuals in "mainstream" services

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The Ottawa Inner City Health Project

A unique partnership in Ottawa is addressing this situation by implementing The Ottawa Inner City Health Project. Participants include: the City of Ottawa; an alliance of community agencies addressing homelessness; The University of Ottawa; local hospitals; Community Care Access Centre (CCAC); plus other primary, secondary, long term, and palliative care providers. Through collaboration, this partnership is addressing the health care needs of the chronically homeless at both a systems and an individual level.

This 2-year project hopes to serve 100-150 clients per year. It embraces a harm reduction approach and will provide care to men, women, couples and youth using drugs and alcohol provided their use does not pose a risk to program staff or other clients. Decreased costs to health and correctional systems and an end to life on the streets or in shelters, for those experiencing intractable homelessness, are expected outcomes.

A model of shared governance is being used whereby overall direction is provided by a steering committee in collaboration with the governing structures of participating agencies. The University of Ottawa as the project sponsor carries out fiduciary functions.

The project which officially started June 1,2001 has 3 main residential sites in existing shelters and a central coordinating unit.

Coordination
A central coordinating unit is in place and staffed by a Project Director, Medical Director, support staff and a team of Client Care Workers. Client Care Workers are supervised by the VON, provide care at the 3 residential sites, and as needed at the women's shelter and in individual client homes.

The coordinating unit works closely with a network of primary care providers and case managers. The network includes staff from local hospitals, Community Care Access Centre (CCAC), the University of Ottawa, Community Health Centres, Public Health, and other agencies serving the homeless.

An innovative information technology private/public sector initiative within the project is about to begin that will facilitate communication between service providers at different locations and support key aspects of care. This tool will also track outputs and outcomes for the purposes of research and evaluation.

Admission to the project and its various sites is determined by one admissions committee and is based on pre-established criteria. Care at the 3 locations is provided by on site nursing staff, care coordinators, shelter staff plus visiting health and support services such as CCAC.

Home Hospice
A 12 bed Home Hospice is now in place within a new wing at the Mission shelter. The care provided is enhancing the quality of life for clients at this site.

Special Care Unit
The Salvation Army Booth Centre shelter is expanding its special care unit by 10 beds to accommodate project clients. Short-term care is provided to clients with illness or injury. This convalescent time is speeding recovery following discharge from hospital and in some instances preventing admission to hospital.

Management of Alcohol Program
A management of alcohol program at the Shepherds of Good Hope shelter assists individuals in controlling their addiction to alcohol. The Program provides a safe place where clients can consume alcohol in a controlled manner instead of what they might typically drink, namely mouthwash, after shave or any other substance that can satisfy the need for alcohol.

The day program which is home to 10 people will expand to 20 this the fall. Clients at this site are out on the streets less, slept out of doors less, and are less intoxicated when on the street. All clients are more willing to participate in health care.

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Sustainability

Funding for this project has come from many sources including the Federal Supporting Community Initiatives Partnership (SCPI), the former Region of Ottawa-Carleton, the Provincial Homelessness Initiatives Funding, and The Community Foundation. Significant in kind contributions have also been made by Ottawa shelters, local Community Health Centres, the City of Ottawa and the VON.

Unfortunately all service related funding for this project is time limited. It is hoped that evaluation of the project and collaboration between local government, an alliance of agencies serving the homeless and the University of Ottawa to carry out research about the health of homeless individuals will attract permanent funding

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For further information please contact:
Wendy Muckle, Project Director, The Ottawa Inner City Health Project
Tel: (613) 562-4500 FAX: (613) 562-4505
e-mail: wmuckle@magma.ca

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Services For Homeless People In The City Of Toronto
City of Toronto 'Backgrounder' http://www.city.toronto.on.ca/health/extreme_cold_backgrounder.pdf

Hostels:
The City of Toronto funds approximately 60 hostels for homeless families, youth, single men and single women in the new city, with a total capacity of about 4,600 people.

Out of the Cold:
61 churches, synagogues and agencies and one hospital provide accommodation and/or meals for up to 450 adults and youth at different locations every night of the week.

Outreach & Drop-ins:
Homeless people receive food, clothing, information and referrals to services, e.g. hostels, AIDS/HIV prevention, through more than a dozen projects. Some target youth, others focus on adults. More than 25 organizations provide regular drop-in services for homeless people year round.

Housing:
Affordable and subsidized housing in Toronto is very difficult to find. There are more than 62,000 people on waiting lists for social housing in the city. Information centres, drop-ins and other agencies help homeless people find and keep housing through such services as housing registries, mail and message services, financial management supports and staff assistance in applying for housing and in educating and supporting landlords in the preservation of low income housing stock, conflict resolution and crisis intervention.

Health Care:
Several organizations work with homeless people on physical and mental health issues throughout the year, including Street Health; St. Michael's Hospital's Inner City Health Program and the Gerstein Centre. (see Resources)

Other:
Many other innovative resources provide homeless people with the tools to help them make changes in their lives, e.g. voice mail to help people who are looking for work, supports to at risk people who lack financial resources and social supports for people arriving at the bus terminal.

Information:
Community Information Toronto (CIT) [http://www.communityinfotoronto.org] at 416-392-3777 operates STREET Helpline [http://www.communityinfotoronto.org/street.htm] year round to help homeless people find shelter and services. CIT also provides general information about services through its Blue Book - the Directory of Community Services in Metropolitan Toronto - and general inquiry line at 416-397-INFO.

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Toronto's Extreme Weather Response Plan for People at Risk

The Heat Wave of Summer 2001
"Recognizing that the hot temperatures can take a toll on a person's health, municipal officials have been taking steps to help those most at risk - people with respiratory and heart ailments, seniors, the homeless and the chronically ill.
"As the mercury soared to 35C this week (Aug 6, 2001), increasing the risk of heat-related deaths, the city's new hot weather response plan kicked in. Under the program, approved this spring, homeless shelters have been kept open during the day, allowing people to stay inside and remain cool. Municipal buildings have been opened up as "cooling centres," where residents can take refuge in air-conditioned comfort. Metro Hall was even kept open overnight.
Red Cross workers and other volunteers have been delivering bottled water to vulnerable people to ward off dehydration and offering them a ride to a cool place. Teams of paramedics have been checking up on residents who may be suffering." (Toronto Star Aug 9/01)

Extreme Cold Weather Alerts for Homeless People
Toronto's Medical Officer of Health issued an extreme cold weather alert in Winter 2000 to help get homeless people in from the cold. An alert goes into effect when Environment Canada:
- predicts a temperature of -15 degrees Celsius or lower, without wind chill;
- issues a windchill warning for outdoor activity for people in the Toronto area;
- predicts extreme weather conditions, such as a blizzard or ice storm.

Under the alert the following extra services are available to help homeless people:
- additional emergency sleeping spaces in Toronto hostels/shelters
- increased street patrols by Anishnawbe Health Street Patrol to reach homeless people
- distribution of TTC tickets through 17 drop-in centres and outreach agencies to help homeless people reach shelters
- provision of emergency transportation through the Canadian Red Cross for homeless people trying to reach services/shelters.

"It is short term emergency response to a serious social problem," said Liz Janzen, Regional Director with Toronto Public Health. "It in no way makes up for the desperate need for long term solutions to the increasing problem of homelessness in our city. However, we hope that by coordinating our resources and temporarily increasing some services we will avoid the kind of situation in which homeless people can't find space or don't know where to go for help when it is extremely cold."
Ms. Janzen chairs a designated alert team that meets regularly throughout the winter to monitor conditions on the street. Team members include representatives from Toronto Community and Neighbourhood Services - Public Health and Shelter, Housing and Support Divisions, the Out of the Cold Program, STREET Helpline, Anishnawbe Street Patrol, Youthlink Innercity, and Toronto Police.

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The Homeless Health Reference Group

When the Mayors Action Taskforce on Homelessness report was released in January 1999, recommendations on health issues were directed to Toronto Public Health to ensure that an alliance of the homeless population and community agencies address the health needs of homeless. A Homeless Health Reference Group was established to manage the process. Working groups were formed to do planning focused on improving services and health out-comes for the homeless in three areas:
Improving discharge planning by building on best practices so that when homeless patients are discharged from hospital they are linked with appropriate follow-up services in the community;
Initiating infirmary services where people who are homeless can recuperate when they are released from hospital; and,
Expanding harm reduction options for people who are homeless in various settings across the city. Currently many agencies require abstinence by program participants.
There was agreement that the primary focus for these initiatives must be on action and implementation,rather than on more reports or recommendations. [Toronto District Health Council Health Planner newsletter Winter 2000-1 http:// www.tdhc.org/pdf/WINTER_2001.pdf]

The South-East Toronto Project (SETO) is a partnership of community agencies, hospitals and health organizations in the in the east downtown sector of the city of Toronto, where 70% of the city's hostel and shelter services are located. SETO partners work together on a continuum of care for homeless and under-housed people.
A SETO workgroup, with representatives from several service provider agencies, has created a model of an infirmary. Partners in this important endeavor include: Street Health; The Community Care Access Centre; Toronto Public Health; Toronto Housing; The Fred Victor Centre; Parkdale Community Health Centre; and Toronto Ambulance Community Health Network of West Toronto;

To facilitate the planning, the group had a key informant survey completed with service providers and with potential clients. The group also looked at other models that have been done internationally and in Canada. The final report about the model will be presented to the Homeless Health Reference Group by the end of the year (2001) See http://www.setoproject.com/profile.html

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