We have an insightful thread on the Community Workspace on Homelessness on voting participation among people experiencing homelessness. The Community Workspace is an interactive space for communities and by communities. It is an opportunity for leaders, service providers and policymakers to share information, seek input and guidance from others, as well as have discussions around homelessness.
We asked you to share your thoughts on the consequences of low voting turn out among the homeless population, their barriers to voting, programs available to facilitate their vote and what stakeholders can do in order to promote voting while eliminating some of the challenges. In this blog entry, I’ll go over what was shared on the Community Workspace. I also encourage you to check the discussion and contribute your thoughts.
During the 2015 federal elections, we posted a blog entry going over the ways that people experiencing homelessness can vote, and touched on the issues of providing identification and not having a fixed address. We also released the Housing and Homelessness Election Guide 2015 which highlighted some recommendations geared towards the federal government from the State of Homelessness 2014. It also included comparison among the main party platforms with a number of resources in order to support voters make informed decisions on who they vote for.
While toolkits such as the Housing and Homelessness Election Guide 2015 are important resources for voters including people experiencing homelessness, there also needs to be mechanisms in place to facilitate the voting process for the homeless population while also reducing the barriers. Below is what we’ve heard from you.
Ideas & thoughts from the Community Workspace
An issue discussed is the discrimination experienced by the homeless population, leaving many to retract or feel uncomfortable in public spaces. As one of the users put it: “Who wants to go vote when you have your stomach in knots?”
Voting locations are just not welcoming to people experiencing homelessness and this is an accessibility barrier. An idea to address this would be to have mobile polling stations traveling between service providers such as drop-in centers and shelters similar to what is currently available for voters living in long-term care facilities and hospitals. Mobile polling stations could visit the same service provider on multiple occasions until no more votes are casted. This would avoid the anxiety that comes from having to disclose their circumstances to polling officers in front of other voters and running the risk of being turned away in front of others. Mobile polling stations would also make it easier for service providers to vouch for anyone that does not have sufficient I.D.
Having a polling on-site made a big difference for the Lookout Society in BC when the organization licensed its shelter as a “care facility”. One of their staff reported on the thread that having a polling station on-site combined with education made voting participation “extremely high”. In addition, Lookout Society supported their clients with obtaining I.D., staff were available to confirm identification of voters, posted information and engaged candidates by asking them to fill out a questionnaire made available to the residents.
While working at YWCA Agvvik Nunavut, we facilitated a series on workshops to discuss the territorial election as requested by a resident. We reached out to candidates to drop off materials, talked to the election officers in advance about what could be done for those without I.D. and they assigned us an election officer that would support voters at the polling station and made herself available to answer any questions ahead of election day. Transportation was provided to and from the polling station and a staff was present at the polling station if needed. While this was a successful initiative, on-site polling stations or mobile polling stations are the better ways to go.
This was proven in the 2015 federal elections when The Calgary Homeless Foundation held a mock election at four shelters including The Alex, Alpha House, YWCA Mary Dover House and the Calgary Drop-In & Rehab Centre. Roughly 500 people participated in this initiative. People had the opportunity to learn about the voting process as well as share their primary concerns. 60% identified affordable housing as their most important issue. In addition, Elections Canada and the Foundation set up a voter registration booth at the Drop-In & Rehab Centre and a mobile polling station on election day. In the first hour and a half of opening, at least 60 people had casted their ballots. However, two people were turned away due to having insufficient I.D. The requirements of identification continue to be a barrier and mentioned in the Community Workspace thread.
Any support available for voters experiencing homelessness may make the difference on whether they vote or not. One person with lived-experience made this clear on the Community Workspace: “The barriers to voting may seem small but to the one on the street it’s almost insurmountable.” We must not assume that because voter turn out is low that people are not interested. Rather, we must look at the systems in place that deter people from casting a ballot and what could be done to facilitate the process.
Below are some questions to consider:
- What are the consequences of low voting participation among people experiencing homelessness?
- What are the barriers to voting that people without housing face?
- How can policy-makers, organizations and advocates reduce those barriers?
- Are there programs and initiatives that have had demonstrable success in this area?
We would like to feature your thoughts on this topic. We encourage you to share your feedback with us on Facebook, Twitter or the Community Workspace on Homelessness, an online forum to discuss homelessness in Canada.
This post is part of our Friday "Ask the Hub" blog series. Have a homeless-related question you want answered? E-mail us at email@example.com and we will provide a research-based answer.
For many years, we have known that youth experiencing homelessness face significant mental health challenges. However, it wasn’t until the release of Without a Home: The National Youth Homelessness Survey (2016) that we learned about the national scale of this issue. The mental health findings of this pan-Canadian study are shocking:
- 42% of homeless youth reported at least one suicide attempt
- 35.2% of homeless youth reported at least one drug overdose requiring hospitalization
This data makes clear that we are failing some of the most vulnerable young people in our country. The time for change is long overdue.
Based on this study’s findings, today the Canadian Observatory on Homelessness and A Way Home Canada launch a policy brief on mental health care for homeless youth. In it, we call on federal, provincial, and territorial governments to address the mental health challenges faced by youth who are homeless in Canada. We argue that this requires two key actions on the part of Canadian governments:
- Federal implementation of a youth homelessness strategy embedded within the renewed federal investment in homelessness, with a special focus on mental health and wellness.
- Provincial and territorial implementation of provincial/territorial strategies to prevent and end youth homelessness, ensuring that the mental health needs of youth at a high risk of homelessness and experiencing homelessness are addressed both through these targeted strategies and the federal mental health transfer funds.
In the policy brief, we offer six key recommendations to guide government action (outlined below). Immediate action, with targeted funding at appropriate levels, is necessary if we expect to address the structural issues and systems failures that are driving youth homelessness and the mental health challenges this group faces.
Falling Short: Mental Health Supports for Homeless Youth in Canada
Numerous studies have shown that the majority of homeless youth experiencing mental health issues and severe mental illness are not receiving any form of treatment or care. For many youth who are homeless, this is an issue of access.
Young people who are homeless in Canada often struggle to access appropriate services that are equipped to support the co-occurring mental health and addictions challenges they often face. Mainstream services are often inaccessible to youth who are homeless because they have been designed for youth who are stably housed and have natural supports. Age restrictions also create barriers for youth experiencing homelessness, and drug-using youth experiencing homelessness particularly struggle to access services. According to a large Vancouver study, 64% of street-involved youth reported difficulties accessing health and social services.
Without intervention, homeless youth experience worsening outcomes for their housing, health, and wellbeing. In the absence of mental health supports, these youth are also more likely to develop addictions or substance abuse issues in their efforts to deal with the stress, violence, and stigmatization of living without a home. Unfortunately, Canadian homeless youth mortality data speaks to these shortcomings, with studies that suicide and drug overdose are the two leading causes of death for young people who are homeless.
The Relationship between Mental Health and Homelessness
Housing status and mental health are inherently linked, and that both are connected to broader structural conditions such as poverty. When a young person faces challenges to accessing secure, adequate, and appropriate housing, they are more likely to face mental health challenges and experience greater difficulty accessing timely, high-quality mental health care. The reverse is also true – youth experiencing mental health issues face unique challenges in obtaining permanent and appropriate housing, including discrimination based on their mental health status.
This close connection between mental health and homelessness means that interventions to address mental health must include housing, and housing interventions to address homelessness must consider mental health and wellness.
Mental Health and Homelessness as Equity Issues
Many of the findings of Without a Home: The National Youth Homelessness Survey demonstrate that both mental health challenges and homelessness are equity issues. Our study found that particular groups of youth are more likely to become homeless, face adversity prior to homelessness, experience greater challenges once on the streets, and experience homelessness for longer. For example, results showed that homeless youth who experienced the greatest mental health challenges included LGBTQ2S youth, Indigenous youth, and young women. This study also found that homeless youth who face the greatest mental health challenges are more likely to:
- Have experienced adversity prior to becoming homeless, such as physical and sexual abuse or neglect,
- Become homeless at a younger age, and
- Experience chronic homelessness and have multiple experiences of homelessness.
Importantly, particular groups of youth, specifically LGBTQ2S youth and Indigenous youth, and more likely to become homeless at a younger age and have multiple experiences of homelessness.
These findings underline something we have known for a long time – access to housing and health care in Canada is in part determined by systems and structures of discrimination and disadvantage based on class, gender expression and identity, sexuality, ethnicity, race, (dis)Ability, and citizenship, among other identities. The inequity manifests itself both within the mainstream housing and health care systems, as well as within the homelessness sector. For example, research has demonstrated that LGBTQ2S youth who are homeless often experience homophobia and transphobia when trying to access services, and studies demonstrate that Indigenous youth are more likely than other homeless youth to have difficulty accessing health services and addiction treatment.
These findings demand action to not only address the mental health and housing issues facing youth experiencing homelessness, but to disrupt the system failures that contribute to inequitable access to housing and health care, including mental health care.
Time for Action: Why Make an Investment Now?
It goes without saying that all governments and policy makers wrestle with competing claims on their time, resources, and priorities. For those of us seeking political change on urgent social problems, we must be able to answer questions that these actors often ask, such as
- Why should we invest now?
- Why should we prioritize investment in this social issue when there are many others that are similarly deserving?
- Can this investment address other governmental priorities?
- What levels of government, and what departments or ministries, are responsible for addressing this issue?
There are at least three key reasons why we should invest now in an integrated systems approach to mental health care for youth experiencing homelessness:
1. We are Facing a Mental Health Crisis in Canada
- Approximately 20% of Canadians experience mental health issues (6.7 million Canadians) (MHCC, 2016).
- 520,000 people living with mental illness in Canada are either homeless or vulnerably housed (MHCC, 2013).
- In Canada, suicide accounts for 24% of all deaths among 15-24 year olds (Public Health Agency of Canada, 2002).
- The wait times for mental health care continue to put many children and youth at risk. For example, only 31% of child and youth mental health agencies in Ontario are able to meet the Canadian Psychiatric Association benchmark for wait times (Schizophrenia Society of Ontario, 2008).
2. Investments can Build on Political Momentum at the Federal, Provincial, and Territorial Levels
- In Budget 2017, the federal government expanded and extended the Homelessness Partnering Strategy
- Most provinces and territories have established new metal health transfers with the federal government, who earlier this year announced a 10-year, $5 billion investment in mental health services. These new funds provide provinces and territories the opportunity to invest in mental health services for marginalized youth. Importantly, Budget 2017 identified one of the key indicator’s of success as “Shortened wait times for mental health services to help children and young persons under the age of 25 in need of support.”
- Increasing numbers of communities across Canada are adopting youth homelessness strategies, many of which seek to address the health and mental health challenges faced by youth who are homeless
- A ‘Systems’ of Care approach has been adopted in some Canadian communities that support strategic and planned approaches to ending homelessness. For example, Alberta’s plan to prevent and end youth homelessness advocates for a System of Care, as does Calgary’s Ten Year Plan to End Homelessness. More recently, the Ontario government also committed to a more integrated response when it announced support for up to nine “one-stop” youth hubs for youth experiencing mental health challenges.
- An investment in youth mental health will not only reduce youth homelessness, but will contribute to other federal, provincial, and territorial policy priorities, including: illness prevention, youth unemployment, infrastructure, federal-provincial-territorial partnership, and Indigenous issues.
3. Investing in Mental Health is Cost-Effective
- The economic cost of mental health problems and illnesses to Canada is at least $50 billion per year in lost productivity – 2.8% of Canada’s 2011 gross domestic product (MHCC, 2016).
- The economic burden of mental health is enormous compared to other diseases. In Ontario, for example, the burden of mental health and addictions is 1.5 times that of all cancers, and more than seven times that of all infectious diseases (Ratnasingham et al., 2012).
- Improving a child’s mental health from moderate to high can lead to lifetime savings of $140,000 (MHCC, 2013).
What should we do?
In our policy brief, we outline the following recommendations for federal, provincial, and territorial action that are necessary to drive positive change for youth experiencing homelessness and mental health issues:
Recommendations for Government
Government of Canada
- Federal leadership in the development and implementation of a National Youth Homelessness Strategy to prevent and end youth homelessness, supported by a targeted investment.
- Federal prioritization and support for systems integration at the provincial, territorial, and community levels to address the mental health needs of youth experiencing homelessness.
- Federal support for program models that focus on prevention and rapid exits from homelessness for youth, within which strategies for addressing the mental health needs of youth should be embedded.
- Federal adoption of a youth-centered approach to addressing youth homelessness, grounded in human rights.
- Federal commitment to addressing the unique needs of diverse youth experiencing homelessness, as reflected in both policy and funding.
- Federal adoption of a national research strategy focused on youth homelessness in order to advance an integrated systems response, within which a mental health strategy is embedded in all elements.
Provincial and Territorial Governments
- Provincial and territorial development and implementation of strategies to prevent and end youth homelessness, supported by a targeted investment.
- Provincial and territorial prioritization and support for systems integration in all efforts to address the mental health needs of youth experiencing homelessness.
- Provincial and territorial support for program models that focus on prevention and rapid exits from homelessness, within which strategies for addressing the mental health needs of youth should be embedded.
- Provincial and territorial adoption of a youth-centered approach to addressing youth homelessness, grounded in human rights.
- Provincial and territorial commitment to ensuring that all provincial, territorial, and community strategies and program responses address the unique needs of diverse youth experiencing homelessness.
- Provincial and territorial knowledge development and data management specific to youth homelessness in order to advance an integrated systems response, with a special focus on youth’s mental health and wellness.
Yesterday, we joined our partners in anticipation as Finance Minister Bill Morneau of the Government of Canada announced the 2017 federal budget. We welcome the investments in housing and homelessness announced in the new budget. Below are some key highlights.
National Housing Strategy
The Government has announced $11.2 billion over 11 years allocated for the implementation of an inclusive National Housing Strategy. This announcement comes after almost 30 years of federal disinvestment in affordable housing, which has contributed to our current housing and homelessness crisis.
The 11-year investment in a National Housing Strategy is significant. Not only does it signal the federal government is ‘back at the table', the length of the investment means this is now a permanent program. The investment also highlights the government’s commitment to flexibility and new ways of working.
The NHS investment includes:
- $2.1 billion/11 years to expand and extend the Homelessness Partnering Strategy.
- $5 billion/11 years to develop a new National Housing Fund to address critical housing issues and prioritize vulnerable citizens such as seniors, Indigenous Peoples, survivors fleeing domestic violence, persons with disabilities, those dealing with mental health and addiction issues, and veterans (unfortunately no mention of youth).
- $3.2 billion/11 years devoted to a renewed multilateral investment framework devoted to building new affordable housing and renovating and repairing existing units.
- $525 million/11 years combined to target support for northern housing and for Indigenous Peoples not living on-reserve.
- $241 million/11 years to CMHC to improve data collection and analytics, which will strengthen the ability to report the outcomes of the National Housing Strategy and make informed policy decisions.
- $202 million/11 years to make more federal lands available for affordable housing and to fund environmental remediation, renovations and retrofits to make the land suitable for housing.
You can read the complete budget at Budget 2017: Building a Strong Middle Class.
It should be noted that in addition to the $11.2B allocated to the NHS, the federal government announced its intention to protect the baseline funding for operating agreements, but with greater flexibility on how those funds can be used. This is significant as until now the commitment of the federal government was to let those agreements expire over the next ten years.
Homelessness Partnering Strategy
Included in the NHS (as mentioned above) is a commitment to expand and extend the Homelessness Partnering Strategy. This is the longest-term commitment to addressing homelessness ever by a federal government. After years of diminishing spending on homelessness (when HPS was most recently renewed in 2013, the annual budget had been cut to $118M), this is an increase to an annual average of $191M.
The budget signals not only an investment in housing and homelessness, but a commitment to a policy direction that is much welcomed.
As we go forward, here are some things to consider:
- While the announcements made in the 2017 budget are promising, ending homelessness in Canada can only be achieved through significant and sustainable investment in housing and homelessness. The Canadian Observatory on Homelessness and the Canadian Alliance to End Homelessness calculated in The State of Homelessness in Canada 2016 that preventing and ending homelessness in Canada requires an investment of $43.8 billion over 10 years.
- Much of the funding announced in the budget is ‘back loaded,’ meaning funding commitments may not kick in until several years from now. While this will undoubtedly raise some concerns, it also creates an opportunity to ensure that programs are thoughtfully designed and funding aligns well with efforts of other orders of government. Further, this provides an opportunity to embed a commitment to ending homelessness within the new federal strategy.
- Absent from the new investment is a “Housing Benefit,” one of the key recommendations of the State of Homelessness in Canada 2016.
- Details about exactly what a renewed homelessness strategy will entail will happen only after a program review is completed later this year. The COH, in partnership with A Way Home Canada and the Canadian Alliance to End Homelessness, will press for the government to focus its investment on those in greatest need, including chronically homeless persons, youth, veterans and Indigenous Peoples, for instance.
- It is promising that the federal budget highlights prevention as an essential component in our efforts to end homelessness. For instance, the government’s intention to champion better outcomes for youth through education, training and employment, is an important strategy in the prevention of homelessness. We will continue to encourage a focus on prevention.
Above all, the 2017 federal budget is evidence that the government of Canada is committed to addressing homelessness, not through the status quo, but by directing resources to better, longer-term solutions; solutions that help those in need today, while preventing homelessness tomorrow.
We commit to working with you, our partners and all levels of government, to ensure we leverage today’s investments, and those of the future, to make the shift toward a new approach: one that ensures everyone in Canada has access to safe, secure, suitable and affordable housing.
It’s hard to believe that in a country as prosperous as Canada, homelessness is such a widely pervasive issue. On any given night, 35,000 Canadians are homeless and at least 235,000 people experience homelessness in a year. For some, this reality is often difficult to rationalize. Because we live in a prosperous country (ranking #9 on the UN’s Human Development Index) and due to the social services we have in place for the very purpose of preventing forms of extreme poverty like homelessness, we are often left asking “How?”
On the other hand, when considering the decline of income and social assistance in Canada and its correlation with the rise of homelessness over the past 30 years, it is clear that our venerated social safety net might not be as reliable as we think.
Welfare in Canada
Many forms of government benefits fall under the umbrella term of “social assistance” including welfare, disability support payments, old age security and employment insurance. They are an integral part of our social safety net. In Canada, social assistance coordination is regulated by each province and territory, resulting in variations in procedures across the nation, while Indigenous populations have a separate, federally administered social assistance program altogether. Generally speaking, recipients are eligible for social assistance if they meet a strict set of criteria for individuals or families who have no means of financially supporting themselves. That includes temporary situations such as loss of employment and long-term situations such as disabilities and other health issues.
Recipients of social assistance often find it doesn’t cover basic living expenses, however. In fact, social assistance payments are lower than what people would have received 20 years ago - since the 1990s, social assistance benefits have consistently failed to keep up with inflation and rising costs of living.
For instance, a single recipient of temporary assistance receives $510 per month in British Columbia. This is clearly nowhere near enough to compensate for basic living necessities like rent, food and transportation. Moreover, research finds that:
- Between 1990 and 2009, inflation increased by 45.9% and most social assistance incomes did not keep up. As a result, many people receiving social assistance are worse off than the recipients of earlier decades. In several cases, social assistance incomes decreased by 20% or more.
- Social assistance incomes were consistently far below most socially accepted measures of adequacy across Canada.
- Amounts for basic needs such as food, housing, clothing, household expenses, transportation and personal grooming items are set by government regulations or policy directive. These amounts are often set arbitrarily and do not necessarily reflect the actual cost of necessities.
- Social assistance programs in Canada are designed as a measure of last resort, which means the recipients must exhaust their sources of income, including savings, before they may qualify. While certain types of exemptions of assets exist for RESP or RDSP, many are nearly destitute by the time they are eligible for social assistance. This is known as “asset stripping”.
Welfare & Homelessness
Homelessness is often not attributed to a single misfortune. Rather, it is a combination of personal factors as well as system and structural failures. The inability of social assistance to supply individuals or families with enough money or support for housing goes hand-in-hand with the lack of affordable housing across Canada. Moreover, minimum wage rates across the country (e.g. $11.40 in Ontario and $10.85 in BC) are hardly sufficient for many people to make ends meet.
State of Homelessness in Canada 2016 confirms that the rate of homelessness in Canada today is a result of austerity measures executed across the country since the 1990s. This includes cuts to our social safety net that have impacted lower-income Canadians. Ideally, individuals experiencing or who are at-risk of homelessness ought to be eligible for and recipients of social assistance as a measure of protection against job loss or increasing housing costs - more often than not, this fails to be the case.
Currently, 1 in 7 (or 4.9 million) Canadians live in poverty, while 1 in 8 Canadian households struggle to put food on the table. According to a McMaster University study, there is a 21-year difference in life expectancy between the poorest and wealthiest residents of Hamilton, Ontario.
Contrary to popular belief, individuals experiencing homelessness are least likely to access or receive social assistance due to variety of barriers and facts that deter individuals from applying. Some examples are:
- Claims stating a decline in the volume of social assistance applications show that increasing level of Canadians are escaping poverty are misleading. On the contrary, the application process for social assistance has become more onerous and difficult to navigate, thereby discouraging applications altogether.
- Individuals who speak English as a second language, those with limited educational attainment or those with physical or mental illnesses often have the most trouble navigating the application system.
- Applying for social assistance generally requires reliable access to a phone or internet, which may prove challenging for those who are at-risk of or experiencing homelessness.
- Application criteria demands a copious amount of documentation required for social assistance eligibility. For those who are experiencing homelessness or fleeing abusive homes, such records may be difficult to retain, leading to ineligibility.
- In British Columbia, individuals turned away from social assistance programs on the basis of ineligibility are often directed by the BC Ministry of Employment and Income Assistance to food banks and shelters.
- To be eligible for social assistance, applicants generally must pass several administrative barriers such as a mandatory three-week job search period as well as having to prove they have earned an income ‘legitimately’ for two consecutive years. However, this does not acknowledge the informal economy that individuals experiencing homelessness are employed by and often limited to.
- Social assistance programs across the country are designed to ensure recipients re-enter the labour market as quickly as possible. However, this criteria fails to consider that many are not ready to work due to lack of transportation, addictions, young dependants, mental illness and/or other factors.
- For single mothers who are able to access social assistance, incomes are often too low to provide financial security and stable housing. Furthermore, single mothers receiving social assistance often face discrimination from landlords and/or employers, making returning to work and finding housing even more challenging.
- In Ontario, youth under 18 experiencing homelessness are ineligible for social assistance if they do not have a guardian or trustee. On the other hand, those over 18 and receiving social assistance don’t earn livable income. Furthermore, studies find that youth on social assistance also face discrimination from landlords, limiting their access to housing.
- Social assistance programs require recipients to find employment as soon as possible, regardless if their wages are sufficient enough to provide financial security or not. In Ontario, when individuals do find work, social assistance is often clawed back by 50 cents to every $1 earned. Under this set up, individuals are forced to exhaust all earnings on basic expenses and in the event of job loss, they are once again vulnerable to homelessness.
Despite the barriers that Canadians living in poverty often face, there are changes happening at the policy level. In July 2016, the federal government introduced the Canada Child Benefit, promising to lift approximately 300,000 Canadian children from poverty. However, given that in 2014 there were a reported 1.3 million Canadian children living in poverty, the positive impact of the Canada Child Benefit is somewhat limited. In light of this, we echo the Canadian Centre for Policy Alternatives in imploring the federal government to address broader structures of inequality.
In fact, support for a basic income is gaining traction on both the left and right of the political spectrum. The function of a basic income would be to provide Canadians with a fixed income not contingent upon market swings, eliminating other forms of social assistance. A basic income also guarantees a reliable income source to buffer against times of financial insecurity, thus preventing more extreme forms of poverty like housing or food insecurity. The benefits of a basic income are encouraging, as one study found that based on the model of Old Age Security, persons aged 65 and older who transitioned from social assistance payments to a guaranteed income experienced increased mental and physical health as well as income and housing security. (For an in-depth consideration of the guaranteed annual income debate please see Dr. Nick Falvo’s piece.)
The implementation of an unconditional, basic income that considers vulnerable, in-need Canadians is a step towards combating homelessness. This is also known as a preventative framework. Much like the philosophy that governs “Housing First,” the provision of a basic income should not be subject to rigid, unrealistic and often discouraging eligibility criteria. Preferably, it should recognize access to social assistance and a broader social safety net as our absolute right and an uncompromisable part of our welfare state, rather than a last resort.
Palliative care is composed of services provided to those at the end of their lives, either from old age or serious illnesses. Palliative care services can be provided in hospitals, nursing homes, shelters, hospices, at home and to a certain extent at drop-in centres or on the streets.
The goal of palliative care is to ease the end-of-life transition, reduce pain, provide medical support and prepare the client and family/friends for impending death. Palliative care is often in a 24-hour facility or at home including visiting nurses, doctors and additional supports provided by friends or family members. It is designed to help the terminally ill spend their last days with dignity and less suffering.
Last year, the Homeless Hub had posted a blog article discussing the types of palliative care services available to the homeless population, as well as the barriers in accessing them. In this article, I will list some of the palliative care services in Canada serving the homeless populations.
So what’s available?
Currently, there are more than 5,000 people experiencing homelessness in Toronto. A recent research study shows the homeless population is more likely to have a wide range of health issues and have two to four times higher mortality rate than the general population. Dr. Dosani, who previously wrote a blog entry on the need for palliative care that meets the needs of people experiencing homelessness, is a palliative care and family physician at PEACH (Palliative Education and Care for the Homeless) offered by Inner City Health Associates (ICHA). ICHA is currently composed of a group of more than 60 health care providers working in over 40 shelters and drop-ins across the City of Toronto, providing health care to the homeless population. Last year, Dr. Dosani performed a powerful TEDx talk, describing PEACH as a service aiming to build partnership between community agencies and the mainstream health system, to ensure that people experiencing homelessness receive the same healthcare other Canadians receive.
Recently, CBC ran a news segment of what Dr. Dosani’s day looks like as he supports his patients. His work takes him from one end of the city to the other wherever his patients are currently staying. Through his advocacy, Dr. Dosani illustrates the great need for programs like PEACH by telling the story of Terri, one of his former patients experiencing homelessness whose tragic death had a profound impact on his work. This experience pushed Dr. Dosani in his quest to ensure the homeless population is not denied of palliative care they too need. He has also written about PEACH and some of the alarming health data coming out of Toronto’s shelter system such as the average life expectancies for people experiencing homelessness are estimated to be between 24 and 47 years. To put this into perspective, the life expectancy of the general population is 83 years old for women and 79 for men.
The program is not only about providing care services but also increasing the capacity of community homeless agencies to support the end-of-life clients, educating mainstream palliative care services about homeless people, advocating for high quality, early and integrated palliative care, as well as advancing the body of research in this area.
The Ottawa Mission’s Diane Morrison Hospice is a 24-hour palliative nursing care available to people facing their final days. It was founded in 1999 and since then, the Mission has partnered with Ottawa Inner City Health and other health care professionals to support patients at any stage of their illnesses. The hospice has space for up to six people needing round the clock care and nine spaces for those needing chronic palliative and extensive health care services. Three more spaces are available for terminally ill clients living elsewhere in the community.
The hospice program serves men, women and couples and is committed to welcoming anyone experiencing homelessness while needing end-of-life care. The goal is to provide patients with the equivalent of a home and a family, as well as staff who are trained to provide quality care comparable to what is provided to non-homeless Canadians. They have trained volunteers, and their doors are open to family and friends who also provide support. The hospice has access to religious caregivers including Indigenous spiritual support staff.
What differentiates this program from other mainstream palliative care services is their harm reduction approach. Patients are not required to abstain from using substances as long as they are not posing a risk to others at the facility. The program is not only a health care facility; it is a space to strengthen communities and bring meaning and dignity to the end of life of those experiencing homelessness.
The Calgary Allied Mobile Palliative Program (CAMPP) is a new two-person team providing care to the homeless population in Calgary suffering from terminal illnesses. CAMPP launched in October 2016 as a mobile service with one nurse coordinator, Rachel Edwards, along with Dr. Simon Colgan. As a new service less than 6 months old, their future is uncertain. CAMPP’s website does not provide information on its program but lists its contact information and a link to their donation page.
In just a few months, CAMPP has served 40 people while making no demands from patients to stop using substances. In an interview with CBC, Dr. Colgan said, “I wanted to make sure that things like addiction and lifestyle didn’t preclude people from the best quality of end of life that we could offer.” The team visits the city’s Drop-In and Rehab Centre, Alpha House and even search for potential patients staying under bridges. It is estimated that approximately 550 homeless people with two or more chronic conditions are currently living in Calgary. With so much need for palliative services among the homeless population, Dr. Colgan recently shared with us that CAMPP recently received funding to extend the program.
Do Mind the Gap
Thanks to the increasing research highlighting the gap of palliative care services available to the homeless population, there has been an increasing recognition of the pressing health care needs in this area. However, there still remains a service gap in Canada.
A recent article on PORT, a network bringing together some palliative services catering to the needs of the homeless population in the Vancouver Island area, stated there is not enough funding. Dr. Kelli Stajduhar and Ashley Mollison of the Institute on Aging and Lifelong Health at the University of Victoria, who co-wrote the article, explain that the lack of funds is typical for hospices across Canada. As a solution, Dr. Dosani provided three cost-effective recommendations:
- Providing accessible health care by getting health care professionals out in communities to treat people early in their disease journey.
- A flexible health care system by adopting approaches such as harm-reduction to build relationships with people who have experienced years of discrimination and trauma should be developed.
- Humanistic and compassionate care that respects human dignity beyond the stigma of patients’ marginalization needs to be promoted.
Palliative care delivery system that meets the health care needs of the homeless populations requires funding for a robust infrastructure. On the other hand, it does not have to be costly, as suggested by Dr. Dosani. Health care services should not be confined to only those who are housed – We should not forget health care is part of the Canadian ethos.
- Advance care planning, palliative care, and end-of-life care interventions for homeless people: A systematic review
- End-of-Life Care for Homeless Patients: She Says She is There to Help Me in Any Situation
- Shelter-Based Palliative Care for the Homeless Terminally Ill
- Advance care planning, palliative care, and end-of-life care interventions for homeless people: A systematic review
- The Homeless Terminally Ill and Hospice & Palliative Care
- Minding the gap: access to palliative care and the homeless
This post is part of our Friday "Ask the Hub" blog series. Have a homeless-related question you want answered? E-mail us at firstname.lastname@example.org and we will provide a research-based answer.
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