Cambridge Shelter Corp

Those who are experiencing homelessness and have a higher level of healthcare needs are often faced with barriers when it comes treatment due to a lack of stable housing. Clients are often refused necessary procedures or medical attention as they do not have an adequate place to recover or prepare for/from treatments. Those who need to prep for a procedure are often met with insurmountable challenges that living with homelessness brings. Many of those experiencing homelessness have medications or conditions that require a more appropriate space to rest or rehabilitate than living in a emergency shelter does not allow for.

Clinicians who are either a part of the shelter system or are a part of the community that provides care to those experiencing homelessness have declared that a more appropriate space is needed to accommodate many of the issues that those who are housed are privy to. By transitioning the Kinsmen space into a multi-purpose facility, we are closer to providing some of the basic necessities required to see that those individuals experiencing homelessness are provided the same access to transition in and out of the healthcare community.

Principles

The transitional space was designed around the following guiding principles:

The individual is the centre of the holistic program
Everyone has the right to access healthcare/treatment options without barriers related to housing
Services will be linked and coordinated so the individual is able to move easily from one part of the shelter/housing system to another, barrier free
Services will be based on best practice
Funding to continue and expand healthcare streams at the men Centre will continue to be sought out

The following standards will guide the wellness models in place at the site as well as the transitioning into and out of the space:

All best practices related to PHIPA, confidentiality and consent will be a priority
Individuals will be active and valued participants in their own case management planning
Barriers or exclusionary criteria which can prevent easy, flexible access to services will be removed
Services will identify individual needs, and we will work with the individual to provide and/or link them to formal community resources
Partnerships will be forged with the appropriate community agencies to ensure the best possible outcome is achieved

Goals of the Program

Identified goals of the program are:

A comprehensive continuum of services will be developed to meet individual needs
Stabilize an individual’s healthcare needs to allow for a safe transition to housing or shelter
Using a holistic, person-centered approach, physical, mental, and emotional health issues will be addressed
To tap into the community healthcare system to provide connection to a variety of services ie. Surgeons, dentists, psychiatry
Services are coordinated and organized to ensure that individuals have access to the services that best meet their needs
Services will be provided in-house, when possible, through community partnering agencies where applicable and community support workers will be asked to come to the site to meet with shared clients as appropriate
Provide an opportunity for virtual visits with specialists when in person is not applicable
The least restrictive and least intrusive interventions, which still provide safety for the person, will be used

Elements of the Program

To ensure success, the program was designed with a combination of services and programs provided by the Cambridge Shelter Corporation (CSC) and by making connections to community partners to provide those pieces of the plan that are not offered by CSC. Essential elements are:

· Individual care plans with benchmarks and measurable goals, are developed in partnership with the individual, the CSC Nurse and community partners as necessary

· Connect individuals with their primary healthcare provider or assist with a new connection

· Assistance to acquire all necessary medications

· Assistance to manage health care appointments in the community while assisting with transportation arrangements

· Access to on site dental care

· Mental health assessment and support ie psychiatry, counselling

· Access to medical support through community hospitals ie surgeons, NPs

· Access to addiction support and treatment navigation – Peer support available

· Assistance to acquire all necessary identification

· Assistance with income support

Eligibility

Any male or female adult experiencing homelessness who is assessed by the CSC Nurse or Operations Manager may be granted access to the program. The person may be staying in shelter system or be unsheltered and staying somewhere in the community. Referrals may come from other sources, but an intake interview will be conducted prior to access to ensure that the individual can manage within the space.

The space, when possible, will be reserved for individuals who, because of their health situation, would benefit from an admission to the Hespeler St location centre as opposed to an emergency shelter. Some examples of situations where an individual would be considered a priority for the space could be part of the below list but not limited to:

· Individuals recovering or prepping for surgery

· Those with mobility challenges

· Those who have sight or hearing impairments

· Those with an infection that may spread to a larger group if admitted to the emergency shelter system

· Those requiring dialysis multiple times per week

Expectations of Residents

Individual participants will be cohorted, as best as possible, into single or dorm style rooms. The program will operate through a healthcare lens and individuals will need to be independent to either care for themselves or be willing to accept assistance with caring for oneself. Program participants will work with the on-site nursing staff to set recovery/maintenance goals and with housing workers to strive towards permanent housing.

Residents will need to abide by the substance use policy as set forth by the CSC. Those not adhering to the guidelines will be removed from the space and returned to another shelter space. In and out privileges will be monitored by staff and at no time will residents be allowed to come in and out of the main entrance without the knowledge and consent of CSC support staff.

Visitors to the site will only be permitted with approval from CSC support staff and the Operations Manager. Visitors will need to be professional in nature, screened prior to entry and only stay for the designated, agreed upon time.

Community Partners

Our community partners will play an important role in helping us to develop a care plan for everyone, and to assist us in providing a circle of support. The on-site nursing staff will be responsible for starting care plans and then making community connections as deemed appropriate by the team. The following community partners will be involved:

· Cambridge Memorial Hospital, Grand River Hospital & St Mary’s Hospital – The Social Work Lead at CMH, GRH and SMGH will be responsible for liaising with the on-site nursing lead to make arrangements for treatment or recovery from procedures on site.

· Porchlight – The Addictions Clinical Supervisor will be available to do treatment planning as identified by the nursing team and offer counselling services, if required and/or desired

· Primary Care Provider or OHT Network of Doctor’s Through Regional Hospital System – provide healthcare supports as necessary.

· Canadian Mental Health Association – We will work cooperatively with the FACTT (Flexible Assertive Community Treatment Team), Specialized Outreach Service (SOS) and Here 24/7 if their support is required.

· ACTT (Assertive Community Treatment Team) – We will work collaboratively with the Grand River Hospital and Thresholds ACT Teams to ensure that ongoing mental health treatment is delivered without disruption.

· In Home Dialysis – opportunity to partner with Grand River Hospital to install and operate an in-home dialysis unit with oversight by the RPN and GRH dialysis team.

· Dental Care – on site dental care could be made available through a group of retired dentists that will provide basic check ups and make external referrals as required.

· Foot Care – foot care will be made available to ensure that folks with diabetes can be properly groomed and maintained.

Projected Outcomes

Individuals experiencing homelessness are often denied medical treatment due to barriers related to their living without stable housing. Their chronic homelessness often prevents them from receiving the healthcare opportunities that all Canadians are eligible for but are overlooked for treatment planning because of lack of housing.

We hope that by continuing to provide a transition space with significant in-house supports and linkages with community partners, residents with higher levels of risk can gain access to the healthcare system the same way that a housed individual would.

· Occupancy for up to 22 (possibly more) individuals who are identified as having an elevated level of healthcare needs that would benefit from a temporary stay in a non-sheltered environment.

· Residents receive or are connected to internal nursing supports who will make connections as needed for supports in the community.

· Individuals receive the surgeries and treatments necessary to keep them healthy and back on a road to secure stable, permanent housing.

· Residents’ health (physical, mental, and emotional) improves because of the transition space.

Social Return on Investment

As people become stabilized in their own health care, their dependence on emergency services drops, and their health outcomes improve significantly. Costs associated with homelessness drop significantly when an individual can access the treatments and procedures necessary to allow them to be housed. Homeless patients on medical and surgical units remain hospitalized longer than housed patients, resulting in substantial excess costs. Homeless patients admitted for psychiatric conditions have higher costs not explained by prolonged length of stay.

Consider the following costs from the Homeless Hub:

· It costs $2559 more per medical hospital admission for an individual who is experiencing homelessness

· It costs $1058 more per mental health admission for an individual who is experiencing homelessness

· The cost of using an ambulance is $240 and most often these costs are not recovered from folks experiencing homelessness

· An average emergency department visit costs upwards of $500 per visit

It is estimated that those who are experiencing chronic homelessness account for $134,642/person/year in costs for emergency room visits, hospital stays, police calls, and incarceration. Individuals experiencing homelessness visit the emergency department five times more than housed individuals and 80% of those visits are for illnesses that could have been addressed by primary or preventative care.

It is our goal to reduce, or eliminate, the use of emergency services by the residents of this transition site. We aim to ease pressures on the regional hospital system by collaborating on joint health plans to prepare individuals for planned hospital visits and allow for proper recovery in order to prevent readmissions.

To Date

When we look back at the last 3 years, we can report that we have successfully provided space for over 120 individuals who reported as being homeless. Every single person was offered a healing environment for their situation and while some could not manage within the space, the vast majority saw improvement in their health post intake. We have assisted several individuals suffering from ailments such as cancer treatment, limb amputation, severe uncontrolled diabetes, breathing difficulties, dialysis, mobility issues and much more.

How we plan to measure success moving forward may not simply be a matter of statistics as with other programs. For example, if an individual is admitted to the space and it takes several months to come up with a housing plan the success would be that they were able to manage their own health and follow the guidelines of the program. Some successes to date have been more immediate in that we have seen a quick improvement in health outcomes related to a reduction in anxiety as well as being afford a place to rest. As we have learned each individual experiencing homelessness has their own story and not all results may be captured with any assessment tool.

As there is no other location like the Kinsmen space within the homelessness sector that we are aware of this would be a great opportunity to initiate a study and possibly create our own evaluation tool with the help of one of our post secondary institutions in the Region. We believe the model we are, and have been, creating can be used as a teaching tool for future projects in other communities and we feel the need to nurture that from the beginning.