People experiencing homelessness often suffer from a range of health problems that put them at heightened risk for severe illness and premature death. But because they lack housing, it can be a major challenge for those individuals to get and keep medical appointments and meet other basic needs to help prevent such poor outcomes.
After seeing so many patients fall into this cycle – being discharged from hospital only to be readmitted a short time later in even worse health – Stephen Hwang decided to do something about it. Dr. Hwang, a general internist at St. Michael’s Hospital in downtown Toronto who studies the connection between homelessness, housing and health, is in the midst of an ambitious research project to determine what happens when unhoused people who end up in hospital are given a helping hand.
That means that when certain individuals experiencing homelessness are admitted to the hospital, they are paired with a counsellor who helps them navigate follow-up appointments and fill prescriptions, makes sure those individuals have a place to stay after they’re discharged, and provides them with food and other basic necessities.
“We found the rates of readmission to hospital were far higher in people experiencing homelessness than the general patient population. We also saw that a lot of times, just basic arrangements like letting the patient know when their appointments were didn’t happen because follow-up contact was lost,” Dr. Hwang said. “What I realized was that we needed to try to do things differently.”
Not all unhoused individuals admitted to St. Michael’s Hospital are paired with an outreach worker. Dr. Hwang is determined to objectively measure the results of the program, so he’s designed a randomized controlled trial that will look at two groups: unhoused individuals paired with an outreach worker, and those given no extra help. If he can prove his program is successful, he’s hoping it will increase the odds of scaling it up to other centres around Canada. Two outreach counsellors are involved with the project and they have so far assisted a few hundred individuals.
The project, based at St. Michael’s Hospital, launched in 2019 and continues for two more years. The pandemic made it more difficult to connect patients to outreach workers, but the disproportionate impact of COVID-19 on society’s most vulnerable groups, including people who are experiencing homelessness, meant it was important to persevere, Dr. Hwang said.
Fred Ellerington is one of the outreach workers involved in the project. No two days are the same and a big part of the job involves creative problem solving. Some individuals need a new pair of shoes and a place to stay with groceries, while others need access to a walker and other mobility aids to move into an apartment he’s found for them. Mr. Ellerington said he’s found that medical staff also treat unhoused individuals differently when he’s there. For instance, they’re more willing to rebook a missed appointment for those individuals when Mr. Ellerington is there to act as a navigator and advocate.
“It’s giving people dignity,” he said. “We stand beside that person and that person is treated differently.”
Alyssa Ranieri, another outreach counsellor on the project, said that without this extra help, many of the individuals they work with would simply not receive the care they need. She recalled the story of a man who needed intravenous antibiotics several days a week to treat a leg wound. But the designated clinic was too far away for the man to get to, leaving Ms. Ranieri to scramble to find another solution. She found a local community health centre in the man’s neighbourhood that was willing to provide the necessary care.
“It’s a lot of creative thinking – thinking outside the box of how to have people access health care in a non-traditional way,” she said.