Keith Hambly, left, CEO of Fred Victor Housing, and Dr. Andrew Boozary, executive director, social medicine for University Health Network, outside Dunn House on Oct. 1. Fifty-one units were built on land donated by UHN and the residential building will be operated by the Fred Victor Mission.Fred Lum/The Globe and Mail
A hundred people living on the streets of Toronto last year accounted for thousands of visits to two emergency departments run by the University Health Network, but most needed something Canadian hospitals don’t normally provide.
They didn’t require stitches or a cast or other emergency care, according to Andrew Boozary, executive director of the Gattuso Centre for Social Medicine at UHN and a family physician, but a permanent place to live.
On Thursday, UHN is set to begin meeting that need for 51 frequent users of its ERs with the ceremonial opening of Dunn House, a unique social housing project designed to improve the lives of people experiencing homelessness, while reducing their use of a strained public health care system.
UHN leased the land for the four-storey building in Toronto’s Parkdale neighbourhood to the municipality for $1. In exchange, Dunn House’s 51 studio apartments will be reserved for patients UHN has identified as regular ER users who are also frequently admitted to the network’s inpatient wards. Tenants have already signed their leases and will begin moving in at the end of the month.
“What excites us most about this project is that it’s scalable,” said Keith Hambly, chief executive officer of Fred Victor, the social-services organization that will act as landlord for Dunn House. “There’s a solution here that is meeting the needs of a particular population that is accessing the hospital system frequently, often very expensively.”
Hospitals in Ontario and across the country are struggling to cope with a rising number of patients with mental illness, substance-use disorders and no place to live. One study found that non-urgent visits to Ontario ERs by patients experiencing homelessness in the fall and winter of 2022-23 increased by 27 per cent compared with past seasons. In Toronto’s ERs, there was a 70-per-cent increase.
Boozary and Hambly take a tour of Dunn House. The unique social housing project designed to improve the lives of people experiencing homelessness, while reducing their use of a strained public health care system.Fred Lum/The Globe and Mail
Homeless patients also stay in the country’s hospitals longer and cost the health system more than people with permanent housing, according to the Canadian Institute for Health Information. In 2022-23, the average length of a hospital stay for a homeless person was 15.4 days and cost $16,800. Patients with homes, by contrast, stayed an average of eight days and cost the system $7,800.
Substance-use disorders, schizophrenia and other psychotic disorders, and infected wounds were the top reasons people living on the street were admitted to hospital, CIHI found.
Homeless patients sometimes stay longer because they’re sicker than other people when they arrive at the hospital, said Stephen Hwang, director of the MAP Centre for Urban Health Solution at St. Michael’s Hospital in Toronto. But more often, he said, “we’re keeping people longer than they need to be in the hospital simply because we don’t feel comfortable discharging them to the street.”
Dunn House is meant to alleviate some of that problem, Dr. Boozary of UHN said. The hospital network first announced its housing plan in 2019. UHN leased a parking lot next to the Bickle Centre, a long-term care facility, to the city for a nominal fee. The federal government gave $14-million in capital funding through its Rapid Housing Initiative to construct the prefabricated building off-site. A crane plunked it down on Dunn Avenue in the spring.
The City of Toronto, meanwhile, allocated $1.53-million annually in operating funding for the services provided by Fred Victor, the homelessness charity, at Dunn House. That money came from a $48-million provincial fund for supportive housing projects, according to Christy Abraham, a spokesperson for the municipality.
The restaurant-grade kitchen at Dunn House. The plan is to serve three meals a day communally, Hambly says, while reacquainting residents with cooking.Fred Lum/The Globe and Mail
On a tour of Dunn House this week, workers were putting the finishing touches on the interior of a building that features a common laundry room, a sprawling back deck, a sunny dining room and a restaurant-grade kitchen.
The plan is to serve three meals a day communally, Mr. Hambly said, while also reacquainting people who have lived on the streets for years with cooking for themselves. Each studio apartment has a fridge, microwave, convection stove and a table for two, as well as a single bed and private bathroom.
Rent will be geared to the income residents receive through the Ontario Disability Support Program.
On the main floor is a treatment space where Dr. Boozary and other health professionals will provide medical care to residents. Selecting the tenants for Dunn House wasn’t an easy task: “There’s no perfect algorithm in a sea of inequity,” he explained.
UHN began with its list of 100 patients of no fixed address who used hospital services most frequently, cross-referenced it with the City of Toronto’s list of people who had engaged with the shelter system or a street outreach team, then approached prospective tenants in hospital or sought them out in encampments. Three people on the list died before Dunn House could open its doors.
Once tenants are settled in, academic researchers will study the project to see if it improves residents’ health, reduces their use of the medical system or saves money.
Eric Latimer, a professor of psychiatry at McGill University who will be part of the evaluation team, said that if past research is any guide, savings for taxpayers in health and social services for the 51 residents of Dunn House won’t fully offset the cost of putting a permanent roof over their heads.
“But the health care sector does a tremendous number of interventions that do not save money,” he said. “If you do a hip replacement on a person who’s retired, you’re not going to save any money. You’re going to improve their quality of life.”