HEALTH SERVICES & HOMELESSNESS
HEALTH SERVICES & HOMELESSNESS
QUESTIONNAIRESEPTEMBER 28, 2011 – NOVEMBER 11, 2011
Submitted by Jane Parkinson, Facilitator
December 2011
HEALTH SERVICES & HOMELESSNESS
FINAL SUMMARY REPORT (V1)
Executive Summary
Ryunosuke Satoro’s statement aptly reflects the underlying premise of the Health Service and Homelessness Project. Key London leaders formed a partnership with health service providers as well as individuals who have experienced homelessness. They began with the belief that a collaborative effort is an imperative for successful change. To address the magnitude of the issues associated with creating a system to meet the core health service needs of individuals and families experiencing homelessness in London, Ontario requires the engagement and effort of many. The commitment to collaborate was what inspired the formation of an ad hoc working group of five partners gratefully supported by London Community Foundation and Ashley Leanne Powell Fund.
The Health Services and Homelessness Project involved bringing together health and other service providers dedicated to working with individuals and families experiencing homelessness. It was agreed from the beginning that, before applying solutions, it was important to engage people who have directly experienced homelessness and to build a deep understanding of the issues they experience in accessing core health services. Further there was overwhelming consensus to better understand the current state of care and services from the providers’ perspective; building on their successes and minimizing barriers would serve as the basis for future improvement in the health services provided to those experiencing homelessness.
This summary provides a collation of the important ideas generated from two well-orchestrated sessions (held on September 28, 2011 and November 11, 2011), and forms the basis for the collaborative work that lies ahead. This summary includes data collected from participants during these two sessions. The data is largely unedited so as to preserve the integrity of the commentary. It is expected that a working group will be established with the leadership of Dr. Abe Oudshoorn to review this information. This report, combined with other existing research and planning documents, will lead to the identification of solutions and a plan to apply them system-wide. Again, those involved in the future will take a collaborative approach to health service system improvements, in the planning, implementation and evaluation phases to address the needs of people experiencing homelessness.
Partners and Purpose
This collaborative project was intended to be the initial step in a long-term process of improving health services for individuals and families experiencing homelessness. Strong commitment to the effort was demonstrated and the process evolved as partners clarified the purpose and outcomes.
PARTNERS / PROJECT PURPOSEArthur Labatt Family School of Nursing, Faculty of Health Sciences, University of Western Ontario
(Abe Oudshoorn) / To provide an opportunity for input and engagement in a process intended to increase understanding of health services currently provided to individuals and families experiencing homelessness.
City of London Community Services, London CAReS
(Jan Richardson)
London InterCommunity Health Centre
(Pam Murray) / OUTCOME
Middlesex London Health Unit, Communicable Diseases
(Cathie Walker & Rhonda Brittan ) / A snapshot of the “as is” state. To capture what is happening now; to understand the strengths, challenges and opportunities before implementing solutions.
Regional HIV/AIDS Connection(Sheila Coad)
Project Scope and Definitions
What do we mean by health?
While recognizing the importance of all the determinants of health, such as food, clothing, transportation, education and shelter, the scope of this effort was focused on what might be best described as direct health services. This component of the project was intended to increase understanding of the health services which are sometimes considered to be more related to the “medical” side of health and encompass primary care, mental health, and acute care. This specific focus was not intended to negate the importance of all determinants of health, but rather to refine and deepen understanding of the current state of these services and the unique experiences of those at greatest risk.
What do we mean by homelessness?
Homelessness is a broad concept and often includes individuals and families who experience homelessness once in a lifetime as well as those who are under-housed and at risk of homelessness, in addition to those who have no fixed address or are commonly referred to as “couch surfing”. The focus of this project was limited to understanding the health services needs of those who are at high risk and experiencing what may be referred to as ”absolute homelessness”. This project was seeking to understand the health service needs of individuals and families who are most street involved, sleeping “rough” and residing in shelters.
Process
The Health Services and Homelessness Project started by gathering information using a questionnaire which was completed by 100 individuals who have lived experiences of homelessness (See Appendix A). The responses to the questionnaire were useful in organizing two main events designed to encourage maximum engagement and information exchange. The first event, a half-day interactive session was held on September 28, 2011 and was attended by over 60 health care and service providers (See Appendix B), and included all of the organizations identified in the questionnaire plus several others subsequently identified.
The second meeting, a full day session, was held on November 11, 2011 and included nearly 100 individuals who have lived experience of homelessness (See Appendix C). Both sessions were designed and facilitated with an external consultant, in collaboration with expert partners, skilled community service providers and highly committed individuals who have lived experience of homelessness.
This process was designed to be very interactive and to encourage forthright information sharing. From the feedback gained, it is clear that the group was highly successful in this regard.
Closing
The input from these sessions will be shared with providers who participated in the process and offers tremendous potential for developing a system map. A working group will be established to review the information and ultimately, to identify an action plan to improve access to health care services and health outcomes. Special thanks is extended to the partners and facilitators from a variety of service organizations as well as those who were considered to be peers of those with lived experience of homelessness. As a result of the involvement of many this process was a success.
addendum 2012: Moving forward
There are three clear challenges that were brought forward again and again in this work: 1) Communication between various agencies and health care providers; 2) Health care that goes to where people are; and 3) Care that bridges the gap between hospital or long-term care and shelter or affordable housing.
1) Communication
As can be seen from the data, dozens of sites of care were represented in the consultation, and service users themselves identified twelve agencies or types of agencies where they accessed care, including hospitals and walk-in clinics which represent multiple sites. There is a lot of health care being provided to people experiencing homelessness in London. However, it was clear from the service provider perspective that quality of care is being jeopardized in contexts where service providers have limited communication. It was clear from providers that they are interested in communicating, but in many situations are simply unaware that their patients are accessing other services, or if so, what they are accessing. Many of the service users admitted to using multiple primary providers, accessing whatever is convenient or whoever is most likely to address their immediate need.
Moving forward: Ideally, all service providers providing health care to people experiencing homelessness would either use a common electronic health record, or electronic health records that communicate well with each other, or have agreements in place to provide reports to each other on patient encounters.
2) Mobile Health Care
Research has shown that the best health care outcomes with people experiencing homelessness come when care goes to where people are. Even the lowest barrier care with the widest open doors does not lead to health outcomes equivalent to the general population, due to the hierarchy of needs limited service seeking, and transportation challenges. Currently, there is some limited movement of health care providers amongst agencies, for example CMHA workers going to different sites, or a nurse practitioner from InterCommunity Health going to a shelter. Some use this more as a model, such as the Middlesex London Health Unit, but for most it happens based on relationships between agencies. Overall, there is no overall plan for access to primary health care in all sites where people are residing/accessing services, and no care that goes outside of service walls other than that provided by Sanctuary London and London CAReS (more social care than health care).
Moving Forward: It was clear from service providers is that the last thing London needs is just another agency providing another health service. Rather, an existing agency with skill in this sector, access to electronic charting, and access to medical supplies should be provided with additional FTEs to provide ‘feet on the street’ health care. This would include going into established agencies, as well as spaces where people spend their time. Particularly appropriate agencies to do so would include the Centre of Hope Family Health Team or London InterCommunity Health Centre. These services would also be best provided outside of traditional agencies hours, such as 3pm-11pm.
3) Respite Care
Shelters, long-term care agencies, and those who support individuals in affordable housing have all spoken to challenges of seeing residents with complex medical needs (and often concurrent mental health and addiction challenges) in their facilities without having the skills and staff to support them. As can be expected from the research literature, this leads to poor health outcomes and the use of most-expensive modes of health care services. London is in need of bed-based health care for people with complex medical needs who aren’t quite ill enough for hospital. These services must have the highest possible level of tolerance around difficult behaviours and substance use, as these are the individuals who tend to have limited access to other equivalent services.
Moving Forward: Ideally, this respite or infirmary style service will be provided by an existing agency, rather than starting from scratch, and will be very ‘high tolerance’. The most obvious mode to accomplish this would be to resource John Gordon Home to add a second site, and staff it with a higher level of health care services (ie. nurse practitioner as a minimum). John Gordon Home has experience in this type of care, and a secondary site would allow them to move from high tolerance to very high tolerance.
HEALTH SERVICES & HOMELESSNESSAPPENDIX A / QUESTIONNAIRE
Item 1: Health Care in London Survey 1
item 2: Health Care In London Survey results 2
Item 1: Health Care in London Survey
You can also do this online at: http://www.surveymonkey.com/s/L92V6DL
- Where are all the places you go to for health care in London?
- What kind of health care issues do you get help for?
- What has helped with your health care in London?
- What is frustrating about health care in London?
- What kind of health care are you looking for?
Please Return To Christy Tran:
For more info go to: http://www.londonhon.ca/?page_id=114
item 2: Health Care In London Survey results
Data is presented in raw form, and categories of data are not mutually exclusive. Data will be distilled by the already established working group for 2012.
1. Where are all the places you go to for health care in London?
Respnses / TotalCentre of Hope / 10
Family Doctor / 15
Hosptial (University Hospital, St. Joeseph’s HC, Victoria Hospital) / 58
Intercommunity / 20
London Health Centre / 5
London psychiatric hospital / 1
Men's Mission / 2
Methadone Clinics / 6
Middlesex London Health Unit / 3
None / 3
RHMC / 1
Street Scape / 1
Walk-in clinics / 32
2. What kind of health care issues do you get help for?
Responses / TotalAddictions help/ Detox / 16
Allergies, Colds, Flu, acute sickness / 14
Asthma / 7
Blood related problems (one surveyed bleeding issues") / 8
Cardiac / 1
Chiropractic care/ Bone related issues / 13
Counselling / 0
Dental / 2
Dermatology / 1
Diabetes / 4
Dialysis / 2
Emergency / 3
Gastric problems / 4
High blood pressure/ High cholesterol / 8
Immune disorders / 3
Mental Health (PTSD, depression, bi-polar, etc.) / 25
Neurologlogy (eg sleep disorders) / 5
(Responses for Question 2 continue on next page)
None / 1
Physiotherapy / 5
Prescription / 4
Sexual Health / 0
Shaking, trembling, twitches / 6
Various / 3
Women's Health (Ultrasounds, pre/post natal care, etc.) / 5
Wound, infection, injury care / 10
3. What has helped you with your health care in London?
Responses / TotalAdvice and suggestions / 3
Ambulance/ paramedics / 3
ER / 1
Getting proper medications / 13
Getting proper procedures done (xrays, blood tests) / 4
Having the available resources (EG: doctor, SW, agencies) / 20
Helpful staff and doctors / 4
My doctor / 6
Not much / 1
Nothing / 12
OHIP / 14
Transportation and accessibility / 6
Social benefits / 6
4. What is frustrating about health care in London?
Responses / TotalDistance of services and where it's situated / 5
Everything / 2
Having good care / 1
I don't have anywhere to go / 1
Lack of empathy or sympathy from doctors and/or staff / 2
Lack of knowledge on where to get services / 0
Not getting desired meds / 2
Not getting the proper diagnosis / 1
Nothing / 19
Shortage of doctors (trouble finding a doctor) / 25
Wait times / 41
5. What kind of health care are you looking for?
Responses / TotalAll inclusive health care / 10
Counselling of any sort / 13
Dental / 9
Getting a stable doctor / 22
Having good quality health care (fast, efficient, nonjudgemental) / 20
Health care that is long term/permanent / 1
More prescription coverage / 2
None / 17
Physiotherapy / 8
Psychiatric help / 4
Readily available emergency treatment / 1
Reduce the wait time / 4
Rehab / 2
Vision / 1
HEALTH SERVICES & HOMELESSNESS
APPENDIX B / QUESTIONNAIRE
Overview OF September 28, 2011 with Service Providers 1