For this post I have had the immense opportunity to work with my academic peer, Natalie Kr to explore how two different Canadian cities are working to better serve individuals experiencing homelessness at time of hospital discharge.
Statistical data as taken from Homeless Hub (2021):
York Region Homelessness:
Found during point-in-time count on April 17th:389 (2018)
No. of unsheltered respondents: 44 (2018)
No. of sheltered respondents:221 (2018)
No. staying in provisional accommodations:124 (2018)
Percentage experiencing chronic homelessness:45% (2018)
Percentage self-identifying as LGBTQ2S+:8% (2018)
Percentage experiencing episodic homelessness:21% (2018)
Calgary Homelessness:
Highlighting complex care gaps:
In our collaborative discussion, Natalie and I were interested to note that the gaps we identified are the same for both provinces. There is no consistent discharge pathway to follow and prioritizing the discharge priorities will be follow different criteria depending on the hospital department that initiates the discharge planning (ex ER vs Post Surgical).
Care delivery gaps in discharge planning for a patient experiencing homelessness:
Discharge to the street
No follow up regarding required services
No continuity of care or shared information
If discharged to a shelter, shelter staff have limited resources/staff to help
Increased reliance on 911
Increased risk for expedited readmission
Increased pressure for Emergency or Urgent Care to access healthcare services
Showcasing innovative strategies to address the care gaps:
York Region
Continue work focused on Housing First as part of Reaching Zero (meaning that there is zero chronic homelessness). This is part of the Reaching Home: York Region Community Homelessness Plan 2019-2024 The plan focuses on coordinated access that will assist with chronic homelessness, include prevention and diversion strategies and provide different housing options.
Leverage current working groups such as Ontario Health Teams that include multiple stakeholders (community agencies, hospital and health care providers) to focus on priority populations
Pilot with local hospital, a local shelter and paramedic services that includes a shared document for the client used when arriving at the hospital and when discharged. Document will also be shared with paramedic service and shelter to keep on file. Goal is continuity of care by sharing up to date health information and discharge plans. May also include community agencies depending on consent.
One barrier regarding this pilot is regarding sharing of information (privacy concerns regarding access to personal health information).
Calgary
The provincial government of Alberta’s homelessness response strategy (2021) is focused on: Housing First; Emergency Accommodations; Strengthening Housing; Stability and Preventing Homelessness
The implementation of this strategy is essential in supporting the health care providers in the hospital setting to develop thoughtful and consistent discharge plans for patients experiencing homelessness that prioritize discharge plans and fosters accessible access to healthcare resources.
In the interim the healthcare teams rely on support from in facility resources like Social Workers to navigate the community resources including housing, emergency shelters and addressing follow up connections in the communities to ensure access to follow up healthcare and access to individualized care plan supports like mental health, and addictions.
As noted, the challenge of sharing information related to patients experiencing homelessness is the same concern in Alberta as it can create a barrier to continuity of care.
There is a project within AHS that includes consideration for patient identification to ensure that they have the information they need to be able to access services and showcase their identity. This is different from information sharing, but this project has empowered many who are experiencing homelessness.
This reinforces the need for discharge plans that include the patient identified prioritized care plan and discharge pathway.
References
Alberta Health Services, (2021). Homeless to happiness: a story from the AHS ID program. Retrieved November 17, 2021, from Homeless to Happiness – A story from the AHS ID Program - YouTube
Government of Alberta. (2021).Alberta’s homeless response. Retrieved November 17, 2021, from Alberta's homelessness response | Alberta.ca Homeless Hub, (2021). Homeless hub: Calgary. Retrieved November 17, 2021, from Calgary | The Homeless Hub
Homeless Hub. (2021). Homeless hub: York Region. Retrieved November 17, 2021, from York Region | The Homeless Hub
Homeless Hub. (2021). Reaching Home: York Region Homelessness Community Plan 2019-2024. Retrieved from:
https://www.homelesshub.ca/sites/default/files/attachments/Finalized%20Community%20Plan%20-%20York.pdf
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