[homeles_ot-l] FW: [cathycrowenews] November 2007 Newsletter
Lynne Browne
lbrowne at ysb.on.ca
Tue Nov 6 14:16:02 EST 2007
You may find Cathy’s “Emerging Hotspots” a useful overview in 2. The United
Nations is a Witness to “Our Katrina”
1. Shelters versus Housing. The deserving and undeserving.
2. Charity instead of publicly funded programs.
3. Growing intolerance, discrimination and hate in Canada towards the
homeless.
4. Two-tiered health care.
5. Deaths
6. Inhumane and unhealthy shelter conditions.
Lynne
Lynne Browne
Coordinator, Alliance to End Homelessness
147 Besserer Street, Ottawa ON K1N 6A7
613-241-7913 x 205, lbrowne at ysb.on.ca
www.endhomelessnessottawa.ca
_____
From: Crowe News [mailto:crowenews at tdrc.net]
Sent: November 6, 2007 1:48 PM
To: cathycrowenews at povnet.org
Subject: [cathycrowenews] November 2007 Newsletter
Newsletter # 39 ~ November 2007
Dear Subscribers,
Below is the thirty ninth edition of Cathy Crowe's monthly newsletter. This
is a great resource for individuals who care about homelessness and housing,
health and other social issues.
You can also view Cathy's newsletters on her website at:
HYPERLINK "http://tdrc.net/index.php?page=newsletter"
\nhttp://tdrc.net/index.php?page=newsletter.
Further information about subscribing to the newsletter is found below. I
want to hear from you - about the newsletter, about things that are
happening in the homelessness sector (what a sad term!), and about good
things which will provide inspiration for all of us.
*************************************************************
1. Sherbourne Health Centre Opens Infirmary
by Pat Larson, Nurse Practitioner, Sherbourne Health Centre
2. The United Nations is a Witness to “Our Katrina”
3. Housing Not War
The slogan ‘Think globally, act locally’ has never been more important. This
newsletter begins by introducing my friend and nursing colleague Pat Larson,
who describes the innovative work being done at the local level, at the
Sherbourne Health Centre’s Infirmary for homeless people in Toronto.
Secondly, the United Nations recently paid Canada a visit, with the Special
Rapporteur on Adequate Housing Miloon Kothari witnessing firsthand the
crisis of homelessness in communities across the country. I met with Miloon
Kothari and I share with you my presentation to him. Finally, I first
became an activist during a much earlier peace movement and now I’m finding
it critical to confront Canada’s growing financial investment in militarism
and the war in Afghanistan.
1. Sherbourne Health Centre Opens Infirmary
by Pat Larson, Nurse Practitioner, Sherbourne Health Centre
When Cathy came to ask me if I would provide a guest article for the Cathy
Crowe newsletter, I had just returned from a short sick leave. As it turns
out, so had Cathy. We shared our stories (remarkably similar) of our
experiences with a particularly virulent form of infection and our contact
with health care providers. We each noted having felt exhausted which
easily led to a discussion of the Sherbourne Health Centre Infirmary program
and its role in the lives of people who are homeless, a topic that has been
on my mind in the past few years.
Before I get on to that topic, I want to “place” myself. Like Cathy, I have
a nursing background; for about 15 years I have been a nurse practitioner in
Toronto, working with people who are marginalized, often who are homeless.
As a nurse, Cathy singularly stands out among us as a tireless advocate and
activist. While I occasionally delve into the world of activism, my nursing
work has tended to focus on the front-line aspects of health care. Over the
years I have provided nursing care in drop-ins, rooming houses, boarding
homes, shelters, under bridges, in ravines, near to train tracks and in
parks and abandoned buildings and cars. These experiences have brought me
face to face with the daily issues of people who are homeless, especially
with people's illnesses, problems and the quest for caring solutions. It
seemed a natural trajectory to join Alice Broughton (the Infirmary’s
manager) in the development of Canada's first non shelter-based infirmary at
Sherbourne Health Centre.
Infirmary or Respite Care
Perhaps I should say a word about infirmary or “respite” care, as it is
known in the United States. Many large American cities have a long history
of respite programs for people who are homeless and ill. Most are
“virtual”, meaning that a certain number (or percentage) of beds in a
shelter are allocated to individuals who are sick, with health care agencies
or providers offering needed care. In 2005, a large study of American
respite programs identified different models of respite care; shelter based,
supportive housing-based and community stand-alone. Some
infirmaries/respite programs are long-term, providing health care and
support for many years, while others offer short-term health care support.
American literature on respite programs describe the circumstances leading
to their necessity including an increasingly impoverished and marginalized
“underclass”, a shortage of affordable housing in medium and large U.S
cities and a lack of health care eligibility for millions of Americans. In
many states, whatever social safety net existed has been eroded. Sound
familiar? Many of the same circumstances have been created here in Canada.
Ontario along with other Canadian provinces are recording increasing levels
of homelessness, housing inaffordability, welfare or social system cuts, and
health care system changes resulting in people being moved out of hospitals
sooner and increasing acuity (illness) in the community.
In Ontario, the idea of infirmary care was formally introduced in 1999, when
the HYPERLINK "http://www.toronto.ca/pdf/homeless_action.pdf" \n‘Anne Golden
Report’ was released recommending a short-term inpatient program in the
urban core of Toronto, with a focus on providing a site for “home health
care” to homeless individuals.
Sherbourne Health Centre was identified as well-situated to develop such a
program. In the meantime, both Seaton House in Toronto, and the Ottawa
Inner City Health program developed infirmary programs. Seaton House's
Infirmary is located within its shelter facility and provides much needed
health support for men while Ottawa's Infirmary program is multi-site and
includes both shelters and a palliative care site. Both programs have the
option of long-term health care and support as they are linked to or located
within the shelter or residential care system.
Sherbourne Health Centre Infirmary
In April 2007, Sherbourne Health Centre’s Infirmary opened to provide
24-hour per day health care for homeless people of all genders to recuperate
from an illness or injury. The facility is autonomous and community based,
situated near Allan Gardens in the newly renovated Sherbourne Health Centre
(formerly the Central Hospital site of Wellesley-Central Hospital).
Typically admissions range from a few days to 3 weeks, with an average of 7
to 10 days. The program provides short-term health care support, similar to
what is provided in people’s homes when they are ill or injured. Referrals
are accepted from hospitals and community agencies and from individuals who
wish to self-refer. Eligibility criteria include being homeless, having a
physical health problem such as an illness or injury so that a short-term
stay (days or a few weeks) in a non-acute care setting is required. While
many people who come to the infirmary have mental health or addiction issues
neither of these can be the main reason for requesting admission.
When the Infirmary program is fully funded, the capacity will be 20 clients
or beds. Twenty-four hour care is provided by a Community Health Worker
(CHW) and a Registered Nurse (RN), with a Case Manager (CM), Nurse
Practitioner, consulting MD, Program Manager and Program Assistant providing
administrative support, health care consultation and continuity of care so
that realistic care plans are developed with clients.
The Infirmary site itself as well as the practices and programming are
intended to be respectful, restful, recuperative and realistic. Harm
reduction is a central feature of care. Partnerships exist with a number of
dedicated individuals and agencies – and are critical for providing health
care, emotional and spiritual support, housing access, welfare system
access to name but a few.
Our Initial Experience
Thus far, the range of issues that people have had are varied and include
wound infections or cellulitis, pneumonia, broken bones, cardiac problems,
liver problems, recuperation following childbirth, major surgery or during
cancer treatment, and for HIV/AIDs care. There have been admissions
pre-surgically to help individuals prepare for surgery or testing and
following procedures such as colonoscopy or cataract surgery.
While there have been individuals who have had fairly straightforward health
issues such as broken bones, the majority have had complicated health and
medical problems. Many individuals have barriers to access; some have not
had active health insurance (OHIP) while others have been without needed
identification (ID) or drug coverage, despite being in a financial situation
where the need for drug access would seem logical.
We believe we are making a positive contribution for people who are homeless
in Toronto, which seems to be borne out in comments from clients and
referees. Feedback has been largely positive, as people have recovered to
the point where they have been able to return to independence. There have
also been bittersweet moments as individuals reflect on the difficulty of
leaving what they describe as a nurturing and healthy environment and the
dedicated, caring staff. Some have described the opportunity of healing and
rest following experiences of chronic sleeplessness in the shelter system as
nothing short of miraculous. There have been moments of anger and
frustration as individuals have left knowing they are returning to the
street, a shelter or substandard housing. Similar feelings have been
expressed by infirmary staff when clients have had to return to
homelessness, despite diligent effort to assist them to access housing or
set in motion needed identification, welfare benefits and health care.
Emerging Issues and Challenges
Recently, the 2007 Street Health Report (HYPERLINK
"http://www.streethealth.ca" \nwww.streethealth.ca) was released,
chronicling the worsening conditions for people who are homeless, the
significant health disparities and barriers to health care system access.
Our experience in the first six months of the Sherbourne Health Centre
Infirmary is consistent with the findings of this study, pointing to the
barriers to health care system access as well as the complex health care
needs of many homeless people.
We anticipated having a steady but small number of referrals for people who
are homeless and living with HIV and AIDs. However, nothing prepared us for
the overwhelming number of referrals and their complexity, coupled with the
lack of community and housing resources, especially those with a harm
reduction focus. While we realized that there would be referrals for mental
health as the main constituent, again we find ourselves grappling daily with
the lack of options for people in acute mental health distress, especially
when their lives are compounded by homelessness, poverty and at times,
addictions. Addiction care resources are also difficult for people who are
homeless to access, as inpatient detoxification or withdrawal management
programs have gradually been replaced by “home” based programs. Quite a
problem, when you are homeless.
The lack of inpatient resources and the need for hospitals to discharge
patients quickly has also been evident. Discharge planners, in very
difficult “squeezes” work hard to find solutions and possibilities when
people have few resources and options. We hear comments as to the moral or
ethical dilemmas that hospital staff face when discharging clients to
situations that are likely to result in a re-admission in the near-future.
On a daily basis we are asked by staff in hospitals and community health
care agencies to help find ways for their vulnerable housed individuals to
access support and care when they are ill. As a nurse of a “certain age”,
the notion of the hospital “social admission” is etched in my brain;
admissions equally are as much about recognizing that many people lack
support in their lives as about preventing complications or a future
re-admission.
As the Street Health Report notes, it seems that the Sherbourne Health
Centre Infirmary program is an idea whose time has come. I have no doubt
that we will be able to provide much needed relief, recuperation and a
chance to heal for many people who are homeless. We will also add a further
credible source of information as to health care system deficiencies and
stress points, which may prove invaluable as LHINs (Local Health Integration
Networks in Ontario) actively pursue ways to weave our system into a more
full, radiant and connected network for all Ontarians, including those who
are vulnerable and marginalized.
The question has been asked by many before me….Do we as a society have the
collective will to develop real and lasting solutions, such as adequate,
supportive, affordable housing and health and social support systems which
truly support each of us?
For more information go to HYPERLINK "http://www.sherbourne.on.ca/"
\nwww.sherbourne.on.ca
Photo credit: Lisa Huang
2. The United Nations is a Witness to “Our Katrina”
In October Miloon Kothari, UN Special Rapporteur on the Right to Adequate
Housing crossed Canada to hear testimony and examine Canada’s realization of
the right to adequate housing. The following is my presentation to him when
he came to Toronto. Cathy
Homelessness was first HYPERLINK
"http://tdrc.net/resources/public/Report-98-TDRC.htm" \ndeclared a national
disaster in 1998 by the Toronto Disaster Relief Committee (TDRC). The
declaration was supported by hundreds of organizations and by city and
regional levels of government across the country. More importantly, the
appeal for emergency disaster relief monies to alleviate homelessness and
for government funds for affordable housing was welcomed by homeless people.
We believed the widespread acceptance of the disaster declaration, the
abundant research and evidence, the sheer numbers of people in shelters and
living on the street in big cities, and more prominent homelessness in rural
communities, that aid would come from the government. 9 years later
homelessness has increased dramatically and the severity of the state of
homelessness has worsened for the men, women and children who are left
homeless for increasingly longer periods of time. In addition, the problems
associated with homelessness have been compounded by senior levels of
government with policies and practices that emphasize privatization, a
diminished role for government and deeper cuts to social spending.
When so many people are unhoused we have a community-wide crisis. When the
numbers are allowed to grow and when all reasonable analyses point to even
more homeless people each and every day, we have a disaster – a situation
that requires emergency relief and prevention measures – in the same way as
when a flood or a storm leaves people homeless. 9 years later, this is our
Katrina. Not unlike the hurricane victims, people homeless in Canada are
left languishing in insufferable conditions on the street and in shelters by
all levels of government, in particular the succession of federal
governments which have resisted the reintroduction of a national affordable
housing program.
The following is a brief summary of what I refer to as ‘hotspots’ - new and
emerging threats that I am witnessing in Toronto and across the country.
These hotspots are evident in both large and medium size Canadian cities
including Vancouver, Calgary, Edmonton, Regina, Winnipeg, Kenora, Thunder
Bay, Sault Ste. Marie, Sudbury, Sarnia, Hamilton, Ottawa, Kingston and
Halifax.
Emerging Hotspots
1. Shelters versus Housing. The deserving and undeserving. Evidence
suggests that homelessness is growing across the country while affordable
housing is rarely being built. In most of the communities I have visited,
with diminished resources from the provincial and federal governments and
the pressures of NIMBYism (Not In My Back Yard), municipalities are forced
into debates about shelter instead of housing. Many Canadian cities are
inviting experts like Philip Mangano from the United States Interagency
Council on Homelessness to advise Canadians on how to create a ‘business’
plan to end homelessness. His prescription, and it’s very questionable as
to whether it has worked in the United States, diverts energies away from
advocating for more senior level government responsibility for housing to an
almost ‘tough love’ municipal approach to homelessness, by targeting the
most visible what he calls the chronically homeless. This usually results
in programs such as ‘Streets into Homes’ in Toronto, or anti-panhandling
campaigns or punitive by-laws which criminalize homelessness. This is the
dominate discussion in cities like Calgary and Toronto, instead of focusing
on real and long-term solutions. One of my colleagues recently showed me
tickets totaling $2,160 given by Toronto police to one homeless woman over
several months.
In addition, writers like Malcolm Gladwell, famous for the ‘Million Dollar
Murray’ story published in the New York Times, have also influenced Canadian
public policy resulting in the targeting of resources towards the more
obvious ‘street homeless’, and the development of plans that determine who
is deserving and not deserving of city funding or of being housed. A
notable example is in Toronto where street outreach agencies have been
de-funded for their work in the provision of ‘survival’ supplies (blankets,
sleeping bags and hot food) to those living in absolute homelessness. In
Calgary, families languish in a temporary emergency (and volunteer driven)
shelter system and are forced to move nightly from church basement to church
basement while resources are diverted to deal with the single adult
‘problem’.
2. Charity instead of publicly funded programs. Since 1998, Canada has
witnessed an unprecedented outpouring of care by the faith and volunteer
sectors in response to homelessness. However, numerous municipalities now
rely on the dozens of volunteer and faith based programs to provide
congregate style emergency shelter and other services in the winter months.
The reduction of federal and provincial contributions toward social programs
means that the volunteer sector replaces adequately funded organizations and
properly trained staff. With increasingly complex medical and social needs,
this is an inadequate and dangerous response for our growing homeless
population. We would not want our health care program Medicare to be
operated in this fashion.
3. Growing intolerance, discrimination and hate in Canada towards the
homeless. I remember the year we saw our first homeless murder in Toronto.
It was the first in a succession of murders and it occurred during a period
of time when the police chief, the mayor and certain right wing media were
using derogatory and discriminatory language to describe squeegee youth and
homeless people sleeping outside. I did not expect to see brutal attacks on
homeless people in our Canadian cities. I assumed that was an American
phenomenon. But it has now happened in all of our cities including Calgary,
Edmonton and Toronto. Most notably, Paul Croutch, an elderly man sleeping
outside in a Toronto park who was beaten to death in his sleeping bag. Three
army reservists have been charged with his murder.
It still surprises me to this day, given the education of our journalists,
that homeless people can be described in mainstream media as vagrants, bums,
drifters, gangrene, hard core, and street people. Media continue to
perpetuate this ignorance. It is still shocking that the title of an article
on homelessness in the Canadian news magazine MacLean’s was ‘Canada’s
gangrene’.
4. Two-tiered health care. Despite a national health program in Canada,
many health care providers treating homeless people point out that as long
as we have the need for mobile outreach programs and nurses with knapsacks
filled with duct tape, socks, underwear and other health supplies, visiting
people in ravines, store doorways, parks and in shelters, we in fact have a
two-tier health care system. The need for palliative care services for the
underhoused has now reached a ‘code red’ state of emergency.
5. Deaths. There is a well documented rising death rate amongst our
homeless and poor populations. The Homeless Memorial outside the Church of
the Holy Trinity in downtown Toronto has now well over 500 names. Health
and social justice advocates have been unable to convince any level of
government or any Office of the Chief Coroner to take responsibility for
tracking and monitoring the growing number of homeless deaths.
6. Inhumane and unhealthy shelter conditions. Poor health and homelessness
go hand in hand. However, in recent years homeless people have had to face
new and emerging health threats, worsened by the situation of congregate
shelter living, forced nightly migration in ‘Out of the Cold’ volunteer
style programs and day and night shelters that have been unable to meet some
of the basic pre-requisites outlined by the United Nations Standards for
Refugee Camps. For example, overcrowding often equates to people sleeping on
mats, in hallways or in a chair all night. Washroom, hand washing and
shower facilities are totally inadequate. These conditions have been ripe
for bedbug infestations which have now hit most major cities. Several
tuberculosis outbreaks have led to homeless deaths. We are now seeing new
and emerging threats of viruses such as Norwalk and ‘bugs’ like MRSA.
Despite Toronto’s experience with SARS, our City continues to rely on the
volunteer ‘Out of the Cold’ program, which forces homeless people to move
nightly from church basement to church basement in the winter months –
surely a risky endeavour should SARS, Norwalk or TB present itself and we
require contact tracing, medical follow-up or prophylaxis.
Federal spending diverted away from social programs like housing
While funds have not been made available for an affordable housing program,
the federal government has recently announced a $13.8 billion surplus. The
Rideau Institute, an Ottawa-based organization reported that the Department
of National Defense estimates that Canada’s military spending will reach
$18.2 billion in 2007-8, the highest amount since the Second World War. The
military budget now represents 8.5% of all federal spending. This flies in
the face of housing advocates and their long time demand for an additional
1% of the federal budget per year ($2 billion) to be allocated towards a new
national affordable housing program and an end to homelessness.
3. Housing Not War
At the October 27th pan-Canadian Day of Action against war in Afghanistan
the Toronto Disaster Relief Committee launched a Housing Not War campaign.
Based on similar organizing methods used when TDRC declared homelessness a
national disaster in 1998, TDRC spokesperson Beric German read the following
declaration and asked people to sign on.
The Declaration
I support the demand that the federal government implement a
Housing Not War strategy. Canada is at war in Afghanistan.
Homelessness remains a national disaster in Canada.
Canadian troops should come home, and funding directed
towards war and militarism should go towards housing and
other peaceful purposes.
As homelessness worsens in Canada, the federal government
can no longer justify spending untold billions of dollars on war.
We call for the 1% solution, which would double current federal
spending on social housing to $4 billion per year.
Housing Not War campaign materials will be on the HYPERLINK
"http://tdrc.net" \nTCRC website soon.
The declaration will be used across the country to collect names that will
be taken to municipal councils asking them to pass resolutions supporting
the declaration. It is critical to build momentum. Housing Not War.
Childcare Not War. Education Not War.
HYPERLINK "http://storywordspics.blogspot.com/" \n
See pictures from the rally and march held in Toronto courtesy of John
Bonnar
Cathy
Thanks to Dave Meslin for layout and Bob Crocker for editing.
HYPERLINK "mid://00000022/#Back to Top"Back to Top ^
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