When Dan Shaffer turned up at the St. Michael鈥檚 Hospital emergency room, it wasn鈥檛 for a medical crisis. In his early 70s, Shaffer had been evicted from his apartment and had nowhere else to go.
ER staff tried to get him into a shelter, but couldn鈥檛. Beds, citywide, were full. They brought him to a small, warmly lit room in a side hallway, with pullout couches and reclining chairs that serve as a stopgap when someone doesn鈥檛 have a medical reason to be admitted. Staff offer food and warm clothes and add a tick to a whiteboard every time they can鈥檛 find shelter beds.
Shaffer remembers the turmoil of that night. He鈥檇 never been homeless, and was at a loss for what came next. 鈥淚鈥檝e never been in a situation where my life was taken out of control,鈥 he said.
Hospital staff called the city鈥檚 shelter intake line over and over that night. By the next day, they found one room at a north 海角社区官网shelter hotel. Over the ensuing year, as Shaffer feared the remainder of his life would be stuck in the shelter system, a new outreach team from the hospital鈥檚 emergency room worked with him to find long-term, stable housing.
This is the reality inside the hallways of St. Michael鈥檚; while 海角社区官网hospitals have struggled with broader pressures on the health care system, their ERs are also on the front lines of the city鈥檚 mounting homelessness crisis. Carolyn Snider, the emergency room chief at St. Michael鈥檚, says more than 4,500 homeless Torontonians came through the doors of the downtown trauma centre in the last year, about 15 per cent of them simply because there were no alternative shelter options.
This crisis has led the hospital to try a new approach over the last year and a half 鈥 an emergency outreach team, funded by private donors, that connects ER patients with outreach workers who can stay in contact after patients leave the hospital. They can offer help with shelter or housing, but also take a long-term approach by connecting that person with primary health care, mental health and addiction support, legal assistance and food banks 鈥 all with hope of clipping the cycles that bring the same patients to their door repeatedly.
When hospital workers call the city鈥檚 shelter line, they鈥檙e most often told to try again later. Their success rate for finding beds hit a low of less than five per cent in September. While the odds have improved slightly, ER staff 鈥 social workers, community support workers, and their new outreach workers 鈥 still only secured beds less than 20 per cent of the time in January.
Snider sounded the alarm at city hall this month, sharing a message she said was backed by the ER chiefs of St. Joseph鈥檚 Health Centre, University Health Network, Sinai Health and the Hospital for Sick Children. As of 7:30 that morning, on Jan. 11, St. Michael鈥檚 had 16 people battling homelessness waiting in the ER. Out of desperation, she later told the Star their team had been handing out backpacks with gift cards to 24-hour food services, hoping it would at least allow people to stay warm.
Meanwhile, the health system at large has been under wider strain.
鈥淟ast night, despite frankly having some of the best numbers in the city, we had seven patients in off-load for EMS. We had 17 patients waiting for acute care beds. And we had wait times of over 10 hours,鈥 Snider said that day. 鈥淲e are trying to lead teams to face challenges like going up a mountain in an avalanche.鈥
When someone doesn鈥檛 know where they鈥檒l sleep the following night, staff know their other health needs can fall to the wayside 鈥 and those problems can compound. Rissa Raposo-Ferreira, an emergency room social worker, recalled a patient who came to the ER with an infected finger wound. Without being cleaned and bandaged, the infection could have become life-threatening, she said. Through the outreach program, her colleague 鈥 outreach worker LP Pavey 鈥 took that patient to their followup appointments and sat with them through their care.
Their work extends well beyond shelter, housing and appointments. Hospital outreach worker Zahra Tahil rattled through a much longer list of supports they鈥檝e offered, from aid with immigration and settlement services to helping someone entangled in the justice system.
鈥淪ome people need support with legal issues, so making sure they鈥檙e able to gain access to a lawyer, making sure they are able to have pathways for mental health diversion court, and the supports that are needed for someone to continue to manage those stresses,鈥 Tahil said. 鈥淵our future housing, your future employment 鈥 everything kind of depends on it.鈥
Helping patients regain their footing isn鈥檛 often a simple, linear path. That鈥檚 been the reality for Nik, a St. Michael鈥檚 patient whose full name the Star agreed not to publish as he works towards recovery from alcohol and street drug use. He was first connected with the outreach team after landing in the ER due to an overdose. He was living at the time unsheltered, staying up as late as he could muster at night before finally crashing under the seats of a TTC subway train or outside on a bench.
After starting to use substances as a teenager, he first sought professional treatment at age 23, but the road since has been rocky. He鈥檇 fall back into drinking, and when he drank too much, he鈥檇 become angry and get into fights that landed him in jail. His relationship with his family had deteriorated, and he felt friends grow weary of him crashing at their homes.
鈥淎s I got older, I always wanted to get clean again,鈥 the 29-year-old said. The outreach team helped him find shelter after his overdose, but it wasn鈥檛 a fix-all, and last summer, he ended up in jail. But he came out on the other side with a date to start a 28-day treatment program.
鈥淚鈥檓 almost two months clean now,鈥 Nik said. He鈥檚 currently staying at a transitional, sober-living facility. Working with the hospital鈥檚 outreach team, the next challenge is getting onto the province鈥檚 disability support program and finding housing where he can continue his recovery.
He believes there are systemic factors that block people鈥檚 ability to climb out of homelessness when battling other challenges like addiction. One is access to treatment, with long waits between someone exiting a detox facility and getting sustained professional help. The other is more intangible 鈥 a lack of long-term emotional support through the ups and downs.
鈥淚鈥檇 been in these kinds of situations before, whether it was mental health or an overdose itself, and then I would just be kicked out (of the ER),鈥 Nik said. Through the new emergency outreach team model, he felt a deeper sense of care, and it imbued him with faith that recovery was still possible and within reach. 鈥淭hey were kind of there for me when no one was.鈥
The reality, though, is the hospital can鈥檛 catch everyone. With its current staffing, funded by donations, the team has connected with more than 200 patients in a year and a half 鈥 but many more people are turning up in their ER without stable housing. Too often, Raposo-Ferreira said she had to discharge a patient with little more than a referral to the shelter intake centre.
鈥淚t鈥檚 sort of end-of-the-line. If you鈥檙e not getting what you need in the community, or it鈥檚 becoming apparent that you have complex health or are living rough, we have to kind of pick who we work with. There鈥檚 a little bit of triage,鈥 Pavey acknowledged. Snider, the ER chief, said the sustainability of the program hinges on it getting longer-term 鈥渋nstitutional鈥 funding.
That often means government money, which requires them to produce hard evidence about the project鈥檚 outcomes. They鈥檙e now in an evaluation stage, looking at indicators from patient feedback to the frequency with which patients returned to the ER compared to nonparticipants.
Budgetary concerns are a real constraint, said Raposo-Ferreira, the social worker. Their team used to be able to give people struggling with homelessness cellphones, which offered a simple prepaid talk and text plan for a few months, in order for hospital workers to establish a constant line of communication. That was on pause due to lack of funding, she said.
During Shaffer鈥檚 time in the shelter system, the 75-year-old said he saw people so far adrift from supports that they simply didn鈥檛 see an exit route. He was the outlier. After a year of communication with the St. Michael鈥檚 outreach team, Pavey told him they鈥檇 found a small, bright, subsidized apartment in east-end 海角社区官网鈥 and two weeks ago, it officially became his home.
鈥淵ou can鈥檛 be alone,鈥 Shaffer said, reflecting on the tumultuous year. 鈥淵ou can鈥檛 have someone who says, 鈥榞ood luck on your own, hope you can swim.鈥 You have to believe someone is in your corner, someone is holding your hand 鈥 Someone is going to walk with you all the way.鈥
Correction 鈥 Jan. 31, 2023: Zahra Tahil is an outreach worker at St. Michael鈥檚 Hospital. A previous version of this article said Tahil is a social worker.
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