Mentors: Sarah Elizabeth Innis, Street Health Community Nursing Foundation & James Read, Sherbourne Health Centre

Homelessness is a growing problem throughout Canada. In Toronto, it has been declared a disaster. Providing healthcare for this population is a challenge that cannot be ignored. The homeless and marginally housed populations have a unique set of needs and interact with the healthcare system differently than other groups.

The homeless population has a much higher incidence of ER visits than the housed population. For most, it is their primary point of contact with the system. It is a complex and often tense relationship. ER staff are often frustrated by the perceived futility of providing primary care medicine in an emergency setting. At the same time, many homeless clients perceive this as a judgment on them.

The fellowship I designed is focused on increasing the quality of care and discharge for our homeless clients in the MT. Sinai ER. It also aimed at increasing staff awareness of homelessness issues and decreasing the frustration of both staff and client.

A basic assessment tool has been designed highlighting various areas of concern that are frequently missed. These include social supports, housing, skin and respiratory assessment and substance use. This tool will allow busy staff to perform a focused assessment without undue strain on their time. It also provides a sense of purpose in their interactions. In the future, this assessment tool will be tied to an interactive database of community resources. It will help guide the health care team in their discharge planning.

In order to provide better discharge pathways for our clients, I engaged Seaton House Shelter to create a partnership. I was more warmly received than I could have imagined. As a result, a referral system has been established by which information and support is exchange between our ER and the various services of Seaton House. By removing the search for housing as a competing priority, our clients are able to focus more energy on their health.

With the fellowship now complete, dissemination of information and expertise to the staff is the next step. An award winning awareness program is being made available to the staff of the entire hospital. This program will increase awareness of the difficulties of life in the homelessness care system. In-services are also being arranged to educate ER staff on the assessment tool and Seaton House referral program.