Since early April, ICHA’s newly formed interprofessional teams have been providing people experiencing homelessness with a novel kind of care, first at a facility in Etobicoke set up to meet the complex needs of those affected by COVID-19 and, as of May 16, at a downtown Toronto site where members of the homeless community wait for their COVID-19 test results, safely isolated in a dignified space with accessible supportive services.
The teams’ tailored work is the heart of ICHA’s provincially funded COVID-19 plan, developed to ensure that everyone in the homeless community receives the help and healthcare they need during this field-reorienting pandemic. To meet those needs and protect people experiencing homelessness from the full force of COVID-19, ICHA has transformed its operations and introduced a new model of team-based care — interdisciplinary, collaborative, integrated.
Members of ICHA’s collaborative care teams at the Etobicoke COVID recovery site take a brief (safely spaced) break from their important and challenging work providing care and support to people experiencing homelessness. Pictured right to left: Tenzin Sangpo, Veronica van Dam, Linda Vu (centre), Linda King, Shaye Martorino, Naiema Alam (centre), Leigh Chapman, Monika Dalmacio, and Yolanda Diston (back).
The teams include more than 70 nurses, recruited in a few short weeks through the VIANurse program, as well as peer workers and case managers. The teams’ foundations include RNs, supported by RPNs, case managers and peer workers, with both on-site and 24/7 on-call services provided by ICHA physicians experienced in primary, psychiatric, mental health and addictions, and palliative care services. Substance use care, overdose prevention services, mental health support, and community, peer and personal support are all part of the program. A focus on social and psychosocial needs, drawing on the value and proven importance of peer workers, helps ensure it is delivered with sensitivity using a harm reduction and trauma-oriented approach.
As of May 20, ICHA’s teams working at the 200-bed Etobicoke site have served 299 people — 89 are currently onsite and 210 have recovered and been discharged. The numbers are quickly rising with more than 60 admissions anticipated over the next few days. So far, 17 people experiencing homelessness have been accepted into the recently opened downtown isolation site, with six currently onsite and 11 discharged.
The two facilities are the result of the collective efforts of a host of partners, including ICHA, the City of Toronto, University Health Network, and a strong alliance of community health partners and social support service agencies who make a comprehensive response possible, including Parkdale Queen West Community Health Centre, Sound Times, the Neighbourhood Group, UHN, the City of Toronto.
ICHA’s initial plan called for two sites, with different staff mixes, to run in parallel: an isolation site and a larger open-concept recovery facility. The facility that opened in early April served as an Person Under Investigation (PUI) isolation site for a short time, providing safe, supportive environments for people experiencing homelessness while awaiting test results. The combination of faster test turn-around times, greater access to hotel rooms for safe isolation, and a rise in the number of COVID-19 cases among people experiencing homelessness prompted the site’s transition to a COVID recovery facility.
In response to substantial positive client experiences and communities’ encouragement of the hotel model, ICHA revised its plan for a large congregate recovery site with clear sight lines, making the appropriate adjustments, including a higher-staffed model of care. The hotel Covid recovery model continues to meet client needs well where they have individual rooms for safe isolation and access to a range of services and supports tailored to meet their needs.
As of May 20, 357 confirmed cases of COVID-19 have been reported in Toronto’s shelter system. There are currently nine active shelter outbreaks according to Toronto Public Health. As the impact of the pandemic on people experiencing homelessness becomes more evident and profound, evidence continues to emerge confirming that people without access to the social determinants of health are hit hardest by the pandemic. ICHA is more committed than ever to addressing those inequities, with a particular focus on housing for health. COVID-19 has precipitated ICHA’s transformation. It must also be a turning point for the health system –away from institutionalizing homelessness and towards its elimination.