Research Matters Blog

Canadian Observatory on Homelessness/Homeless Hub: York University
July 22, 2016
Categories: Ask the Hub

As Canada’s aging population and rates of chronic and terminal illnesses rise, palliative and end-of-life care services will be more and more in demand.

Palliative care helps people live the best lives they can while facing life-threatening illness. It focuses on relieving pain, easing confusion, and considers the emotional and spiritual needs of the patient and their families. As Dr. Dosani pointed out in his blog post a few years ago, there’s increasing evidence that early palliative care (upon diagnosis) should be a priority for everyone.

According to research by Donna Wilson and others, most Canadians want to die at home, or in places that feel like home (cabins, somewhere in nature, etc.), with only a small percentage of people saying they want to die in a hospital or nursing home (where most people do end up dying). This discrepancy has inspired much conversation about the rising importance of hospices, palliative care, and making it more affordable for people to die at home. But what happens to someone who is terminally ill and doesn’t have a home?

People experiencing homelessness, especially chronically, are more likely to have a wide range of health issues and a much lower average mortality age than people who are housed. Despite having high needs, many have a hard time accessing mainstream health services due to stigma, discrimination, past negative experiences, inflexible programming, and location. While there isn’t much research on people experiencing homelessness and palliative care, we know that many are interested in advanced care planning and choosing location of death. One 2007 study found that among its 53 participants:

  • Many had experiences with death (of friends, family and other street-involved people).
  • There was a lot of interest in advance directives and end-of-life care, but participants felt that programs were inaccessible.
  • Many echoed the same sentiments about dying that have come up in other studies with the general population (being reunited with family), but others had more unique concerns, like dying anonymously, alone or undiscovered.

Despite expressing a desire for choice, most people experiencing homelessness die in acute-care settings.

Barriers to palliative care

A 2013 Toronto-based study assessed how people experiencing homelessness accessed palliative care. The participants, nurses and outreach workers, highlighted the following as important barriers:

  • Housing sector staff are rarely trained in end-of-life care, and don’t have sufficient access to medical professionals.
  • Many people experiencing homelessness have had past negative experiences in healthcare and don’t feel comfortable seeking it.
  • Many echoed the same sentiments about dying that have come up in other studies with the general population (being reunited with family), but others had more unique concerns, like dying anonymously, alone or undiscovered.

In another study, participating housing workers outlined four main recommendations to help improve access to palliative care: “(1) increasing positive interaction between the health care system and the homeless, (2) training staff to deal with the unique issues confronting the homeless, (3) providing patient-centered care, and (4) diversifying the methods of delivery.”  

Types of palliative care

There’s a few different ways people experiencing homelessness can get palliative care, depending on where they’re located:

Shelter-based programs

Some hostels and shelters coordinate with other organizations and medical staff to provide palliative care when needed, though there are limitations to what can be offered in many cases. Many residents are expected to leave during the day for cleaning – not a possibility for the very ill – and guests are often only allowed within specific timeframes. Exceptions can be made but it is at the discretion of shelter staff.

Even so, there is evidence that this model is not only effective at reducing pain, improving comfort and – sometimes – helping patients reconnect with friends or family, but is also more cost effective than if patients sought treatment elsewhere. In one 2006 study, 28 patients who were terminally ill and homeless were admitted to and died in a hospice.  Researchers compared the hospice to other care locations and projected $1.39 million in savings for these patients’ care.

One of the challenges of these programs is that partnerships with health professionals aren’t always strong enough, resulting in role confusion and a burden of work placed on shelter workers. Another is the devaluing of end-of-life and palliative care in general, resulting in unpaid overtime and heavy emotional stress for shelter workers. The participants of Webb’s U.K-based study all identified situations in which they’d gone beyond the call of duty for residents:

‘That weekend when I spent 17 hours at the hospital it was in my own time.’ Participants had even visited dying residents while they were off duty in order to meet their emotional needs. Two had worked unpaid in order to be there for the resident’s final moments of life and one staff member described a scenario where she took complete responsibility for arranging the resident’s funeral (p. 242).

While it’s wonderful that there are people willing to provide such care, these stories speak to a greater need for funding and training for end-of-life care in the hostels and shelters that provide them.

Mobile programs

Another less common, but more flexible model of palliative care is mobile programs, which meet people in need whether they be on the street or sheltered. In Toronto, PEACH (Palliative Education and Care for the Homeless) is one such program (its principles listed below). In May of this year, The Toronto Star ran a story about nurse Namarig Ahmed, who coordinates PEACH, and secured a bed for a man dying of cancer in the shelter he spent most of his time in. Though PEACH is doing much to give people experiencing homelessness the dignity of choosing how to die and minimizing their pain, there is much more work to be done. As Alex Newman wrote in the article:

Although the PEACH program is “one step closer to dying with dignity, and with as little pain or discomfort as possible, we’re still trying to find better way to deal with this,” Ahmed says. “Having conversations with other health-care providers is a vital first step to find a solution and make this care accessible to all."

PEACH Principles


Improving access to palliative care

Of course, both shelter- and mobile-based programs are usually only available to people living in urban centres. Hospices, shelters, and hostels are in much smaller supplies in rural and remote areas. There, people almost always need to go to hospitals or pay for personal care – options which are often unavailable to people experiencing homelessness.

As the writers of this 2015 literature review point out, we need more models of intervention for advanced care planning, palliative care, and end-of-life care that address the needs of people experiencing homelessness. More importantly, as Huynh, Henry and Dosani proposed in a recent article, a national strategy is needed to “address this glaring gap in our healthcare provision,” and promote policy development around ensuring everyone has access to palliative and end-of-life care.  

This post is part of our Friday "Ask the Hub" blog series. Have a homeless-related question you want answered? E-mail us at thehub@edu.yorku.ca and we will provide a research-based answer.

Graphic credit: Juxta Magazine

Canadian Observatory on Homelessness/Homeless Hub: York University
July 20, 2016

This week’s infographic is from Rock Trust, an Edinburgh, UK-based organization that educates and supports homeless and at risk youth to enable them to build the skills required to make a positive and healthy transition to adulthood. The infographic, based Rock Trust’s Beyond Homelessness report, demonstrates the positive impact both formal and informal relationships can have for young people.   

The Beyond Homelessness report studied the everyday experiences of youth over a three-year period. The study found that the social networks directly impact a youth’s resiliency to homelessness, wellbeing and need for formal support while homeless. Access to informal supports, such as family members or friends, were proven to help youth become more resilient and feel less isolated, leading to an increase in their overall wellbeing. When youth were homeless, there was a decrease in the amount of contact with informal supports. As a result, youth would depend on formal supports such as individuals from organizations or agencies, who could provide help or assistance through homeless services or programs.

Youth who were homeless were highly dependent on formal support networks to help with housing issues, physical health, depression and for general advice. In many cases youth were equally as likely to approach formal or informal networks for support. There was a balanced distribution of sources of informal and formal support concerning wellbeing, addictions and relationship issues; however, there was a large number of those interviewed who did not know where they would go to for help on a range of issues.

The area where youth felt they would like more support were additional monies (48%), housing (44%), legal matters (30%), and mental health (26%). Creating stronger relationships with family members and friends, or with personal feelings were one of the least areas needing additional support (11%).

In a follow-up interview, the key skills interviewees felt they had developed were confidence, self-esteem, overcoming addictions, reducing their negative networks, better self-awareness, better understanding of relationships, patience, money awareness, socializing/opening up, help to pick oneself up/keep going, and life skills such as cooking/cleaning/budgeting. Of those interviewed, 85% felt that there had been an improvement in their wellbeing, 78% felt that they had been able to make good use of the support offered and 93% felt more able to support themselves compared to year prior.

The Beyond Homelessness report aimed to act as a resource for those working within the homelessness sector to develop an understanding and awareness into the integral role social networks can play in developing paths out of homelessness. 

Beyond Homelessness Report Infographic

Canadian Observatory on Homelessness/Homeless Hub: York University
July 15, 2016
Categories: Ask the Hub

We received this question from Raymond W.: “Can you please provide me with any statistics on people who are working and experiencing homelessness in Canadian cities?”

Many people experiencing homelessness struggle to find and keep employment for all kinds of reasons: the difficulty of staying in shelters, facing discrimination from employers and colleagues, being unable to wash up regularly, lacking professional clothing, missing key identification and/or equipment, and many others. Furthermore, sudden job loss and precarious employment are sometimes the triggers that lead to homelessness. So we tend to assume people experiencing homelessness are also unemployed, but this isn’t always true.

In the past few years, journalists have drawn attention to the high numbers of “working homeless” in the U.S. The New York Post profiled city workers in New York City, of which 300 were currently experiencing homelessness. A 2013 story in The New York Times interviewed people working full-time jobs (sometimes more than one) and estimated that 28% of families experiencing homelessness included at least one working adult, and 16% of homeless individuals had jobs. Jeffrey Jones, executive director of the National Coalition Against Homelessness, told Al Jazeera that of the 3.5 million Americans who experience homelessness each year, 25% are employed.

Wage gap and job growthStatistics on Canada’s “working homeless”


Though not given the same media coverage, many people experiencing homelessness in Canada are also employed. A lot of area-specific data is collected during Point-in-Time Counts, which are done by different agencies in each area, and many past surveys have not asked about sources of income or employment. This year marked the first Co-ordinated Point-in-Time Count, which included a core question about how people make money, so newer counts should give us more information about people who are employed and homeless. That said, we have some numbers available from past counts:

Vancouver

  • Overall employed: 23%
  • Binning: 4%
  • Panhandling: 4%
  • Sex work: 1%
  • Self-employment: 1%

Source: Vancouver Homeless Count 2016

Kelowna

  • Overall employed: 6%
  • Informally employed: 12%

Source: 2016 Point-in-Time Count, Kelowna, British Columbia

Calgary

  • Full-time: 18.3%
  • Part-time: 10.4%
  • Casual: 28.3%
  • Self-employment: 0.8%

Source: 2008 Count of Homeless Persons in Calgary

Regina

  • Full-time: 6.3%
  • Part-time: 7.8%
  • Panhandling: 6.3%
  • Under-the-table jobs: 4.7%
  • Binning: 3.1%
  • Crafting/painting: 1.6%
  • Informal (sex work, dealing): 1.6% 

Source: Regina 2015 Homeless Count Final Report

Winnipeg

  • Overall employed (including temporary and part-time): 16.5%
  • Self-employed or informally employed: 18.5% 

Source: Winnipeg Street Census 2015

Toronto

  • Overall employed: 20%
  • Full-time: 5%
  • Part-time/casual/seasonal: 12%
  • Informal: 6%

Source: 2013 Street Needs Assessment

Montreal

  • Full-time: 3%
  • Part-time: 4%
  • Unreported full-time: 1%
  • Unreported part-time: 4%
  • Panhandling (informal): 6%

Source: I Count MTL 2015 / Je Compte MTL 2015

Halifax

  • Full-time: 4%
  • Part-time: 7%
  • Casual: 9%
  • Informal: 18%
  • Other (sex work, petty theft, metal collection): 16%

Source: 2015 Halifax Homeless Point-in-Time Count

Things to consider


I’ve included informal employment (sex work, binning, etc.) because they are often important income sources for people experiencing homelessness. Finding and maintaining formal employment involves many more barriers (like access to professional clothing or equipment) than informal work, and the chaotic nature of being homeless often makes keeping a regular schedule difficult. In many of the surveys, people living on the streets were more likely to report sources of informal income than those who were sheltered.

It’s also important to remember that Point-in-Time Counts only give us a snapshot of who is experiencing homelessness and that they are typically underestimates – especially when it comes to people who are experiencing “hidden homelessness” like staying with friends/family, in hotels or hostels, or couch-surfing; who are also likely to be employed.

How is it possible that working people can be homeless?


While having a stable income is generally key to both finding and keeping housing, having a job isn’t a safeguard against homelessness. A 2013 report by Citizens for Public Justice found that in 44% of poor households, there is at least one working person. Across North America, there’s been growing income disparity and an increasing number of people are classified as “working poor:” people who work but don’t make a living wage. As Richards, Cohen, and Klein wrote in Working For a Living Wage (2010):

A living wage is not the same as the minimum wage, which is the legal minimum employers must pay. The living wage sets a higher test—it reflects what earners in a family need to bring home, based on the actual costs of living in a specific community.

The days of stable, well-paying jobs with good benefits are long gone for many Canadian workers. For a number of years now, the marketplace has trended towards precarious and low-wage employment, which doesn’t offer security or living wages. For people with disabilities or mental health issues, securing and keeping any kind of employment can be extremely difficult, putting them at a higher risk of experiencing homelessness.

These (and other) factors create the conditions of poverty: people living paycheck to paycheck and at the whim of the labour market. With housing prices (both to buy and rent) soaring in most Canadian cities, it's not hard to see why one change in circumstance can result in homelessness. Though the causes of homelessness are complex and often include more than employment status, we must look to income supplements and more affordable housing to help people live above the poverty line and avoid homelessness.

This post is part of our Friday "Ask the Hub" blog series. Have a homeless-related question you want answered? E-mail us at thehub@edu.yorku.ca and we will provide a research-based answer.

Photo credit: Workers Action Centre

A Way Home
July 13, 2016

In an earlier blog post I shared with you an overview of everything that the A Way Home Canada coalition has accomplished to date and a few highlights of what was coming down the line, including the recently released Youth Homelessness Community Planning Toolkit and the Youth Rights, Right Now! Ending Youth Homelessness: A Human Rights Guide. The Canadian Observatory on Homelessness, a founding member of A Way Home, also released the Canadian Definition of Youth Homelessness. All of these resources are based on months of consultation with youth with lived experience, service providers, researchers, policy makers, and planners (and a few lawyers for good measure). We see this resource trio as essential for crafting and implementing strategies to end youth homelessness.

Community plans alone will not prevent and end youth homelessness. So what else do we need to do, and where will A Way Home focus our efforts in the coming months? First of all, we need to continue building out our “toolbox” so we can hit this complex social issue from every possible angle. For example, not everyone is swayed to act by the moral argument concerning youth homelessness. Some ask instead for the economic argument for why we should invest in prevention. The Canadian Observatory on Homelessness and A Way Home are currently scoping out a cost benefit study which will answer these important questions: What would it cost to make a young person’s experience of homelessness their last? Conversely, what would it cost if we did nothing? This study along with the results of our first ever national survey on youth homelessness, Leaving Home (coming this fall) will give us compelling arguments for all levels of government and the public for where and how we should prioritize and invest.

Earlier this year in collaboration with the Canadian Observatory on Homelessness we released a Federal Policy Brief and one specific to Ontario. A good part of the work of A Way Home is harnessing the coalition’s collective voice to make strategic recommendations to government. Along these lines we are currently developing youth homelessness-specific recommendations to inform the development of the National Housing Strategy. We will release these recommendations in the fall. More information on the government’s consultation process can be found here.

A more recent development is A Way Home’s lead partner role in the Canadian arm of the Youth Homelessness Social Innovation Lab (SI Lab). This is an international initiative led by the Canadian Observatory on Homelessness. The work of our Social Innovation Laboratory is to identify and imagine policy and practice innovations that have a high potential of contributing to effective solutions that will tip systems in positive directions.  The Canadian Youth Homelessness Social Innovation Laboratory brings together leading minds with an agenda of identifying and nurturing innovation, and enabling funders, governments, communities, and service providers to adapt and implement social innovations in order to more effectively respond to, and eventually end, youth homelessness.  Moreover, the work of the SI Lab will be further enhanced through participation in the COH-led International Youth Homelessness Social Innovation Network. This network will link thought leaders from around the world with a similar agenda of identifying and mobilizing innovative and effective approaches to ending youth homelessness. 

A Safe and Decent Place to Live: Towards a Housing First Framework for Youth. Download the report at homelesshub.ca/housingfirstyouthOne concrete example of the work of the Social Innovation Lab is Housing First for Youth. Since the Canadian Observatory on Homelessness developed the Housing First for Youth Framework in collaboration with the Hamilton Street Youth Planning Collaborative and the National Learning Community on Youth Homelessness (hosted by A Way Home), the model has gained traction internationally. Our next step is to work with international partners to refine the model, develop a comprehensive toolkit complete with fidelity testing, and then to document and share examples of Housing First for Youth in action around the world. A Way Home’s role will be to ensure Canadian examples are highlighted and that we support at both the policy and practice levels the growth of this important model. A good portion of the work of the SI Lab will be focused on models of prevention and housing and supports.

I’ll end by reminding everyone to come out for the National Conference on Ending Homelessness in London, ON, November 2-4. We collaborated with the Canadian Alliance to End Homelessness to program a cohesive youth stream that deep dives on a number of issues critical to the prevention of youth homelessness. Stay tuned for my August post where I take a closer look at The Upstream Project and the critical role that schools in partnership with communities can play in the fight to end youth homelessness.

This post is part of a monthly series that follows A Way Home's progress as we create real change on the issue of youth homelessness. On the second Wednesday of every month, join us for an update from A Way Home's Executive Director, Melanie Redman. 

Homeless Hub
July 11, 2016
Categories: Topics

People experiencing homelessness face a number of challenges with finding employment in the formal labour market. The stereotype that all homeless people are unemployed because they are lazy is simply not true. Research consistently shows that people who are homeless want to work and many diligently pursue employment opportunities or work in some capacity. However, being homeless makes it next to impossible to obtain and maintain formal employment.

Barriers to Employment 

Not having a home means that people experiencing homelessness may not have an address to put on a résumé, a phone number for job call backs, and a safe place to prepare for job interviews. It also means not having the opportunity to recover from a day's work in a safe environment where they can shower, get a good night of sleep, prepare their own food (including food to take to work), recover from illness or injury, rest, and maintain their health. Participants in a research study reported the shame and embarrassment they felt when providing a shelter’s address to a potential employer or having to explain why they didn’t have ID or a bank account. Many decide not to disclose their homelessness status in fear of being automatically disqualified as a suitable candidate. Other barriers to employment among the homeless population can include:

  • Low educational attainment
  • Physical disability
  • Mental health and substance use
  • Criminal record
  • Limited access to transportation
  • Lack of experience in the field of interest
  • Lack of vocational training
  • Lack of computer access in addition to low levels of computer literacy required to perform job searches and fill out online applications.

Even when a homeless person is able to find employment, it is often on the margins of the economy. Many are forced to work in unsafe and unregulated jobs and/or are paid under the table where the pay may be inconsistent and/or lower than average wages. Temporary work has also been described as a barrier to meaningful and permanent employment as it hinders relationship building with employers while interfering with long-term career planning. Precarious work not only foregoes benefits or a living wage but may also lead to vulnerable workers being exploited as cheap labour

On the other hand, some homeless people have no other option but to adopt dangerous survival strategies to generate income including panhandling, dealing drugs, stealing, squeegeeing, and/or sex work. A study found that homeless youth who dropped out of high school are more likely to engage in sex work, squeegeeing or panhandling but the overwhelming majority who engage in such work would prefer gaining employment within the formal economy. Homeless youth face a number of additional barriers to employment in comparison to homeless adults, including:

  • Age discrimination
  • Lack of encouragement to plan and pursue career opportunities
  • Weak social and human capital (education, friends, families, networks)
  • Lack of life skills (budgeting, time management, conflict resolution)
  • Lack of recognition and value in hiring youth with barriers
  • Lack of support with transition to adulthood

What is Being Done?

From the employers’ side, many shared their limited notion of homelessness based on stereotypes of the homeless population. Some indicated their lack of knowledge and experience working with people who are homeless, and felt ill-equipped to address the needs of their homeless employees. As a result, employment was terminated despite their best of intentions. 

To better support employers and employees, one study found that homeless youth require strong partnerships between employers and youth-serving agencies. A growing number of youth service providers are building strategic partnerships and fostering strong corporate engagement in order to meet the needs of their clients and employers. The Train for Trades program at Choices for Youth in St. John’s, NL works directly with local trade unions to enable young people to learn on the job, gain credentials and work on a personal plan towards long-term sustainable and viable employment. Using an intensive support model, the Train for Trades program reaches out to support youth with lower education levels, those with poor mental health, and/or those who have been involved with the criminal justice system.

Youth Employment toolkit

Another successful program is HireUp, a community of youth-serving organizations and employers from across Canada helping youth gain meaningful employment while raising awareness about youth homelessness. Participants are provided with holistic supports, accommodation, case management and on-the-job training by both employer and youth agency to improve their chances of success. Employers receive supports to increase their benefits from their involvement with HireUp while gaining recognition in the media and other communication channels that increase their brand’s reputation.

In Toronto, Eva’s Phoenix Print Shop is a social enterprise that offers a job training program for homeless and at-risk youth. Eva’s Phoenix Print Shop has connected over 100 youth with career opportunities in Canada’s graphic communications sector. The goal is for program graduates to achieve self-sufficiency through formal employment.

While these innovative youth job training programs are successful, more supports and initiatives like these are needed to lift youth and adults out of homelessness through formal employment. Additional research is required to shed light on the specific needs of families with children, single mothers, older adults, veterans, newcomers and individuals with health concerns who are looking for employment.

With the appropriate supports, people experiencing homelessness can overcome barriers to thrive and succeed in the workplace. Employment is just one component in the broader set of strategies to end homelessness through collaboration and coordination over a number of sectors.

Photo Credit: Homeless Hub, Train for Trades Youth Employment Toolkit

Pages

Recent Tweets

Content on this site is licensed under a Creative Commons Attribution Non-Commercial No Derivatives License

The analysis and interpretations contained in the blog posts are those of the individual contributors and do not necessarily represent the views of the Canadian Observatory on Homelessness.