Providing Services to People who have Experienced Homelessness

In 2001, I accepted a job at Sherbourne Health Centre, which was a new health centre in the east side of downtown Toronto.

The ‘infirmary’ is a 20 bed program, open 24 hour/day, for homeless and marginally housed persons who have an acute medical condition and have no place to go to adequately recover. It is staffed by nurses, community health workers, a nurse practitioner, case manager, and consulting physicians. Back in 1999, many community agencies came together with representatives from the City of Toronto to develop a plan to better meet the needs of people experiencing homelessness. Homelessness had increased greatly around this time, a result of the lack of affordable housing and cuts to welfare. The infirmary was one of the initiatives that emerged, particularly because people who were ill did not have any place to recuperate. Shelters often made people leave during the day, many rooming houses had little access to bathroom facilities and were not accessible if you broke your leg, and sleeping outdoors is not conducive to improving health.

In 2001, I accepted a job at Sherbourne Health Centre, which was a new health centre in the east side of downtown Toronto. At the time, there were only 10 full time staff working there planning the services to come. There were many delays in opening, and moving into a new site, nonetheless, it was very exciting to work in a place where there was so much hope, energy, and passion for building health care services for marginalized communities including persons who had experienced homelessness. There was a genuine commitment by the staff to serve those who faced the most barriers to receiving care due to discrimination and poverty, and there a consistent focus on removing these obstacles. The staff grew from that initial 10 to over 120 when I left a few months ago.

The infirmary opened in April 2007. It is a beautiful place, with spacious hallways, a stunning array of vibrant and warm colours on the walls and floor, a sunny and bright dining room, a computer for clients to use, an exercise room and rehabilitative equipment, many single rooms, and a phenomenal group of committed and capable staff. Most significantly, the staff developed a common focus and approach to care, which is inclusive and collaborative. Values were collectively developed to inform the work and the decisions made – the 3 defining values are: courage, belonging, and social justice. As you can imagine, developing values in a meeting and actually living by them are very different.

Having courage means both speaking out sometimes and living by a decision made by the team or a client with which we don’t always agree. It means sifting through the grey area of not always knowing or agreeing upon a course of action. It is being thoughtful and caring, and also brave when we disagree with the group. It is finding that balance and not allowing disagreements to turn into petty arguments or growing animosity with either a client or our team. If a client smokes in his room and won’t change that behaviour and has to leave the infirmary, this doesn’t mean that he won’t be in a place to accept the rules when he is sick and needs our help next time. It takes courage to allow someone to have another chance, to not be punishing, even when they may have hurt you in some way.

There is growing literature which demonstrates that people who don’t feel a sense of belonging in their community have more health and mental health issues. Belonging can be defined in many ways, however, my favourite definition is: ‘happiness felt being in a secure relationship.’ And now how do we go about achieving this? I think the easiest way is in the words a colleague’s mother said to her when she got married – love is in the details. This means providing sensitive and respectful care. For example, asking someone up front about their substance use, without any value judgments, and being sensitive about how we will genuinely support him/her to take care of their health while s/he is using. It is also recognizing the importance of making a cup of tea when someone is feeling down. And, working with each person who is in the infirmary to develop and implement a workable plan when they leave, which includes matching them with a housing worker, completing applications for a disability pension, finding health care providers, and making referrals to a range of programs for social supports. And, critically, offering some follow up support when needed. An Advisory Committee with former clients has also been set up to ensure that the program promotes a sense of belonging and remains warm, welcoming, and receptive to a diverse group of clients.

Social justice is weaved into various aspects of the program. Although operating a 24 hour/day program makes it difficult sometimes to focus on social justice principles, they are a critical foundation to the work. Other wise, we can start to focus on individual struggles and barriers that people face and lose sight of the importance of systemic change. It is essential to sustain a direction and purpose to the work and identify ways to improve the service, work collaboratively, and build on initiatives and networks directed at reducing and ending homelessness. This is a critical piece of the work, and will always be an ongoing struggle the balance between operations and developmental work.

Now that I have left the infirmary and taken a new job, I look back and am struck by how the values have shaped the program and remain intact. Feedback from clients was always consistently positive, many returned to visit to say it was an oasis for them – a place where they could recover, but more significantly felt valued and respected. Many are now housed and say that there life changed as a result of being there. Those are my best memories – the beautiful cards and messages that were passed on to the team. I often think that the key to having a meaningful life is about how much we are willing to risk, to reach out and care about one another, even when we have different opinions, experiences, and opportunities. I think as a provider of service, that we are obligated to reach back to the person behind us, who is still struggling on the ladder, and give him/her a helping hand, like all of the people who has gone before us, and reached out a hand to us. This is the only way to bring about change. One helping hand at a time.

Publication Date: 
Toronto, ON, Canada