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The toll COVID-19 is taking on Canada's homeless
TORONTO -- Sanctuary Ministries Toronto is normally bustling with as many as 200 people, but nowadays it’s filled with about half a dozen staff members floating around in protective gear, and about just as many members of the city’s homeless community.
Whenever there’s a drop-in, Kathleen Smith, an outreach worker and media spokesperson for Sanctuary, usually stands just outside its doors, screening homeless individuals before they step in. This involves taking their temperature and asking if they’re showing any symptoms of the novel coronavirus.
“It’s night and day,” she told CTVNews.ca over the phone on Thursday. “We would know at least 70 per cent of the people coming in the doors before COVID – people that we had existing relationships with and who mostly hung out in our neighbourhood.
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“Now, [we’re seeing] lots of new faces, lots of unfamiliar faces of people who are coming from farther away because there are just no resources in the part of the city where they normally hang out.”
As a result of the pandemic, the community outreach centre has had to adjust many of the services it offers. Before the outbreak, Smith recalls the organization would serve between 300 and 400 meals per week to clients who sat inside to eat. Now, the shelter packages meals in takeout containers and hands them out to those in need – as many as 600 meals a week are distributed, Smith said.
Clients are still allowed to eat their meals inside the facility as well as take showers or use the restroom, but they can only stay for 30 minutes. Only 10 clients are allowed inside at a time – five on the main floor and another five in the basement.
In a building with a dinner capacity of nearly 200 people, you won’t find more than 20 people at a time now, Smith said, including staff.
“Normally, drop-ins are a really great chance to just connect with people as human beings,” Smith explained. “At Sanctuary, we try to eat together, so the staff will eat with everybody else and just try to create a comfortable, homey atmosphere.
“That’s just impossible right now; we have to be so careful with [physical] distancing.”
Not only have these measures made it difficult for people who are homeless to connect with the community around them, but measures have also made it hard to secure a space in existing shelters.
According to Smith, one of the main issues Sanctuary Ministries Toronto is facing right now is locating spots for homeless people in local shelters. She said it has been impossible to find shelter spaces nowadays, mainly due to physical distancing measures.
Sanctuary Ministries Toronto is one of several advocacy groups that have filed and now settled a lawsuit with the City of Toronto involving physical distancing standards.
Previous guidelines allowing beds to be placed less than a metre apart were revised to maintain two metres of distance, in accordance with government and public health recommendations for physical distancing.
While these new guidelines were recently put in place, Smith said there continues to be a lack of proper physical distancing in most shelters she’s aware of.
‘CROWDED SETTINGS’ PUT HOMELESS AT RISK
The communal setting that characterizes many homeless shelters places clients at a greater risk of transmitting and contracting COVID-19, explained Dr. Sarah-Taïssir Bencharif, an emergency department doctor based in Ottawa.
“We always have a high index of suspicion for COVID-19 because our homeless patients are living in more congregate, crowded settings in homeless shelters,” she told CTVNews.ca on Thursday via telephone. “For any communicable disease, that increases the chance of both getting the disease and spreading the virus.”
Aklilu Wendaferew, assistant executive director of Good Shepherd Ministries, a charity for homeless people in downtown Toronto, explained that the organization has been at capacity for some time and isn’t taking any new clients.
“In terms of people that are staying in the shelter itself, [interaction] has reduced because movement is very low,” he told CTVNews.ca over the phone on Thursday. “People don’t move out of the shelter [unless] into housing and we can’t really bring in new clients.”
The charity group’s Queen Street location had a 95-bed capacity prior to the COVID-19 outbreak, said Wendaferew. This has been reduced by about 50 per cent to create more physical distance between clients, with 50 beds remaining at the shelter and 45 clients moved to rooms in a hotel paid for by the City of Toronto. Wendaferew said this has greatly helped the organization better adhere to the city’s physical distancing measures.
The impact of the COVID-19 pandemic is most felt in the shelter’s outreach efforts, particularly its housing resettlement program, which provides support to former homeless people that have secured housing.
Previously, case managers would assist former homeless people in looking for a place to live, following up with them during their transition and offering support. Not only has much of this been impossible to do, but virtually any contact between case managers and clients will have to take place over a phone or computer. With many former homeless people facing a lack of resources, this makes it hard to stay in touch, explained Wendaferew.
“There’s a significantly reduced service in terms of support for people who have been housed,” he said. “A lot of former homeless people may not have a telephone or access to Wi-Fi, therefore it is a big challenge.”
He also points to the sense of loneliness and isolation perpetuated by the pandemic, which also presents a challenge for those who are homeless.
“Interaction, particularly in terms of [individual and group] counselling, has really decreased,” he said. “For a lot of homeless, counsellors are the only support that they have on their journey to get out of homelessness and be independent.”
Dr. Asha Seth is an obstetrician and gynecologist based in Toronto and a former senator. She has been working with Toronto’s homeless community since 2009 and has volunteered with Good Shepherd Ministries for the past four years.
During the pandemic, she has spent time at the shelter handing out pre-packaged meals to vulnerable members of the community.
Resources like food are something many of those experiencing homelessness greatly rely upon shelters for, she explained.
“I was surprised when I was serving the food… and the same people would come not one, but twice, three times,” she told CTVNews.ca over the phone on Thursday. “What they were doing was storing the food for a day or two, so they don’t have to come to the shelter.
“These are heartbreaking stories.”
PHYSICAL AND MENTAL HEALTH
With shelters like this one operating at a distance and with limited services, Seth pointed to the toll this is taking on members of the homeless population, many of which are already vulnerable.
“There’s a lot of misconception surrounding homeless people,” she explained. “Homeless people have a higher prevalence of mental illness than the general population.”
Studies conducted in a number of Canadian cities have shown that between 23 and 67 per cent of homeless people report having a mental illness.
Not only is adequate access to mental health services a challenge for homeless populations across the country, so is access to physical health-care services, said Smith.
“Living on the street is hard on your body in a lot of different ways,” she said. “People who are homeless are a lot less likely to be able to access consistent preventative care.”
Based on her work with Toronto’s homeless population, she said there is a reluctance among members towards seeking care in the first place.
“People are afraid about how they will be treated once they enter a medical institution,” she said. “We've seen that fear makes people really resistant to wanting to get tested.
“Even if they might want to get tested for their own wellbeing [or] they want to seek treatment, they don’t really feel confident that they're going to be treated with dignity, that they're going to be given good options.”
Many of those enrolled in the homeless system have a number of pre-existing health conditions, including lung diseases, heart disease and diabetes, explained Bencharif.
“Having those other diseases and illnesses makes you more susceptible to getting more sick from something like coronavirus, especially when they’re not adequately or optimally managed to begin with.”
Studies have also shown that those with underlying health conditions are more at risk for developing more severe cases of COVID-19.
Bencharif said that the number of homeless patients she’s seen displaying symptoms consistent with COVID-19 has decreased over time, which she thinks is the result of increased testing.
“Earlier on in the pandemic, we were seeing more of these patients coming into the emergency department, but it’s been my experience that in the last many weeks, testing has been done more at the level of the shelters,” she explained, pointing to a mobile clinic run by Ottawa Inner City Health that is testing patients in various homeless shelters.
“So I have not seen as many now in the last few weeks in the emergency department.”
A community survey conducted by the Canadian Alliance to End Homelessness (CAEH) shows that 93 per cent of organizations working with Canada’s homeless say reasonable access to COVID-19 testing is provided for clients who are symptomatic.
A NEED FOR HOUSING
However, even with physical distancing measures and increased testing in place, Tim Richter, president and CEO of CAEH, insists neither of these addresses the larger issue at hand – the fact that a portion of Canada’s population lacks a home.
“Public health tells us that we should be at home, isolating…[and] wash our hands often with access to hygiene, which are all difficult to do when you’re experiencing homelessness,” he told CTVNews.ca on Thursday via telephone. “Communities around the country have been scrambling to set up isolation shelters [and] create [physical] distancing.
“Ultimately, the best protection from COVID-19 is a home.”
According to the CAEH, up to 235,000 Canadians circle through homeless shelters each year. On any given night, it can mean as many as 35,000 people are in a shelter.
The ultimate solution lies in getting people off the streets and into affordable housing, something that can be done with changes to government policy, Richter said.
“The housing and homelessness crisis we see today is a product of policy decisions made by federal and provincial governments over 30 years,” he said. “We have to move quickly to reverse policy decisions and start making investments in housing, moving people into apartments and housing as fast as we can.”
He urges the launch of initiatives similar to the Canada Emergency Response Benefit (CERB) that provide temporary income support to Canadians. CERB, for example, offers $2,000 a month to eligible Canadians who have lost their source of income as a result of the COVID-19 pandemic. This includes those who have lost their jobs, become sick, or entered quarantine. Those who are eligible can apply for this benefit for up to four months.
Richter also suggests that the government seriously consider guaranteed minimum income across the country. These, he insists, should come in addition to greater investment in housing while protecting the rental housing market from financialization.
Richter predicts that if the current situation continues, the consequences for Canada’s homeless population could be more dire than they already are.
“If it continues and if there aren’t support measures put in place for lower income Canadians, then there is a very real risk that more people will return to homelessness.”
HELP FOR THE HOMELESS ACROSS CANADA
While advocates have criticized government and public health authorities for their slow response in supporting the nation’s homeless, the federal government has announced $157.5 million for assisting the general homeless population with physical distancing.
The City of Toronto has also launched a program focused on moving people out of congregate living situations, such as shelters, and into hotel rooms and apartments that have been bought or leased. According to Toronto’s general manager of shelter, support and housing administration, Mary-Anne Bedard, more than 2,500 people have been moved out of city shelters and into 27 different temporary sites.
As of Tuesday, the city says 352 people in the shelter system have tested positive for COVID-19, with two deaths and 306 active cases.
In British Columbia, more than 500 people have been moved from homeless encampments in Victoria and Vancouver into housing. The provincial government is also providing the population with smartphones. In total, 3,500 phones will go to those across the province, distributed by community organizations and the Social Planning and Research Council of B.C. Providing access to Wi-Fi and equipped with a data cards, the phones are meant to increase access to supports and services no longer offered in-person due to the pandemic.
In Winnipeg, a new community COVID-19 testing site for those experiencing homelessness recently opened. Montreal Mayor Valerie Plante also announced on May 21 that the city will be distributing face masks to its homeless population.
Seth calls on all levels of the government to come forward with organizing more housing and job opportunities, as well as mental health support. She explains that the cost of housing is cheaper than leaving the homeless population vulnerable and cycling through the health-care system.
“Many studies have shown that giving the homeless a stable home is cheaper than hospitalization when they get sick.”
The CAEH places the cost of homelessness in Canada at about $7 billion per year.
“Prevention is better than the cure,” she said.