In this issue of CMAJ, Alston and colleagues discuss the urgent and complex problem of homelessness among older adults, a growing population nationwide. 2 The latest report from the Canadian Institute for Health Information (CIHI) reveals that in 2023, 30,000 people will be homeless. In Canada, people experiencing homelessness admitted to hospitals lasted twice as long and cost more than twice as much as hospitalizations for people without housing. . 3 Both the CMAJ analysis and the CIHI report reveal the devastating compounding health effects of homelessness. This means that people are unhoused, become unwell when admitted to hospital, and are unable to receive the primary care and home care services they need upon discharge. The number of people experiencing homelessness is increasing and often faces the need for long-term hospitalization. Based care is needed and there are no alternative solutions, so some hospitals are building housing. Is this the most appropriate response given the current excessive demands on hospital resources?
The human suffering caused by homelessness is immeasurable. Chronically unhoused people live half as long as housed people, age faster, have more comorbidities, and live at a much younger age than housed people. develop a health condition. 5 Homelessness disproportionately affects Indigenous people, Black people, refugees and newcomers. Clinicians working in hospitals recognize the urgency of this issue. One reason for this is that recent years have seen a “surge” in emergency department visits by people who are homeless,7 and hospitalization rates are high. 8
The rapid growth of the unhoused population in Canada is the result of policy decisions. In 1974, more than one-fifth of all housing options were public or non-market housing, contributing to affordability for low-income people.9 However, social housing currently accounts for less than 4% of the total housing supply and rents. 10 The decline in affordable housing has a major impact on older adults, who often have fixed low incomes. Lack of affordable housing and adequate community support to age well makes older adults more vulnerable to homelessness, which has implications for the health sector. This problem has led several health networks to identify and implement upstream solutions.
First, hospitals can partner with social service organizations with housing expertise to emphasize to policymakers the importance of affordable housing. Better integration of health and social support interventions can also help support patients experiencing homelessness during hospitalization and discharge. 11
A more unconventional approach is for hospital networks to leverage public land and other potential resources to build supportive housing in collaboration with various levels of government and social service organizations. In 2009, St. Joseph Health Center established a housing corporation to increase widespread access to affordable housing in Guelph, Ontario. We received funding from the federal and state levels to build an 80-unit rental housing development for low-income seniors. 12 In Edmonton, Bridge Healing Transition Accommodation will launch in 2023 in partnership with Alberta Health Services, providing 36 transition beds for patients discharged from the emergency department. 13 In Toronto, the University Health Network (UHN) identified 51 homeless patients who visited the emergency department more than 3,300 times in 2023. 13 These data forced UHN to partner with the City of Toronto and a not-for-profit housing operator to build 51 units of permanent social care housing on a parking lot for high users of acute care services. it was done.
The fact that hospitals are dedicating scarce resources to providing housing is a testament to how undeniable the homelessness crisis has become, and how ineffective and costly traditional approaches, such as long-term hospitalization, have become.
In the Spring 2024 Budget, the federal government of Canada sought to redress the decline in affordable housing through several policy measures. The focus on building on surplus, unused, and vacant public land is particularly relevant to healthcare institutions. 14 Affordable and supportive housing initiatives for people experiencing homelessness are being built through various funding streams, including the $4 billion Rapid Housing Initiative. is highlighted and could provide funding to health organizations to foster meaningful partnerships to expand housing access for those who need it most.
Under ideal conditions, hospitals and other health care institutions would not need to build supportive housing. Realistically, the health sector will not be able to build enough affordable housing to eliminate the housing crisis. But health systems and hospitals can help in concrete ways. Leaving homelessness as a public health crisis is unsustainable, and Canadian society's inaction has proven too costly.
This is an open-access article distributed under the terms of the Creative Commons Attribution (CC BY-NC-ND 4.0) license, which permits any use or distribution in any medium, provided the original publication is properly cited. , reproduction is permitted. For non-commercial (research or educational use) and no modifications or adaptations. Reference: https://creativecommons.org/licenses/by-nc-nd/4.0/
