BY ANDREA BODIE
Winnipeg Health Region
Published Tuesday, October 2, 2012
Life can change in an instant.
Raymond Troughton knows this as well as anyone. The Winnipeg man, who is in his mid-fifties, used to have a job as a shipper/receiver in a warehouse, and his own apartment. Then one day in 2011, his world changed. He was out of work, and very soon after that, he was out of his home.
Like many in his situation, Troughton was able to get by for a while, sleeping on couches at the homes of various friends. Eventually, though, he turned to an emergency shelter.
For several months, he stayed at Siloam Mission, living in close proximity to 109 others in the homeless shelter. For the better part of a year, he had no personal space and no autonomy, as one of approximately 2,000-some people in living in Winnipeg at no fixed address.
But then Troughton's luck changed for the better. Through a referral from Siloam Mission and by participating in an interview process, he was able to secure a room at the Bell Hotel Supportive Housing Complex at 662 Main St.
Opened in 2011, the Bell offers Winnipeggers like Troughton a chance at safe, affordable and permanent housing in downtown Winnipeg. With 42 self-contained suites, it is similar to other apartment complexes in the city, except it offers additional support via case management and health-care services.
Having a safe home to call his own has made a huge difference to Troughton, who says he enjoys the sense of community in the building. "Having a bed of my own is a blessing," he says. Having his own space makes it easier to deal with stress, so since moving in, he feels more rested and has put on a few pounds. "It's an incredible place," he says. "There's a lot of love and fun."
The Bell Hotel is one example of how the Winnipeg Health Region is working with other organizations to help people like Troughton.
Homelessness has a huge impact on both an individual's health and the health-care system. The Winnipeg Street Health Report 2011, for example, found that:
The homeless were three times more likely to have a heart attack.
One in five women who didn't have a fixed address was sexually assaulted within one year, many more than once.
Thirty-nine per cent said they couldn't get enough food at least two days a week.
Twelve per cent go hungry at least once a week.
One-third recognize not getting nutritious food is the hardest part of staying healthy while homeless.
Forty-five per cent spent at least one night in a hospital over the past year.
Of the 32 per cent of people who said they could not obtain prescriptions, 54.7 per cent of them said they couldn't afford them.
The Bell Hotel Supportive Housing Project was set up following the emergence of data from Toronto's Streets to Homes project, which showed that when people are housed, even without supports, health improved among 36 per cent of those formerly homeless. Manitoba's provincial government began to look at the results, to construct a similar model.
Sharon Kuropatwa, Winnipeg Health Region Project Lead for the Bell Hotel project during its implementation year, says there was a similar effect in Winnipeg. "All good things come from safe, stable housing. Housing alone changes people's lives in very important ways," she says.
The Bell Hotel was purchased by CentreVenture, and three levels of government, the Main Street Project and the Winnipeg Health Region worked together on the project. Winnipeg Housing and Rehabilitation Corporation contributed to the developmental partnership and is the building's landlord.
For the first year, along with offering health services to residents, the Region assumed leadership of the project. Today, Main Street Project staff are in charge, working on-site 24 hours a day, connecting residents with services to support their health and wellness.
Nurse practitioners at the nearby ACCESS Downtown health clinic are a part of that connection. The nurse practitioners are proactive when it comes to meeting this population's needs. For example, if someone doesn't make their 10 a.m. appointment, the nurse practitioner might call the Bell to see if they're okay.
Three philosophies guide the Bell project: Housing First, harm reduction and client-centred planning.
Housing First is in contrast to the traditional "Treatment First" model, which requires a person to complete treatment for mental illness or addictions before finding private housing.
Under Housing First, all people have a right to housing, explains Kuropatwa. From that perspective, housing models reflect the challenges presented by people who have been homeless for long periods of time. Using substances or criminal activity are factors that are considered, but don't necessarily prevent someone from being housed. While routine rental checks are still conducted on prospective tenants, the information is used to develop an eviction prevention strategy for the individual as opposed to denying them access to a home.
"Our system can feel like jumping through a lot of these hoops," says Kuropatwa. "Housing First offers a language and an approach that frames the issue through a human rights lens, compelling housing, health and service systems to re-imagine how housing can be supported for this population."
Many homeless shelters in Winnipeg require people to be sober to get in. Only the Main Street Project is considered a "wet" shelter. Some shelters have a "three strikes" policy, where if there's been an incident three times, you're banned for life.
At the Bell, house rules prohibit people from being intoxicated in common spaces but what happens in an individual's suite is private, as it is in our homes, says Kuropatwa.
When people are on the street, they're in survival mode. Once they're housed, even if they use substances, often the next progression for a person is getting their life on track, she says. For some residents, that means finding healthier ways to cope. For others, it means pursuing goals like family reunification, going to school or getting involved in paid or volunteer work.
"People have the mental space and physical energy to focus on other things. Being healthy and housed tends to lead people to reduce harmful behaviours," says Kuropatwa. "We're not their family or friends and the work we do doesn't put us in the role of parent. We're not going to focus on the service plan that we think they need but the one they want. We do get to know people and their story, so we can understand their goals."
This philosophy is necessary to deliver health care to this population, who traditionally meets health-care needs through emergency services, as they don't have a primary-care provider. Using emergency services to meet day-to-day health care comes with a high price tag. This housing model saves the system money.
Health experts report a 70 to 80 per cent reduction in tenants using emergency health services such as emergency rooms, ambulances and detentions under the "Intoxicated Persons Detention Act", when comparing data from 12 months prior to living at the Bell and during the implementation year.
"The people at the Bell are not homeless any more," says Kuropatwa, adding that the residents are regularly paying rent and learning how to clean their units, budget and cook. Each individual is learning to be accountable and autonomous. For many tenants, this represents an opportunity to make powerful, yet simple day-to-day choices, like who they would like to see and when, having a bubble bath or decorating their living space.
There have been growing pains during the pilot year, as the project is a radical shift in how to do business. Also, that change takes longer than a year, says Kuropatwa.
One of the biggest successes of the project is that 42 people have had greater stability in their lives. It's difficult to measure the impact of this, particularly given the elements that create stability are what most people take for granted, says Kuropatwa.
"While we have a world of work ahead, we're off to a terrific start," she says. "It's really the individuals who are changing their lives. We're just putting ourselves in a different position as a health region to facilitate those changes."
When residents are asked what's changed for them, they all say the same thing: everything. Propelled by that, they can dare to dream a little bit bigger about who they are and their place in this world.