Homelessness and the health-care system

A letter from the Winnipeg Health Region

Winnipeg Health Region President & CEO
Wave, May / June 2014

Arlene Wilgosh
Arlene Wilgosh

Here at the Winnipeg Health Region, we spend a lot of time working to improve the efficiency and quality of our health-care system.

And the thing that seems to be at the heart of a lot of these efforts is the need to improve "patient flow." Let me explain why.

The term patient flow is generally used by administrators to describe how patients move from one department to another once they have entered one of our hospitals or clinics.

As I have noted in this space in the past, when patients are moving through our hospitals and clinics efficiently, it means we are providing the right care to the right people at the right time. When they aren't, it means we can expect to experience longer wait times throughout the health-care system, especially in the Emergency Department.

We also know how important it is to increase access to primary care. As you might expect, we have taken a number of actions to improve access to doctors, nurses, nurse practitioners and other health-care professionals.

For example, we have established QuickCare Clinics throughout the city in a bid to provide patients with an alternative to visiting hospital Emergency Departments.

We also opened a new mental health Crisis Response Centre last year. Located at 817 Bannatyne Avenue, this facility offers 24/7 walk-in urgent mental health-care services, as well as scheduled mental health services. It also serves as the home base for the Mental Health Mobile Crisis Service. Over the last year, it has taken on many patients who might have ended up in a hospital Emergency Department. The recently opened ACCESS Winnipeg West on the campus of the Grace Hospital - one of five ACCESS centres in the city - is another example of how we are providing community-based alternatives for the delivery of care.

Of course, there are a number of different things that can affect patient flow, including some that are not entirely within the Region's control. A report released earlier this month outlining issues associated with homelessness underscores the point.

Produced by a group of Winnipeg business and social services leaders, the report points out that homelessness should no longer be considered an intractable social problem that can never be eliminated. To the contrary, The Plan to End Homelessness in Winnipeg argues that housing should be considered a human right.

"This is consistent with the United Nations Charter and other international laws, such as the International Covenant on Economic, Social and Cultural Rights," the report states.

In addition, the task force's report offers up a 10-year blueprint for eliminating homelessness, including 33 strategies that can be adopted in the first four years. Read more details about the report and its recommendations here.

What does all this have to do with the health-care system? Quite a bit, actually. As the Main Street Project noted in a report published in 2011, many of the people who don't have a roof over their heads tend to be people who suffer from mental health disorders such as depression or schizophrenia. They may also suffer from a range of physical ailments and be at increased risk for developing illnesses such as tuberculosis.

A good number of these people often end up in hospital Emergency Departments when they have health issues. That's not because Emergency is necessarily the best place for them to receive care. It's just that, through no fault of their own, they have nowhere else to go, and it is open 24/7.

Our efforts would be better placed taking actions to minimize the risk of homelessness and, at the very least, improving primary care outreach to the population before their health deteriorates.

The Region's Point Douglas/Downtown Community Area has developed its Health Outreach and Community Support Service to do such work with this population by bringing services to the homeless population and especially those in shelters.

Efforts like this should reduce reliance on Emergency Departments. This is more appropriate than relying on Emergency, is less costly and, in the end, is likely a more sustainable approach to dealing with homelessness.

The cost to the health-care system of failing to address homelessness is not insignificant. The task force report notes that at least one study suggests that the homeless are five times more likely to be hospitalized than the average person. Numbers produced by the Region suggest that it costs about $700 a day to treat someone in an acute care bed. By comparison, the Main Street Project reported in 2011 that the cost of a bachelor apartment for a homeless person is about $16.37 a day.

The good news is that we can address this issue. Research shows that when people have a proper, permanent home with appropriate health supports in the community, they are much better able to take care of themselves, and are better able to access the care they need more efficiently. In other words, by taking action to solve one problem - homelessness - we can help address another - unnecessary hospital visits and admissions.

Now, none of this is to say that ending homelessness will be easy or that doing so will magically eliminate all the demands on the health-care system. Far from it.

But the fact remains that by working to end homelessness, we can eradicate a social problem that has been allowed to continue for too long. The fact that doing so will also relieve some of the pressure on our health-care system is just a welcome bonus.

Wave: May / June 2014

About Wave

Wave is published six times a year by the Winnipeg Health Region in cooperation with the Winnipeg Free Press. It is available at newsstands, hospitals and clinics throughout Winnipeg, as well as McNally Robinson Books.

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