Recovery site for homeless COVID-19 patients offers dignity and a pathway to housing
A homeless mother lies in bed with her new born baby snuggled up beside her.
Mom recently tested positive for COVID-19, but her new bundle of joy is virus-free.
Toronto doctors recommended that mom and baby not be separated, in large part because studies have shown a low likelihood of COVID-19 transmission from mothers to babies during and after pregnancy.
And weighing the pros and cons, it was decided that keeping baby and mom together was better for their bonding than separating them.
Their room isn't in a hospital. Nor are they in a homeless shelter.
They're in the city's new 200-bed COVID-19-positive recovery site for Toronto's homeless, a new hybrid model of care that's part of the city's $200-million effort aimed at helping homeless people during the coronavirus outbreak.
The recovery site in Toronto's west end opened in mid-April and operates out of a major chain hotel the city is leasing during the pandemic, one of about 12 private hotels the city has already leased or bought to house the homeless during the pandemic.
Most of the hotels were obtained by the city to facilitate social distancing between homeless people who aren't infected, and the city intends to lease 15 more hotels, motels or private highrise buildings for the same purpose.
But the recovery site for COVID-positive homeless people is so much more than that. It's a unique collaboration between the University Health Network, the city's Shelter, Support and Housing Administration, Inner City Health Associates and community organizations Parkdale Queen West Community Health Centre and The Neighbourhood Group. All are co-leads on the site and recently signed a legal memorandum of understanding to work together and operate it.
The organization Doctors Without Borders/Mi(C)decins Sans Frontier Canada is also involved, providing expertise on project co-ordination and logistics when it comes to dealing with a large scale pandemic, given the organization's experience dealing with major outbreaks overseas, such as malaria and Ebola.
Additional support is provided by community organizations Breakaway Addiction Services, LAMP Community Health Centre and Toronto North Support Services.
Among the primary goals of the recovery site is treating homeless patients with dignity in a clinical setting and ensuring they have a home to go to afterward - not a return to homelessness.
"We need to commit to housing as a human right, not just for infection control but as a matter of health and human dignity," explained Dr. Andrew Boozary, the UHN's executive director, health and social policy, a social medicine lead who is involved in helping set up the recovery site. "The only lasting treatment we have is housing."
"This isn't a hospital. People there don't require acute care. But neither is it a shelter because we have infectious disease protocols in place and wraparound health supports. It's a new model for the city's most vulnerable to recover in a dignified way," said councillor Joe Cressy, who chairs Toronto's Board of Health.
"It's a critical piece of care, a critical new health resource," Cressy later added.
Plans are in place for a second recovery site, this one also in a hotel but in downtown Toronto. It's slated to open in the coming days and will provide more than 250 beds.
Earlier this year, as the virus took hold around the world, health care and housing leaders in the city began talking about the effect of COVID-19 on the city's homeless population.
For example, Mary-Anne Bi(C)dard, general manager of the city's Shelter, Support and Housing Administration, spoke with physicians with the Inner City Health Associates, a group of more than 90 doctors working in more than 50 shelters and drop-in centres across Toronto.
"We identified that there would likely be a high number of people testing positive because of the high contagion level of this virus.
"Also people who got sick, but not sick enough to stay in hospital - a lot just get flu-like symptoms - if a lot of people from the shelter system " couldn't return to shelters because of their (COVID-positive) status, that was going to really overburden the health-care system in a way that wasn't needed because they didn't actually have to be hospitalized. But they have no other place to go," Bi(C)dard said.
"So we recognized early on this (recovery site) was going to be critical - not just because of the overburdening issue but also to make sure this clientele received the support they needed and felt comfortable with," Bi(C)dard added.
At the recovery site clients have their own room, washroom, television, and they're delivered three meals a day and two snacks, visits that provide staff an opportunity to check in on the welfare of residents.
As well as doctors and nurses, there are also community-based workers including peer support workers who've experienced homelessness and challenges with mental health and substance abuse.
"We also check in multiple times a day by phone to see if they're OK or need anything. We also escort people who want to go outside to smoke, in an outside secure smoking area. It's another opportunity for social interaction with people so they don't feel too isolated," Bi(C)dard said.
This week there were 105 COVID-positive residents at the recovery site. An additional 16 have recovered and been discharged, Bi(C)dard said.
Staff in the site have full personal protective equipment and maintain a six-foot separation from clients during these interactions. Health-care staff doing blood pressure or heart monitoring, for example, come closer, but those are nurses and doctors who are trained on how to do those activities safely.
Fine details to protect staff working in the site - even down to the location of hand sanitizers depending on "low-risk or high-risk zones" - have been worked out to ensure safe pathways, explained Dr. Andrew Bond, medical director at Inner City Health Associates.
There's also a harm reduction component for residents at the site. That includes an on-site managed alcohol program and harm-reduction supplies for people who use drugs, Bi(C)dard said.
Harm-reduction staff also provide crisis de-escalation and "trauma-informed" motivational interviews and other therapeutic approaches.
The recovery site is "going incredibly well," said Bi(C)dard. "Nobody knew at the beginning how it was going to go. When there are multi-partnership arrangements like this, there's always a bit of nervousness."
There are a variety of ways clients arrive at the recovery site. In concert with Inner City Health Associates, directives were developed and given to all the testing centres and hospital emergency departments in Toronto.
When there's a COVID-positive test result for a homeless person at one of these facilities, there is a referral to the recovery site through an Inner City Health physician.
There's also an isolation site in Scarborough where homeless people are sent to await their COVID test results. Clients are sent from there to the recovery site if they test positive, again with direction from an ICHA physician.
There's a third group that can isolate at their home shelter where that's available. The homeless person remains there until their COVID test result comes back. If positive, the same co-ordinated referral process involving an ICHA physician is in place to move the person to the recovery centre.
Transportation is provided by the city's fleet services.
When it's time to leave, the recovery site team works on getting housing for people.
That could mean going to one of the physically distancing hotels for homeless people who aren't infected. Hotels, rather than traditional housing, are used by the city because they are "quickly responsive" to surges and contractions in demand from the city, Bi(C)dard explained. It was easier for the city to secure hotels to deal with the coronavirus than it is under normal circumstances because many of Toronto's hotels were closed due to the virus.
People leaving the recovery site might also be sent to a Toronto Community Housing unit or a private market unit with the tenant possibly accessing a housing allowance. There are also efforts to connect departing clients to outside case management support.
"We recognized that discharge planning would be very important for this group. Even after you've recovered from COVID-19, you still have a vulnerable health status," Bi(C)dard said.
Donovan Vincent is a Toronto-based reporter who covers housing issues. He can be reached at dvincent@thestar.ca.