Nowhere to Isolate

Homelessness in Hiding is a podcast that discusses youth homelessness in Peel Region and elevates the voices of people with lived experience while highlighting social service workers on the frontlines. This conversation addresses the gaps in healthcare that complicate access for a person experiencing homelessness, and highlights the importance of providing coordinated services from trained nurses specialized in trauma-informed care for people of all ages. Homelessness in Hiding is produced by the Restoration and Empowerment for Social Transition Centres (REST Centres), an organization that combats housing insecurity among BIPOC youth in Peel. In this episode, producer and host Mya Moniz is joined by Rasheen Oliver, Director of Operations, and Kimone Rodney, Nurse in Charge, at Homeless Health Peel. Founded in 2020 in response to the COVID-19 pandemic, Homeless Health Peel provides coordinated access to healthcare for people experiencing homelessness in the Region. This is an edited and condensed version of Homelessness in Hiding episode 5, first released March 25, 2022. 

Kimone Rodney: We ended up at Homeless Health Peel when the pandemic happened. They were pulling nurses from hospitals and community settings to help as they started the isolation program. I loved our philosophy and what we stand for: our value in trauma-informed care, autonomy, and self-determination. I was like, “This is me.” At that time, our contract was month-to-month. We literally gave up our full-time job that we had—that had stability—and went into an isolation centre to help our community out when the world was in dire need of nurses. And we went straight forward. That was it. Now, we haven't looked back. 

Rasheen Oliver: Not for a moment. I was wrestling with wanting to leave the nursing home. I was yearning to learn more, in my field, within my scope. Coming over and seeing [everything] within the first week of working alongside the nurses, as well as [working with] our Nurse Practitioner, Clinton Baretto, I had learned so much from him and I fell in love with the work. I'm glad that Kim accepted the position and brought me along. 

MM: I want to start off by defining what homeless healthcare is and why [it] deserves attention. I have a statistic from the World Health Organization. There are social determinants to health, which they define as “the non-medical factors that influence health outcomes.” These factors are often out of one’s control such as, “the conditions in which people are born, grow, work, live, and age,” as well as “the wider set of forces and systems shaping the conditions of daily life.” That can include things like economic policies and systems, development agendas, social norms, social policies, and political systems. Near the top of the list is “access to stable housing.” With these social determinants in mind, my question to you both is: 

RO: Our goal is essentially to ensure that homeless people have access to healthcare. In Peel, there isn't an agency that provides access, and we're the only region that doesn't have it. So, people are going to hospitals and walk-in clinics to access care. And when they do such things, for lack of better words, there's a lot of hands in the pot. There are a lot of people dealing with the care, and there's no follow-up to [it]. Essentially, what Homeless Health Peel is trying to do is become that agency where people know that they can come to us, and they're able to get these services and we're able to follow [up with them] whether they're in Mississauga or Brampton. We want to have a nurse in every shelter, whichever city they go to, [so] we're able to track their care and assessments. 

KR: Why do the homeless have to be in [their own] category away from regular population? It infuriates me. What we've noticed at the isolation centre was when patients would go to the hospital for COVID-related symptoms, they weren't seen as patients, but they were put on a bed in the hallway. [Many unhoused people] didn't even have ID, they didn't have health cards, and no one was helping them with that. A lot of them are not on Ontario Works (OW) or Ontario Disability Support Program (ODSP), where [access to] medication and certain [supports] can be built. What the hospital did was send the patient right back out. A doctor never assessed them. They were never seen by a nurse. Just the fact of them being homeless, and they're not getting the same care. It makes me sad that we have to have a subcategory for the homeless. But this is why Homeless Health Peel is here. We're trying to break down those barriers.  

KR: While everybody else had their home, the homeless had nowhere to isolate. Shelters were overcrowded. There are not enough beds.…When they came to the isolation centre to isolate and to social distance in order to stop the spread of COVID-19, it wasn't a runny nose, or chills or fever, it was addiction withdrawal that came along too, and a lot of them didn't have their medication with them. We had their mental health, addiction, [and trying to access] harm reduction, [which] we were dealing with in an isolation centre in a hotel. 

KR: In the shelter, there's no one there managing medication. Some of them need to be tapered off certain medication, or some of their medications need to be changed. Some of them have family doctors, but if they don't have OW, or ODSP, they don't have funding to be able to take the bus to their family doctor. If no one is doing follow-up work with them, the cycle continues. I understand that the world was at the mercy of COVID-19, but it really shined a spotlight on what the homeless are facing. It wasn't just a cough, runny nose, and a fever. They were dealing with so much more. 

RO: Lack of funds and transportation to get to a healthcare provider. Some of them may be chronically depressed. To get up and go all the way down to Toronto—that's a barrier for them. If you're chronically depressed, you're homeless, you’ve got a lot of things going against you, do you really want to get on a bus and go all the way down to Toronto or to see a specialist? 

RO: They shy away from it. ID is a big one. If you don't have a health card and you're going to the hospital, they're asking you these questions: where's your ID? Where's your health card for a clinic? If unhoused people don’t have OW or ODSP, the doctor prescribes a medication, but then, they don't have the funds to pay for the medication.  

KR: If they don't have the funds to get the medication, nobody even assists them to find out why. A lot of times, it’s their OW. Their OW is frozen, it got frozen, or the ODSP got frozen, because they're deemed to be difficult. 

RO: Or they are blocked from a different region. For example, they're coming from Toronto, and they're coming to the Region of Peel—their OW was cut off, they've got to reapply for it in this region. What if they need their medication right now? And they have to wait for a whole process: go into the shelter, get a housing worker, fill out the application, but they need it now. […] It has to be a holistic approach with wraparound services, because it's not only stable housing that they need, but what about their health? What about the pain that they're having? If they're having a lot of pain, and you get them into stable housing, and they're able to pay for [it] but they have so much pain that they have to seek drugs…how long are they going to have that stable housing for? They need that follow-up care. 

KR: I think first we just need to look at ourselves, because we all could have made that one bad decision [where we] could have ended up homeless. [At] Homeless Health Peel, we meet [unhoused people] where they're at. For a lot of them, they were working, had a work injury that hurt their back, a doctor put them on Percocet and gave them a whole bunch at once that they abused. That’s how they started tapering down. The stigma that's been portrayed out there for the homeless is how they look: “They're addicts, they might rob you, or beat you up.” We've worked at the isolation centre with all of them. When they are going through the worst withdrawal you can ever think of, they are very respectful. Never [have] I felt like I was put in a position or a situation where I was going to be harmed or hurt by any of them. Never once, and we've seen hundreds, maybe even thousands of them that have passed through the isolation centre. When you hear someone's telling you, “This is not who I used to be. This is not who I want to be anymore.” Asking for help; not receiving the help. It truly does break your heart. 

RO: They’re not receiving the help because of the way they look. They're perceived as dirty, or people [fear] homeless people. They're people just like us. They're perceived as criminals. People look down on them. So, they don't get the treatment. Whereas if they were clean, shaved, with clean clothes on, they get treated differently. They're now fearful to go to seek healthcare, because they don't want to be looked upon like that. They'd rather stay amongst the people who they're with, where they're not being judged. 

KR: The fact that they had to isolate was hard for them. They were in a hotel room by themselves now, and everybody's thinking, “Why are they complaining? They should be fine.” But all their traumas are coming back to haunt them. They've always been on-the-go. A lot of times they get into substances to mask what they're feeling. Now, they're not using any substance[s], they're getting cleaned up. All of their traumas come back. They don't know how to internalize what they’re feeling. They've never been taught. This is where the urge comes back in to self-medicate. So again, it wasn't just COVID-19 we were dealing with.  

MM: I think there's definitely a gap between the shelter and the instant sort of help. [In] thinking about the long term, especially regarding mental health, you’ve said it: you can't have all these individuals in a shelter for the rest of their lives. They need long-term housing [and] they need long-term healthcare. It’s that transitionary piece that I've picked up on that is lacking. 

KR: But you're on the outside. I completely understand where you're coming from. And this is what everybody sees on the outside, but we're in it, right dead-centre in it. It's not just about one thing; not having access to healthcare, that's a big part of it. But there's so many other things as well. And then, the youth are going into adulthood, and then they're becoming seniors. Alzheimer's and dementia are kicking in. You can't have thirty, forty, fifty, sixty men or women in a shelter that have Alzheimer's and dementia. So, what is the future plan? 

KR: What frustrates me are the barriers. I've never been affected by a patient. All our nurses get trauma-informed training. That's how we lead. A lot of times a patient gets deep into just wanting to talk; we listen. We're not trained therapists or counsellors. A lot of times you hear a patient say: “You know what, thank you for listening. I haven't had anyone that has listened to me in a long time.” That is where [the] majority of my energy goes [as well as] trying to get them their IDs, or trying to get them that 24-hour drug card so that we can get them back on their medication. A lot of them are on narcotics, we can't just supply them with a seven-day supply of narcotics—their methadone—they have to go to a pharmacy every day to get a daily dispense, because it's an observed dosing. Without funds, without money, without their health card, the pharmacy won't be able to provide them with any of that. It goes really, really deep. What we do at the isolation centre is we just focus on who we have in front of us, and we just take it one at a time. The frustration doesn't come from the patients. I enjoy seeing them. I enjoy our conversations.  

RO: I agree with Kim. It's the barriers and the lack of support that they get, and the lack of people's willingness to help them, which goes back to being stigmatized, and then they don't want to go to the people who are supposed to be helping them. There's a thing that we always say in our office, “Stay in your lane.” As the nurses, practicing in a trauma-informed way, providing trauma-informed care, we want to be able to give them that wraparound service, but there's only so much that us as a nurse can do. There are other people that have their roles that they have to do. When you hear the patients saying stuff like, “I don't want to go to them and ask for their help.” And they're asking me for the help and it's out of my scope, like getting ID—I don't know how to do it. My frustration is the lack of helping people showing the willingness and the compassion. Where's the compassion? If this is what you're here to do? This is what your role is in helping them.…Why can't we get it done? Why can't we work together and get it done for them? Why do they have to wait? People are looking at them like, "Oh, they're homeless. They can wait. It doesn't have to get done right now." No, it does. Because based on other people's work, this is how we complete our work. This is why we all need to be on the same page. Like Kim said, [the frustration never comes from] the patients. 

RO: It seems like a simple question because we know we've impacted the community in such a positive way. How do we put that into words? We see the outcomes of what we've done. We've gotten people into long-term care facilities, gotten them off the streets, gotten a few people in housing. We've seen positive outcomes. We had a patient that came to us from outreach. He was an elderly man; he was considered palliative, had cancer, and he came into the isolation centre. Through the services that we provided to him, we were able to nurse him back to health. He was able to get up and walk. When he came, he wasn't able to walk that well, wasn't steady on his feet, and needed a commode by him to use the washroom. After a few months, we were able to transition him into long-term care.  

RO: We'll start with checking ourselves when we come across somebody who's homeless. We [tend to] automatically start stigmatizing, judging, and looking at them differently. It has to start within everybody; you and how you look at them, because they're no different. They were just dealt a bad hand; as such, all of us could have been dealt a bad hand, and could have went down that path. [Take] a chance to speak with these people because they all have stories, and they're heartbreaking stories. How the community can help is by looking at yourselves and how you react when you see a homeless person. Because essentially, that will be a doctor, that will be another nurse, that will be a social service worker, that will be a grocery store clerk. [Everyone] that these people have to deal with, if they are looked at just as if they were clean [and] in proper clothes, they wouldn't face a lot of the barriers. They wouldn't feel like, “I’m scared to go to the hospital because of the way people are going to look at me. I'm scared to go to certain places because of what people are going to say to me.” Let's figure out how we can help them to overcome these barriers as a community. 

KR: To add to Rasheen, COVID-19 had shined the spotlight on what's happening in terms of the barriers that the homeless are facing, but I think, whether COVID-19 is dying down or we learn to live with COVID, we need to continue to have this conversation. Start reaching out to your Regional Council or the mayor of your city and start having these conversations. What we need is funding, in order for us to do the work. We're ready and willing. We have a team of twenty-five nurses that are ready to be placed in a shelter [and] ready to have our own facility where we can start helping our community. Even though we've been doing this for the last two years, we have the records, we have the data to show that our model [is] working, and it's very successful. But it's the constant conversation of: why do the homeless need nursing? I think we just need to continue to have this conversation. People need to continue to be aware that this is a problem. My fear is that when COVID-19 is finished, then what? What happens to them? Do we just go back to how we were? That is why Homeless Health Peel is here. We're willing to do the work.  

MM: Every day, people experiencing homelessness struggle to be seen, heard, and advocated for, especially in regards to their health, from fighting the uphill battle of stigmatization to receiving the same standard of care that we as residents of Peel and as Canadians take for granted. These human beings have been consistently overlooked by not only the healthcare system, but by us. Our community needs to come together and consider the lives of those experiencing homelessness as valid and as deserving of care.