A unique community partnership featuring UHN has over the past three months helped more than 900 people experiencing homelessness isolate in two Toronto hotels as they overcome COVID-19.
From refugees and newcomers staying in shelters with their newborn children, to individuals and couples living on the streets, the sites in Etobicoke and downtown have since mid-April provided rooms, meals, medical care and community-based support for people who are asymptomatic or showing mild symptoms of the coronavirus. They do not require hospitalization but have no home in which to isolate.
"COVID-19 has compounded crises across our city," says Dr. Andrew Boozary, UHN's Executive Director Population Health & Social Medicine. "Partnerships and prioritizing our most resilient communities are the only way to get through this.
"And we need to commit to housing as a human right, not just for infection control, but as a matter of health and human dignity. The lasting treatment we have to collectively work towards is housing."
The two COVID-19 recovery hotels originated with a Toronto Region working group formed in April in response to the impact coronavirus was having on people experiencing homelessness. Ontario Health, the City of Toronto, UHN and numerous community-based organizations formed the group, which is co-led by Dr. Boozary, Angela Robertson, Executive Director of Parkdale Queen West Community Health Centre, and Dr. Andrew Bond, Medical Director of Inner City Health Associates (ICHA).
In addition to the hotels, the working group is also facilitating coronavirus testing for people experiencing homelessness and implementing harm reduction and street outreach initiatives.
The work at the COVID-19 recovery hotels is bringing together a collective expertise on behalf of some of the city's most vulnerable people. The partnership plays to each partner's strength: funding, resources and structure of two levels of government; infrastructure of UHN in terms of Infection Prevention and Control (IPAC), personal protective equipment, electronic health records and site management; doctors and nurses from ICHA, and on-the-ground know-how of community groups with harm reduction, peer support, case management and neighbourhood outreach.
"It's been a great example of how cross-sector partners can all come together and bring value to this work," says Wilfred Cheung, Acting Vice President, Health System Strategy, Integration and Planning with Ontario Health (Toronto). "The infrastructure that UHN provided has been critically important as have all the community providers stepping in and using their expertise to guide how best to provide care for this vulnerable population in order to deliver great care and the most positive client experience.
"When we think of where we want the healthcare system to go, this is the type of cross-sectoral partnership we want to support and encourage."
Through July 14, 917 people have been cared for at the two hotels – 668 in Etobicoke; 249 downtown.
To put those numbers into perspective, the City of Toronto's most recent Street Needs Assessment survey estimated that on April 26, 2018 there were 8,715 people experiencing homelessness in the city.
The two hotels managed by UHN operate like a City of Toronto shelter. People tested for COVID-19 – in the shelter, an assessment centre or via mobile test – who are positive or suspected positive, are transported to one of the sites to either wait 24 or 48 hours for final test results or isolate for 14 days. For discordant families or couples, where some people are positive and others are not, are isolated for twice as long.
"For discordant families, the recommended isolation period is 28 days, which we are able to provide at both recovery sites," says Andrea Sharp, Strategy Lead at Toronto Western Hospital (TWH), who manages the Etobicoke hotel location. "This approach allows us to support families to stay together, and at some points has increased our census significantly.
"In May, we had more than 50 children residing at the Etobicoke site."
Andrea, a trained social worker who in the past year has worked with UHN Vice President Clinical, Jan Newton, on community outreach from TWH, says the urgency of the pandemic made the COVID-19 recovery hotels a priority.
"We were responding to an outbreak emergency within the shelter system and hearing stories from around the world how negatively shelters were being impacted by COVID," she says. "So, there was a commitment made by all the partner groups to get this up and running as soon as humanly possible."
Jane Ballantyne, Manager of UHN Patient Relations, managed the downtown site in May and June. A registered social services worker who has held jobs in both the health sector and at the City of Toronto, she says all partners in the project have benefitted from the strengths of each other.
"The groups have come together in an unprecedented and chaotic time to do some really important work that needed to be done," says Jane, who first met Andrea 20 years ago when each was doing a student job placement at Toronto General Hospital. "Everybody who's there is there with the same principles and values guiding them, which is to uplift the folks who need it most."
Just as the partnership is unique, so is the setting. The two hotels, which are rented by the City of Toronto, feature different groups of people on different floors based on their requirements. The idea behind housing entire families and couples, even if only one person has COVID-19, is that by staying together – but in isolation – virus spread will be limited because people won't try to leave.
It's the same idea behind having on-site measures such as harm reduction supplies for drug users, a managed alcohol program, mental healthcare support and other key community-based initiatives.
"The people we've housed have very diverse needs – harm reduction supplies for some, diapers for others," says Dr. Leigh Chapman, Director of Clinical Services with ICHA, which in addition to supplying physician and nursing services is also looking to add pharmacy technicians and nurse practitioners.
"It's a kaleidoscope of service providers who have come together under the duress of COVID," says Dr. Chapman, a registered nurse with a PhD in Nursing, who also works part-time as a Senior Advisor with Dr. Boozary's Population Health & Social Medicine team at UHN. "It's a successful model to build on.
"Feeling safe is a luxury mainly afforded to people who are housed. It's something we've been able to give to people for a period of time during COVID and it's wonderful, but it's not a long-term solution."
That's a recurring theme with so many involved with the COVID-19 recovery hotels and the working group. While they are proud of the work they have been able to accomplish, they believe its legacy is in underscoring the need to embrace this community-based healthcare approach that starts with housing.
"For a lot of us, this has been a well-known set of issues for decades," Jane says. "As much as I wouldn't like a pandemic to highlight where the gaps are, it has certainly shown again that because of their financial, social, employment or immigration situations, some are disproportionately impacted."
Those sentiments are echoed by Andrea when asked if she considers the recovery hotels a success.
"If the goal is to provide a safe place for people from the shelter system or who are experiencing homelessness to self-isolate and recover from COVID-19, then yes, I think it's been a success.
"But the bigger systems question is, why is safe and affordable housing not available to all? While this project provides temporarily space for isolation, we need to work towards having the right supports in place that will ultimately end homelessness."
