The Mess that is Healthcare for the Homeless

My primary activity with the London Homelessness Outreach Network is to explore street-level healthcare for people who are experiencing homelessness.  The idea is that we know there is a gap in care in terms of healthcare services that go out to people, rather than requiring them to go to the care.  So, although there are clinics such as InterCommunity and the Centre of Hope FHT, or walk-ins and emerg, these all require that the individual accessing the service goes there, waits, and sees a professional in an examination room.  This often leads to people waiting far too long to access care, and having complications of relatively benign conditions.

Our initial thought is that we should create some kind of community health bus that brings the care to places where people are at, and can also provide some kind of system-wide coordination/communication.  However, in talking with folks around town, we have found that more agencies are continually adding more services, but with little coordination or thought for the big picture.  For example, while we were engaging in our discussions, a local shelter started to host CCAC nurses.  The goal was to pick up patients who would go missing after being rostered to CCAC in emerg, but to also provide minor care and triage for anyone seeking assistance.  In talking with them, they stated their current goal is to get a nurse practitioner or a physician to join them.

So, the problem is, we just keep doing more of everything, without thinking about how, why, who, what, when, and where we should really be doing this.  People who are homeless in London continue to have high morbidity rates and low age of mortality, even though we keep adding more providers into the mix.  Our solution is to host a community summit in the fall to bring together all parties who are currently involved to do some mapping, do some ‘follow the money’ exploration, and see if we could do smarter rather than just doing more.

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