Homeless people in Edmonton are at greater risk of a slew of physical and mental health concerns and are having a disproportionately large impact on the health-care system.
That’s according to a report that Edmonton city council’s community and public services committee received from Alberta Health Services (AHS) executives on the effects of homelessness on the health-care system at a committee meeting Tuesday.
“Being homeless is a risk factor for so many downstream health effects: injury, assault, poisoning, amputations, frostbite,” said Dr. Chris Sikora, lead medical officer of health for the Edmonton zone, who gave the report alongside Selene Tash, executive director of community health services for the Edmonton zone.
A count from Homeward Trust shows that as of Monday, there were more than 2,800 homeless people in Edmonton, almost a third of whom were sleeping outdoors. About half were “provisionally accommodated,” meaning their housing is temporary or lacks security.
To study the health problems that homeless people are more susceptible to, AHS identified a group of more than 1,100 people that are known to use homeless shelters in Edmonton and tracked the broad health challenges they had over a three-year period.
Eighty per cent had drug or alcohol dependence. About half dealt with skin infections or injury. Almost 40 per cent had open wounds and 30 per cent had pneumonia. Almost half of the patients dealt with drug poisoning.
Sikora gave an update on another health issue that people in Edmonton’s inner city were uniquely affected by: the shigella outbreak that began last fall. By the end of January, AHS reported 200 cases of the infectious disease usually found in developing countries. Two thirds of the cases required hospitalizations. Only four cases were reported in January.
Sikora said a study done by the University of Alberta’s injury prevention centre found that from 2019 to 2020, homeless people in Edmonton made 5,800 visits to the emergency room. The leading causes for these visits were poisonings, falls, environmental factors like cold, and violence.
About four per cent of people showing up to emergency rooms with traumatic injuries were homeless, despite only making up about 0.25 per cent of Edmonton’s population.
“Individuals that are underhoused are at increased risk for violence,” said Sikora.
However, stable housing contributed to a decrease in visits to the emergency room and length of hospital stays for people experiencing homelessness.
The report contained a high-level evaluation of “a handful” of people who got into permanent supportive housing. When comparing their medical visits two years before landing housing and two years after, there was a decrease in visits and the severity of stays.
“After being housed, there was a 58 per cent drop in the number of inpatient admissions and 81 per cent drop in the overall number of inpatient bed days,” said Sikora.
Sikora added there was a nearly 50 per cent drop in the number of visits to emergency departments and a decrease of 68 per cent in the number of noted addictions and mental health-related EMS events.
“Housing works,” he said.
The executive director of Radius Health agreed, saying that she sees her patients get housing and then stabilize in their medical conditions.
“Unfortunately, we also see patients lose their housing for one reason or another and then completely destabilize in their health status,” said Tricia Smith.
According to Smith, there is a severe lack of detox beds in the city for those looking to fight their addictions. She said once the client decides to get clean, they have to line up for a bed and may get turned away and asked to come back the next day.
“When you’re in active addiction, that decision to go to detox is a really difficult one,” Smith said.
Smith said she hears from clients and partners who provide detox beds that sometimes 30 people will be lined up for three beds and staff have to triage, meaning 27 people don’t get a chance to detox.
“We hear that from our clients as well: ‘Today’s the day I want to detox, but there’s nowhere for me to go,’” she said.
Sikora said there are 42 detox beds at Alberta Hospital that are full with a waitlist and a handful more in the community.
Smith said one of the services the city can provide to help keep the homeless population as healthy as possible is hygiene facilities, like the ones the city provided during the shigella outbreak.
“We need public bathrooms, showers, we need laundry facilities, but we need them permanently, not just when there’s an emergency,” she said, adding that while these are sometimes available in shelters, they’re only open in the evening.
Bradley Lafortune, executive director of Public Interest Alberta, said minimum shelter standards are needed as well as a “massive reinvestment” in permanent supportive housing and near-market housing.
“We need investments in wraparound supports and services so that those supports and services can walk alongside individuals when they’re being housed and rehoused, so that we don’t see a failure in Housing First policies,” said Lafortune.
Ward Karhiio councillor Keren Tang said a takeaway from Tuesday’s meeting will be the need to centre the conversation around what she calls a public health crisis.
“I think the past year and a half we’ve been putting disproportionate attention on the public safety aspect of it – criminalizing homelessness and poverty – and I think that shifts the conversation around what solutions are appropriate,” said Tang.
“How do we create belonging? How do we create connections at a neighbourhood level so that we can provide the best service, programs and support that’s needed so people can thrive and stay housed?”
Ward pihêsiwin councillor Tim Cartmell said he wants to strengthen the city’s shelter system with more 24-hour access and minimum shelter standards.
“Clearly, there’s a lot of work to do and a lot more resources needed,” he said.
“It’s going to take everybody coming to the table. I do think it’s achievable but it’s not overnight.”