Opinion Piece
By Stephanie Molloy
I was reading Canadian Jesse Thistle’s autobiography From The Ashes: My Story of Being Metis, Homeless, and Finding My Way” (1) when I came across a few passages that really moved me. Particularly, those about Thistle’s journey after shattering his right heel and ankle joint, breaking his left wrist, and spraining his right wrist from a35-foot fall. His healthcare treatment was primarily in Brampton, Ontario sometime between 1997-2008. While I personally have not dealt with the Ontario Healthcare system, his experiences within Canada were noteworthy. Below, are two quotes that describe the scenario in which he faced:
“The surgeons decided it was best to leave my wrists exposed so I’d be able to walk with crutches” (p. 236)
“They sent me home after three days - scabs hadn’t even formed” (p. 236)
Although homeless, after his ankle surgery, he was able to stay with his brother for a while, but soon had to move on. Having an unstable housing situation, infection and gangrene developed in his right leg - leading to a return to the hospital.
There, he was given an antibiotic prescription, a suction-pump machine for leg circulation, and an aftercare nurse was to come twice a day to change his dressings. Upon telling the doctor he would be staying at a homeless shelter, the doctor’s expression changed. Thistle could tell that his journey to recovery from this injury would not be straight-forward. Heknew he had held his own on the streets and shelter system before, but things were different now.
“The first night at the shelter, the pump disappeared. By the third and fourth nights, my prescription was stolen. A week into my stay, the infection was back. Not surprisingly, the nurse never came. When I had the pump and my meds, I could at least feel hopeful, I could at least dream of keeping my leg and walking on my own again. Now I had nothing. I wanted to forget everything. I gave up.” (p. 243)
I’m going to repeat that again: “Not surprisingly, the nurse never came … I had nothing … I gave up”.
As a health care worker, and especially a physiotherapist who would treat this type of injury in an outpatient clinic, I was appalled, disgusted, but sadly, not shocked in the slightest.
As a Canadian I have seen homeless individuals begging for cash to take a taxi to the hospital for their check up, witnessed individuals limping in a cast or boot long past the expected time it would take to recover, and seen individuals who clearly need crutches or walking aids go without, the list goes on.
Also not surprisingly, if you’ve taken a hard look or are up to date on the data, the majority of homeless individuals in Canada are Indigenous. Their relationship with our healthcare system is a double edged knife of anti-homeless discrimination and racism.
From reading this deeply personal experience, and truly having it stare me in the face, I was inspired by what a better world could look like for physical rehabilitation and continuity of care for Canada’s homeless population.
To understand hospital discharge planning in Canada a survey was done in 2017 (2) which found:
“hospitals and homelessness sector agencies often struggle to coordinate care. The result is that these patients are usually discharged to the streets or shelters and not into housing or housing with supports. The health care and homelessness sectors in Canada are currently structured in a way that hinders collaborative transfers of patient care.”
Additionally, data from the USA (3) finds that homeless individuals are re-admitted nearly 4-times higher than other low-income patients.
A homeless patient who was readmitted a week later stated: “I was not ready to go and it was quite frustrating to have to come back. I was quite angry. I don’t want to go back [to the shelter] when I’m not really feeling better than when I came in.” (3)
Which leads to my vision. Rather than discharging patients to shelters or simply onto the street, a dedicated facility needs to be created specifically for homeless individuals who are ready to leave the hospital.
This facility would look a lot like inpatient rehabilitation, but would be specifically for the homeless population. Just like a hospital patients would get their own or a shared bedroom, meals would be delivered, care would be personalized and brought to them. There would be doctors, nurses, aids, social workers, psychologists, support staff, physical and occupational therapists. There would be communal spaces for recreation, peace, and healing. There would be a connected safe consumption site for patients struggling with addiction. Mobile patients would be free to wander around unaided, like a care home. The services would be completely free, covered by tax money like other outpatient rehab.
It would be a place to heal physically from whatever trauma the individuals went through. A housed individual with 2 injured wrists and a shattered ankle would never be on crutches with our healthcare system. For a homeless individual it’s the best option to maintain autonomy - but their healing is at risk. To this day (2019), at the end of his autobiography Thistle complained that his foot will never be the same or normal again. He awakes everyday to shooting pain with his first steps.
What the homeless population, in Canada and globally, need is a place to properly heal. Different from an addiction rehabilitation center, specifically to heal physically from hospitalization and injury. A place that would set them up for future success. A place where the individual has the choice to stay or to leave, to seek spiritual healing or not, or seek sobriety or not, to transition to an addiction or other such like rehabilitation center after.
For now, all we are doing is subjugating our homeless population to a lifetime of pain, recurring injuries, misaligned healing, and validating in their mistrust of the healthcare system.
How could anyone possibly heal when their health supplies are stolen? When care never arrives? When they are unable to even have a shower or soap? How could anybody heal in such conditions?
The gap in continuity of care in Canada’s homeless population is enormous, and it harms people as well as floods our system with unnecessary re-injury and failure to heal. To truly have person-centered care, to truly do what’s best for a patient to thrive, is to have somewhere safe where they can go to recover.
An in-patient physical rehabilitation facility for our homeless population is not only an idea, but has become a necessity.
**Disclaimer: In my personal view, homelessness itself should be eradicated so problems such as nowhere to go post hospitalization should not exist. Currently though, Canada has an ever growing homeless population and given such, these problems need to be addressed now while they are the current reality.
References:
Thistle, J. (2019). From the ashes: My story of being indigenous, homeless, and finding my way. Simon & Schuster Canada.
Buccieri, K., et al. Hospital discharge planning for Canadians experiencing homelessness. Hospital Discharge Planning for Canadians Experiencing Homelessness | The Homeless Hub. (2018). Retrieved March 3, 2022, from https://www.homelesshub.ca/resource/hospital-discharge-planning-canadians-experiencing-homelessness
Hwang, S., and Wen, M. Mei Wen, Stephen Hwang. Hospitals discharge homeless patients too quickly. Healthy Debate. (2016) Retrieved March 3, 2022, from https://healthydebate.ca/2016/10/topic/homeless-hospital-readmission-rates/