This week one of The Lighthouse’s residents hadn’t been seen for a couple of days. He has limited mobility and poor health and no longer can take care of himself. As one healthcare professional said, “we have a failure to thrive”. I went up to his room thinking that I would find a dead body but he was okay but had some health issues. We talked for a minute and I talked him into getting an ambulance to the hospital. There is no way he should have been housed at The Lighthouse but here is where the system fails.
When someone is housed, the system ignores him because there is such a shortage of housing, especially care home beds. The higher level of care one needs, the less there are for options. CPAS couldn’t help him because no one wanted someone that had that high of needs. Home care didn’t want to help him because his room was so disgusting and he needed that much care. We were told to get a cleaning service in but places like Service Master would charge more than we got paid for in room and board to keep him. While Marcel, The Lighthouse’s maintenance person did a good job cleaning his room, the resident is incontinent and you can imagine the mess. So no group home, no home care, and no other supports were able to be acquired for him. Sadly the suggested course of action was to evict him and toss him out to the street. If we did that, then we would force the Saskatoon Health Region to have to do something. That’s right, the recommended course of action to get assistance for a senior citizen is to kick him to the street.
It’s actually quite common. It’s often how the system takes care of it’s hardest to deal with cases. When I was at The Salvation Army, many people with physical and mental health problems were dropped off at the curb of 19th and C with a bag and the car just drove away. You would wander outside (or they would wander in) and be dazed and confused as to what had happened. Often it was care home operators who dropped them off. With such a shortage of beds in the system, operators were actually rewarded for this behaviour as they get someone more to their suiting.
Hospitals can be just as bad. Over the years the hospital would say anything to get you to take someone was discharged, including the time they sent us people with H1N1 into a congregate setting before staff even had the vaccine. Over time they developed such a reputation for lying to discharge someone, we used the phrase, “No one lies to us like a hospital”. They can’t by law discharge to the street so they do everything they can to discharge to the shelters, even if that means being dishonest. The worst example I ever experienced was on a Easter morning where a nurse wanted me to put an suicidal girl in a hotel room because her family had kicked her out. Suicidal. Homeless. The best that they could do was to suggest a hotel room where this girl would be alone. I guess getting her help, keeping her around others, and even calling in a psychologist was too much work. I have been told numerous times that a man could handle the two flights of stairs at the shelter only to have them unable to walk or have a wheelchair. One time we were told that a person was fine and they had to use two ambulances to deliver him and his breathing equipment to the shelter. No one lies like a hospital.
So for our resident, we had little other option when we called for an ambulance. The paramedics went into his room and were overwhelmed by the smell and sight. Yes we managed to overwhelm paramedics. They took him and we informed the hospital that we would not take him back. The family was supportive of the move as well but it is still really, really tough. It’s hard not to feel like we are taken advantage of by the system. It’s also hard not to be disgusted over how we take care of seniors with a disability in this province.
The second story that I have about this is a women with significant mental health issues who again would struggle from a failure to thrive. Same kind of story. In better shape physically but far more difficult mental health issues. We have been told that she has burned her bridges with all of the mental health group homes in the city which could be said for most of our population (more on that later). She isn’t that unpleasant, we chat every day but has some struggles taking care of herself. Home care is willing to come in but they want a schedule and sometimes when you have mental health issues, keeping a schedule is not one of the things that you do well. The result is no home care which means that it affects her mental and physical health. The solution is to put her back into a group home (if they can find one for her) but that is way more expensive than it is at The Lighthouse and she hates it there which means that she will burn her bridges there and end up back here or in an unsupported environment which will lead to further health deterioration and an even more expensive solution.
Finally, here is a somewhat positive story. We have several really good mental health professionals that are always in and out of the building. The mental health nurses have a really hard job and I don’t know if it the common dark humour we share or we just all really appreciate working together but when they are in the building, things seem a little better. One of the residents is really violent to his room. He’s not violent to people and is actually quite nice but he punches holes and does other damage to his room that is both annoying and costly. He gets evicted all of the time and has landed at The Lighthouse where we are now an owner of a really beat up room. His worker works well with him and us and I think we are making incremental progress but… the room and the facility are paying the cost. Being funded by Social Services, he can be charged with an overpayment because of room damages that will take off $15 off his check but that’s it. A person on Social Services could trash 10 rooms and still, it would be $15 off the check for the overpayment. It’s been suggested that as a course of treatment and consequences, all of it comes off (he is still paid his room and board) but that can’t be done because the system allows for $15 to come off his check. Remember, it’s not the money to us that it the issue. In the end Wendy and I will probably be joined by some other staff over pizza, some wall patching materials, and paint on a Friday night to fix up his room. His caregiver wants to do this as a course of treatment and responsibility but the system doesn’t allow for that to happen. Also I was tossing around the idea of using special institutional wall coatings for his room that are impossible to damage but who is going to pay for that. A $30,000 room upgrade would do wonders and is a lot of money but again, a lot cheaper than him being homeless, in emergency shelters, hotel rooms or the Dube Centre over a couple of months. He would realistically live there for years and when his demons were under control and dealt with, the room could be used for someone else like him. A single room could conceivable save the system hundreds of thousands of dollars over a decade but no one is building it because those that could benefit from placing people in that room, aren’t the funders of rooms.
The biggest issue is that the province is organized into silos. We call them ministries but they don’t cooperate enough. Social Services has it’s own budget and mandate and Health has their own and within there are all of these other silos which allows people to fall between them or even worse, need services from both. I criticize Social Services lots but they do a pretty good job in writing checks but what about those that need more than money. Social Services doesn’t offer anything else than check writing services anymore in the province (for adults anyways). Mental health does a good job of providing medication and supports but they sometimes need more cash to give out because sometimes money does solve problems. CPAS, well they just normally disappoint but their big issue seems to be a lack of care beds, especially for high need seniors in poverty (two tier healthcare is totally fine when it comes to care homes apparently).
This isn’t a partisan issue. This isn’t about housing first or housing last, this is about dealing with the issue from a government centric approach rather than a client centric approach. The government centric approach is always going to be more efficient for most of the people. Your doctor’s office is the best example of this. I need a doctor’s appointment and so I phone over, make the appointment, show up at the appointed time, read an out of date magazine, and then see him and hopefully things work out okay. Now this can fall apart if your doctor isn’t available or if you are too sick to get to an appointment or if you can’t get to an appointment. American city’s homeless “depots” are famous for this. You go to the intake centre, go to the shelter and spend the rest of the next day going back to the intake place and back to the shelter to sleep that you can’t really make progress on being homeless. The bigger the city, often the bigger the problem.
The solution is someone in charge and someone responsible for the problems. I have listened to Tim Richter, Iain Dejong, and Sam Tsemberis talk about housing first models and their stories and they ignore one thing. Someone (them) is responsible getting homeless off the streets. In Calgary’s situation Tim isn’t alone with the Government of Alberta and the Premier taking the lead in helping solve the problem and making a commitment to change things. In Saskatchewan we aren’t at that point yet. It still is everyone’s problem which as we all know, makes it no one’s problem. Saskatchewan doesn’t need more money in place, it needs someone to look at at elderly’s man’s “failure to thrive” and notice that every government department passed the buck and make someone fix the problem. It mean’s looking at a kid who has some inner demons and realizing that his living situation needs some help and demanding that it get fixed. Saskatchewan is a small enough of a province that we can do it this way. It is just that no one wants to name that person to make it happen.
