After finding it difficult to take its residents to medical care, a Toronto shelter for homeless men has begun bringing the care to them.
For years, sick, homeless men would arrive at Seaton House, but it was almost impossible to find effective care for them. It took the winter-related deaths of 3 homeless men 6 years ago, and a subsequent inquest, to drive home the message that the status quo was not working. The result is a partnership between the shelter and St. Michael's Hospital, and a special 36-bed infirmary that opened at Seaton House last September.
The first step in the process was a harm-reduction program launched by Dr. Tomislav Svoboda, medical director at the shelter, and Art Manuel, Seaton House's program supervisor: Seaton House became “wet.”
“The men we see here are 15 years on the street, they are chronic alcoholics,” Manuel explains. The previous policy was to take bottles away from men seeking a bed and pour them down the drain. Now the bottle is taken away, but returned the next morning, and the men are offered beer under supervised conditions.
“What we did not want them to do was to down a bottle of wine before arriving at the shelter, or to sleep on grates or under bridges because they didn't want to give up their bottle of wine,” says Manuel. “Once we went wet, magic started to occur.”
That magic included growing trust. “Who would have thought that a chronic alcoholic, a man who had been living on the street for 15 years, would give up alcohol or reduce his consumption in a wet shelter?” says Manuel. “But that is what happened.”
He says the process was akin to “peeling the layers off an onion. First the obvious, find shelter, then the alcohol problem, then as trust developed it became apparent that these guys were suffering from a host of problems.”
But a hospital is not the ideal environment for treating men who normally reside in homeless shelters. This fact, and a 1999 recommendation from the Mayor's Homelessness Action Task Force, provided the impetus for the infirmary.
Six months after it opened, all 36 beds were full. The patients had health problems ranging from liver disease to uncontrolled diabetes, pneumonia and schizophrenia. In December, 14 of the patients were found to have tuberculosis. “Here were guys who lived to drink,” says Manuel. “We were able to convince them not to drink while taking this medication because it would severely damage their liver. All of them either stopped or severely cut back on their drinking. We had a 100% success rate in getting rid of the tuberculosis.” — Peter Wilton, Toronto