Vulnerable groups & Health in Canada

Reference List

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Please find my resources related to the vulnerable groups and health in Canada.  In my role as the Patient Access and Community Transitions manager of an acute care hospital, we see many patients who are homeless.  Often, these patients face challenges at discharge that increases their hospital stay or makes readmission more likely (unable to afford recommended medication, no available contact number to link with follow up services or lack of a discharge environment that facilitates safe function are a few of the challenges I see).  I have looked at resources related to the homeless population in Canada.

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This study examines the linkage between housing instability and unmet health needs and emergency room utilization in the homeless population in Vancouver, Toronto, and Ottawa over a four-year period. The authors found that housing instability was a determinant of health associated with increases in unmet health needs and higher emergency room use and higher rates of inpatient admission to hospital. 

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Jaworsky, D., Gadermann, A., Duhoux, A., Naismith, T. E., Norena, M., To, M. J., Hwang, S. W., & Palepu, A. (n.d.). Residential

Stability Reduces Unmet Health Care Needs and Emergency Department Utilization among a Cohort of Homeless and Vulnerably Housed Persons in Canada. Journal of Urban Health, 93(4). https://doi.org/10.1007/s11524-016-0065-6

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Those that are homeless tend to have longer lengths of stay in hospital than individuals with stable housing.  This could be due to many factors such as low income; increased number of health conditions; food insecurity as well has housing instability.   In this article, the authors look to determine the barriers and systems gaps to timely discharge of homeless individuals from hospital to community.  They find that hospital discharge teams and housing teams are often unable to intersect to coordinate discharge for several reasons.  One concern relates to privacy and confidentiality, another due to a lack of knowledge on behalf of hospital staff of the availability of connection in the social care sector. The authors also site systems pressures such as no available hospital beds, limited medically equipped shelter beds and lack of supportive housing spaces. 

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Buccieri, K., Oudshoorn, A., Frederick, T., Schiff, R., Abramovich, A. Gaetz, S., Forchuk, C. (2018).  Hospital discharge

planning for Canadians experiencing homelessness. Housing, Care and Support.

https://www.emerald.com/insight/content/doi/10.1108/HCS-07-2018-0015/full/html

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In this commentary, O’Connell examines the challenge of providing health care to people who are homeless.  He states that traditional discharge plans are often not feasible for homeless individuals naming access to and storage of medication, dressing changes, rest/bedrest or adequate diet as being some of the unachievable issues.  He discusses literature that recommends health care provision away from typical acute care centres and medical offices as a way of health care delivery that meets the needs of this population. 

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O’Connell, J. J. (2004). Dying in die shadows: The challenge of providing health care for homeless people. In CMAJ (Vol. 170,

Issue 8, pp. 1251–1252). CMAJ. https://doi.org/10.1503/cmaj.1040008