Calgary Drop-In & Rehab Centre

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A Picture of the Health of a Homeless Individual

Calgary Drop-In & Rehab Centre

by Dr. Isabel Ries Ferrari Ed.D

Kim Brown BA

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The Calgary Drop-In & Rehab Centre (Calgary Drop-In) provides services of food, shelter, and clothing, counselling and basic medical attention to all those in need. In operation since 1961, the Calgary Drop-In & Rehab Centre now sleeps 1100 nightly, and provides meals to 3500 people daily. Providing health services to the complex medical problems faced by the homeless are one of the challenges providers struggle with. This presentation is an examination of the breakdown in the

continuum of care.

ABSTRACT

Objective: A data collection study was completed to meet the following objectives: · to obtain a snapshot picture of the current health of Drop-In clients.

· to determine which medical services are used by clients · to examine gaps in services and providers

The Calgary Drop-In & Rehab Centre, an emergency shelter located in Calgary’s downtown core, has approximately 950-1100 individuals using the shelters services on any given night. A noticeable trend has emerged, as the numbers of shelter users have grown; clients have increasingly more complex medical conditions. As a result of these complexities, there is a need to provide appropriate, integrated care. A study was completed in-house asking clients about the length of time they have been homeless; their impressions of their health; where they seek medical services; the types of medical conditions they currently live with; the types of medication they

have been prescribed and are currently taking; and how they pay for their medications. A sample of one hundred fifty-one (151) clients were surveyed, approximately

15% of the CDIRC’s sheltered population.

METHODOLOGY Procedure Method:

· Self Reporting Questionnaire of 151 Drop-In clients; about 15% of the population.

· length of time homeless · impression of health

· where they seek medical attention · medical conditions they live with · types of medication prescribed · how they pay for prescriptions

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Demographics of population surveyed

· Gender: 88% male / 12% female

Location of demographic surveyed

· Intox: 75% male / 25% female · Emergency: 91% male / 9% female · Transitional: 87% male / 13% female

Types of sleeping services offered at the Calgary Drop-In & Rehab Centre:

1. Intox beds: are for individuals under the influence of either drugs or alcohol. 2. Emergency beds: are for sober individuals on a first come, first

serve basis.

3. Transitional beds: semi-permanent housing to facilitate the move from shelter to independent living.

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Intox Shelter Clients - Age Range 16-25 0% 25-35 5% 65+ 5% 56-65 10% 46-55 60% 36-45 20%

Intox Shelter Clients - Length of Time living on the

streets or in a shelter.

0.0% 5.0% 10.0% 15.0% 20.0% 25.0% 30.0% 35.0% 40.0% 45.0% < 1 month 1-6 months 7-12 months 1-3 years 4-6 years 7 - 10 years > 10 years

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Intox Shelter Clients - Right now, how would you

rate your overall health?

0.0% 5.0% 10.0% 15.0% 20.0% 25.0% 30.0% 35.0% 40.0% 45.0%

very poor poor average above average

good very good

Intox Shelter Clients - Where do you usually go for medical treatment?

0.0% 10.0% 20.0% 30.0% 40.0% 50.0% 60.0% 70.0% 80.0% 90.0%

CUPS 8th & 8th Alex Emerg Family Dr. Walk-in None

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Intox Shelter Clients - Please list any medical conditions or concerns? 0.0% 5.0% 10.0% 15.0% 20.0% 25.0% 30.0% 35.0% 40.0% 45.0% 50.0%

No concerns / conditions 1-2 concern / conditions 3-5 concerns / conditions >5 concerns / conditions

Concerns Reported by clients 12 - Alcoholism

8 - feet and leg problems 4 - hypertention 3 - siezures 3 - broken bones 3 - heart condition 2 - Athsma 2 - larengitis 2 - depression 2 - diabetes 2 - drug addiction 2 - thyroid 2 - hep-C 1- arthritis 1 - bipolar 1 - cyatic nerve 1 - manic-depressive 1 - blind in one eye 1 - nerve damage 1 - steel plate in jaw 1 - exema

1 d l

Total of 20 Clients Interviewed

Intox Shelter Clients - Have you ever been prescribed ongoing medications? Are you taking the above regularly?

0.0% 10.0% 20.0% 30.0% 40.0% 50.0% 60.0% 70.0%

Yes No Taking Not taking

Reasons given 2 - Cost 1- Stolen 1 - Do not work 1 - Do not bother Medications reported 4 - dilantin advair venolin centrum fluoxetine norvasc tylenol 3 blood pressure pill eltroxin paxil ibupruten pms glyberide concerta pms-gabapentin vasotec plendil premarin? lotensin altace hydrochlorthiazide asa metformin wellbutrin lithium

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Emergency Shelter Beds - Age Range 65+ 2% 56-65 9% 16-25 12% 25-35 23% 36-45 31% 46-55 23%

Emergency Shelter Clients - Length of Time

living on the streets or in a shelter.

-5% 5% 15% 25% 35% 45% < 1 month 1-6 months 7-12 months 1-3 years 4-6 years 7 - 10 years > 10 years

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Emergency Shelter Clients - Right now, how

would you rate your overall health?

-5% 5% 15% 25% 35% 45%

very poor poor average above

average

good very good

Emergency Shelter Clients - Where do you usually go for medical treatment?

0% 10% 20% 30% 40% 50% 60% 70% 80% 90%

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Emergency Shelter Clients - Please list any medical conditions or concerns? 0% 5% 10% 15% 20% 25% 30% 35% 40% 45% 50%

N u m b e r of R e s ponde nts

Total of 66 Clients interviewed - 15% of population

Concerns Reported by clients 7 - feet and leg problems 6 - dental 6 - Flu / cold 3 - Pneumonia 3 - broken bones 2 - heart condition 1 - seizures 1 - thyroid 1 - hep-C 1- arthritis 1 - Stress 1 - Bruising 2 - Sleeping Disorder 1 - Anxiety 1 Bl d Cl t 1 -Eye Infection 2 - sclerosis 1 - Breathing & Lung 1 - Cancer 2 - Dizziness 1 - Ulcers 1 - Gluten Intolerance 1 - Gout 1- Swollen Hip 1 - Lacerations 1 - Bronchitis

Emergency Shelter Clients - Have you ever been prescribed ongoing medications? Are you taking the above regularly?

0% 10% 20% 30% 40% 50% 60%

Yes No Taking Not Taking

Reasons given 4 - Cost 2 - Cut Off 1 - Only when required 1 - Does not work 1 - Overdose 1 - Finished Prescription 1 N Medications reported advair 8 - puffers-flovent ventlin (salmutamol) inhalers puffer - combivent lithium paxil arthrotec antidepressants 3 - effexor zoloft neproxen nitro apo doxycycline 3 - do not know betamethasone celebrex ibuprofen ferrous gluconate wellbutrin metoprolol water pill tylenol 4 tylenol 3 coumadin seroquel rhoxal-bisoprolol spironolactone fosinopril apo-cal? flexeril apo furosemide steroids (lungs) oxycodone glucosamine folic acid flomax ensure arthrotec

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Transitional Shelter Clients - Age Range 65+ 0% 16-25 6% 56-65 6% 46-55 34% 36-45 35% 25-35 19%

Transitional Shelter Clients - Length of Time

living on the streets or in a shelter.

0 5 10 15 20 25 30 < 1 month 1-6 months 7-12 months 1-3 years 4-6 years 7 - 10 years > 10 years Number of Respondents

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Transitional Shelter Clients - Right now, how

would you rate your overall health?

0 5 10 15 20 25 30

very poor poor average above average

good very good

Number of respondents

Total of 53 Clients interviewed - 15% of population

Transitional Shelter Clients - Where do you usually go for medical treatment?

0 5 10 15 20 25 30 35 40

N u m b e r of R e s ponde nts

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Transitional Shelter Clients - Please list any conditions or concerns? 0.00% 5.00% 10.00% 15.00% 20.00% 25.00% 30.00% 35.00% 40.00% 45.00% 50.00%

Concerns Reported by clients 10 - Alcoholism

1 - Drug Addiction 9 - Depression 4 - feet and leg problems 9 - dental 2 - Flu / cold 1 - Pneumonia 1 - heart condition 1 - thyroid 7 - hep-C 7- arthritis 2 - Stress 3 - Anxiety 5 - Bad Back 2 - Cancer 1 - Bronchitis 1 - Numbness in hand 1 - Ringing in ear 1 - Obesity 1 - Bursitis 1 - Calcium in feet 1 - Ovarian cyst 2 - Amputee 7 - Hypertension 6 - Asthma 1 - HIV 1 - Tendonitis 1 - Social Adjustment 1 - borderline personality 1 - Chronic fatigue 1 - Fibromyalgia 2 - Hypoglycemia 1 - Brain aneurism 2 - Paranoid schizophrenia 1 - ADHD 2 - Epilepsy 1 - Rashes 3 - Hernia 1 - Sciatic nerve 1 psorisis

Emergency Shelter Clients - Have you ever been prescribed ongoing medications? Are you taking the above regularly?

0% 10% 20% 30% 40% 50% 60%

Yes No Taking Not Taking

Reasons given 4 - Cost 2 - Cut Off 1 - Only when required 1 - Does not work 1 - Overdose 1 - Finished Prescription 1 N Medications reported advair 8 - puffers-flovent ventlin (salmutamol) inhalers puffer - combivent lithium paxil arthrotec antidepressants 3 - effexor zoloft neproxen nitro apo doxycycline 3 - do not know betamethasone celebrex ibuprofen ferrous gluconate wellbutrin metoprolol water pill tylenol 4 tylenol 3 coumadin seroquel rhoxal-bisoprolol spironolactone fosinopril apo-cal? flexeril apo furosemide steroids (lungs) oxycodone glucosamine folic acid flomax ensure arthrotec

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Observations

· Female respondents perceived their health as very poor to average as compared to the male respondents whose perceptions ranged from very poor to very good. · Respondents living in Intox and Transitional housing were older and longer on the streets than those living in emergency shelter beds.

· Respondents living in emergency shelter beds have a perceived health from poor to very good, however the longer the respondent lived on the streets a decline of perceived health was reported.

· No matter where a respondent resided in the shelter system, they reported their health as Average, even if they reported more than 2 medical conditions or concerns.

· The primary service provider was 8th &8th Medical Centre, followed by CUPS. Almost 60% of respondents stated that they will not go to another medical service provider as a secondary service provider.

· 71% of the respondents did not have a family doctor

· Majority of respondents paid for their medications either by cash or through Social Services.

Our Conclusions

· Homelessness affects the health and well-being of an individual. The longer they are on the streets, there appears to be an inconsistency between the observed health of the individual and the individual’s personal perception of their own level of health

· As one’s housing becomes more stable, their perceptions of their health become more realistic and their overall health and well-being appear to improve.

· There is a need for a continuum of care for the homeless population.

· An integrated care model would benefit this population’s diverse medical needs including addictions and mental health.

Discussion

Survival is this population’s primary struggle.

The medical needs of the homeless do not meet the criteria of any one medical service provider, therefore an integrated care model would benefit this

population’s diverse medical needs including addictions and mental health. Most homeless people suffer from one or more chronic conditions, yet our delivery systems are focused on the episodic treatment of chief complaints at a given moment in time. Readily accessible, consistent, and continuous care from a known, trusted clinician is not always available for many people experience

homelessness. For an agency that offers services to more than 1100 individuals a night, an on-site medical clinic would be of great benefit to meet their medical needs.