DORA REPLANSKI

• “Approximately 35,000 Canadians experience homelessness on any given night, and at least 235,000 are  homeless in any given year.^[1]

• “ Between 136,000 and 156,000 Canadians use an emergency shelter each year.”^[2]

• “The economic cost of homelessness is high. Some estimates indicate that it costs the Canadian economy over $7 billion annually.”^[3]

• Available data indicate that of all the homeless, “ 27.3% were women, 18.7% were youth, 6% were recent immigrants or migrants, and a growing number were veterans and seniors.”^[4]

Vulnerable groups

•  Aboriginal people, women affected by violence, immigrants and LBTQ  individuals are overrepresented among the homeless in Canada.

Homeless Women

• “Intimate partner violence is the main cause of homelessness among women, including immigrant and refugee women.”^[5]

• “ 30% of families on any given day are newcomers using  shelters located in a large Canadian urban centre”.

• “ Lone-parent women and children make up the majority of families experiencing homelessness and  high rates of family violence.”^[6]

Newcomers

• “Homelessness is a risk for growing numbers of immigrants. Largely as a result of low incomes, newcomers are more likely than the Canadian‐born to spend over 50 percent of total household income on housing costs.”

• “Many  newcomers suffer ‘hidden homelessness’. They do not use shelters and other services, but share accommodation, couch‐surf and rely on their social contacts for temporary and precarious housing.”^[7]

LGBTQ Youth

• They “ comprise nearly 30% of all young people facing homelessnes in Canada.”^[8]

“LGBTQ homeless youths are more likely to experience poor mental health, more likely to exhibit risky sexual behavior and use drugs, more likely to use survival sex and sex trade strategies for coping with their situation, and more likely to be HIV positive.”^[9]

Recommendations

• “Providers who work with homeless youth engage in specific work on unlearning racism and homophobia/biphobia/transphobia, as well as learning how to foster culturally safe practices and environments for Indigenous LGBTQ2S youth.”

• “Professionals should also be trained in trauma-informed care, given the levels of trauma experienced by Indigenous LGBTQ2S youth experiencing homelessness.”^[10]  

Homeless Seniors

• “As of 2016 those over 50 years of age  accounted for more than 41 percent of the homeless in Canada.”^[11]

• “People older than 55 are the fastest-growing homeless demographic in Metro Vancouver. ^[12]

• Main causes are:” lack of finances to pay for housing (low government assistance, insufficient pensions etc), lack of affordable and secure housing (including conversion of apartments into unaffordable condominiums), declining physical health, mental health issues, relationship breakdown, violence and abuse.”

• “The risk of homelessness can also be compounded by the death of a spouse, social isolation, discrimination, or lack of knowledge of benefits and services.”^[13]

Government Approaches

• “Reaching Home Canada/s Homeless Strategy” is the  Canadian Government response to the increasing housing crisis in this country.
• This strategy  has been described as “ a community-based program aimed at preventing and reducing homelessness across Canada”
•  This program provides funding to urban, Indigenous, rural and remote communities to help them address their local homelessness needs.”^[14] 
• It aims at reducing chronic homelessness nationally by 50% by fiscal year 2027 to 2028.^[15]

Housing First

• “Housing First involves moving people experiencing homelessness — particularly people experiencing chronic homelessness—rapidly from the street or emergency shelters into stable and long-term housing, with support.”^[16]

Modular Housing

• In September 2017, the province of BC announced that it was investing $291 million over two years to build 2,000 modular supportive housing units across B.C. for people who are homeless or at risk of homelessness.
• In addition, more than $170 million were committed  over three years to provide 24/7 staffing and support services to people living in modular homes.
• This modular housing initiative will deliver a mix of permanent and temporary units.^[17]

Needed Services

• Experts pointed out that the ”initiatives implemented in Canada do not  address the particular needs of homeless seniors  affected by poverty and lack of access to social and health services.”^[18]

Heath Impact

• “Homemless people have higher rates of premature mortality than the rest of the population, especially from suicide and unintentional injuries, and an increased prevalence of a range of infectious diseases, mental disorders, and substance misuse. High rates of non-communicable diseases have also been described with evidence of accelerated ageing.”^[19]

• “Those who are homeless are more likely than older people in the general population to suffer from geriatric syndromes such as functional impairment, frailty, depression, visual impairment, and urinary incontinence”.^[20]

Recommendations

1. For homeless people with mental health problems

• “Clinical assessment and care of homeless and vulnerably housed populations should include tailoring approaches to a person’s gender, age, Indigenous heritage, ethnicity and history of trauma; and advocacy for comprehensive primary health care.”

•  “As initial steps in the care of homeless and vulnerably housed populations, permanent supportive housing is strongly recommended, and income assistance is also recommended.”

• “Case-management interventions, with access to psychiatric support, are recommended as an initial step to support primary care and to address existing mental health, substance use and other morbidities.”
• “Harm-reduction interventions, such as supervised consumption facilities, and access to pharmacologic agents for opioid use disorder, such as opioid agonist treatment, are recommended for people who use substances.” ^[21]

2. For overrepresented groups and seniors

• “Rehousing people with limited financial resources as they transition from shelters or hospitals.”

• “Ensuring access to safe and affordable community housing, with links to health and social care supports.”

• “Ensuring an income base, and housing for at risk groups, including groups that are currently over-represented among homeless populations (e.g., Aboriginal people, older immigrants, LGBTQ people).”

• “Ensuring access to appropriate services and long-term care when necessary.” ^[22]

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[1] Natalie Rech, Homelessness in Canada, The Canadian Encyclopedia, July 9, 2019 https://www.thecanadianencyclopedia.ca/en/article/homelessness-in-canada

[2]  Employment and Social Development Canada Advisory Committee on Homelesnees.Final Report.  2018 Final report of the Advisory Committee on Homelessness – Canada.ca

[3] Homeless Hub “Cost Analysis Of Homelessness” ,2013 https://www.homelesshub.ca/about-homelessness/homelessness-101/cost-analysis-homelessness

[4] . Gaetz S, Dej E, Richter T, et al. The state of homelessness in Canada 2016. Toronto: Canadian Observatory on Homelessness Press; 2016. The State of Homelessness in Canada 2016 | The Homeless Hub

[5] Tabibi, J., & Baker, L.L (2017). Exploring the intersections: immigrant and refugee women fleeing violence and experiencing homelessness in Canada. London, Ontario: Centre for Research & Education on Violence Against Women & Children. ISBN # 978-1-988412-10-8

2017-summary-report-1-ESDC-CREVAWC-Meeting-Report.pdf (vawlearningnetwork.ca)

[6] Katrina Milaney , Rosaele Tremblay , Sean Bristowe  and Kaylee Ramage Welcome to Canada: Why Are Family Emergency Shelters ‘Home’ for Recent Newcomers? Societies 2020, 10, 37; doi:10.3390/ (PDF) Welcome to Canada: Why Are Family Emergency Shelters ‘Home’ for Recent Newcomers? (researchgate.net)

[7] Valerie Preston, Robert Murdie, Jane Wedlock, Sandeep K. Agrawal, Uzo Anucha, Silvia D’Addario, Min J. Kwak, Jennifer Logan, Ann M. Murnaghan  Immigrants and Homelessness: At Risk in the Outer Suburbs.Canadian Geographer, 2009, pages 288-304, Vol.53,  Issue 3. Immigrants and homelessness—at risk in Canada’s outer suburbs – PRESTON – 2009 – The Canadian Geographer / Le Géographe canadien – Wiley Online Library

[8]  Covenant House LGBTQ Youth and Homelessness LGBTQ Youth and Homelessness | Covenant House

[9] Mary Cunningham, Michael Pergamit, Nan Astone, Jessica Luna “Homeless LGBTQ Youth”, Ufban Institute, August 2014Homeless LGBTQ Youth (urban.org)

[10] Elizabeth Saewyc, Brooke Mounsey, Jessica Tourand, Dana Brunanski, David Kirk, Jeffrey McNeil-Seymour, Kyle Shaughnessy, Samantha Tsuruda & Natalie Clark “Homeless & Street-involved Indigenous Lgbtq2s Youth In British Columbia,: Intersectionality, Challenges, Resilience & Cues For Action” , in Alex Abramovich   and Jama  Shelton Ed, “Where Am I Going To Go? Intersectional Approaches To Ending Lgbtq2s Youth Homelessness In Canada & The U.S, Canadian Observatory on Homelessness,   Jan 1, 2017 2. Homeless & Street-Involved Indigenous LGBTQ2S Youth in British Columbia: Intersectionality, Challenges, Resilience & Cues for Action | The Homeless Hub

[11] Chris Draper Seniors Homelessness and Poverty, Seniors Lifestyle Magazine ,February 26, 2018,Senior Homelessness and Poverty – Seniors Lifestyle Magazine 

[12]  Lori Culbert ‘It’s “heartbreaking’: Many more B.C. seniors asking for help to avoid homelessnsse” Vancouver Sun, November 21, 2020.Many B.C. seniors need help with homelessness, depression | Vancouver Sun

[13] Homeless Hub “Seniors”Seniors | The Homeless Hub

[14]Employment and Social Development Canada About Reaching Home: Canada’s Homelessness Strategy – Canada.ca, June 9, 2020.

[15] Employment and Social Development Canada Funding: Expansion of Reaching Home: Canada’s Homelessness Strategy – Designated Communities stream – Canada.ca, December 14, 2020.

[16] Employment and Social Development  Canada  “ Housing First”,  2019 https://www.canada.ca/en/employment-social-development/programs/homelessness/resources/housing-first.html

[17] Homelessness – Province of British Columbia (gov.bc.ca)

[18]  Grenier, A., Barken, R., Sussman, T., Rothwell, D., Bourgeois-Guérin, V., Lavoie, J-P. (2016). A literature review of homelessness and aging: Suggestions for a policy and practice-relevant research agenda. Canadian Journal on Aging, 35(1), 28-41(2016)

[19]     Public Health Ontario “ Evidence Brief: Homeless and Health Outcomes: What are the  Associations? “,April 2019 https://www.publichealthontario.ca/-/media/documents/e/2019/eb-homelessness-health.pdf?la=en

[20]  Brown , R. T. , Kiely , D. K. , Bharel , M. , & Mitchell , S. L. ( 2012 ). Geriatric syndromes in older homeless adults, Journal of General Internal Medicine , 27 ( 1 ) 16 – 22 .

[21] Kevin Pottie et al  Clinical guideline for homeless and vulnerably housed people, and people with lived homelessness experience, CMAJ 2020 March 9;192:E240-54. doi: 10.1503/cmaj.190777 Clinical guideline for homeless and vulnerably housed people, and people with lived homelessness experience (cmaj.ca)

[22] Grenier, A., Barken, R., Sussman, T., Rothwell, D., Bourgeois-Guérin, V., Lavoie, J-P. (2016). A literature review of homelessness and aging: Suggestions for a policy and practice-relevant research agenda. Canadian Journal on Aging, 35(1), 28-41(2016)