A man limps into a downtown emergency department (ED) around midnight. His foot, which is probably infected, is throbbing, he's got a fever, and he can no longer ignore the pain.
Before entering the ED, the man – let's call him Stanley – left his belongings in a nearby alley, hoping they would be there when he got back. He is currently living on the street.
Stanley spends a couple of nights in the hospital, getting the immediate care he needs. He's discharged with three prescriptions, instructions on how to clean his wound, and a referral to a specialist.
In a typical hospital, this might be the end of the interaction. Stanley would walk out onto the street at 9 a.m. and search for a spot to grab a few hours of sleep.
With no clean, dry, or safe place to tend to his foot, it would get infected again, and he'd end up back in the ED.
But if he'd walked into St. Michael's Hospital's ED in downtown Toronto, the night might go differently, thanks to a program that’s transforming how the hospital provides care for people like Stanley.
Launched in 2019, St. Michael’s Navigator program's innovative approach to frontline healthcare is helping to remove barriers for people experiencing homelessness and poverty.
"We're using the hospital as a transition moment to help people improve both their health and social circumstances," said Kate Francombe-Pridham, Research Program Manager at St. Michael’s Hospital’s MAP Centre for Urban Health Solutions.
A $2 million gift to the St. Michael's Hospital Foundation from TD through the TD Ready Commitment, the Bank's corporate citizenship platform, will go a long way to help this kind of work keep running.
Meeting needs beyond the emergency room
Here's how Stanley's night might have gone at St. Michael's.
While waiting to be seen by a doctor, Stanley would meet an outreach worker — called a navigator — who'd grab him a coffee and some warm socks. She'd ask about his living situation and if he's receiving income assistance.
While a nurse brings Stanley a dose of antibiotics, the navigator might get on the phone to local shelters to see if she can secure him a bed.
The new approach to care for unhoused patients starts in the ED, and in the hospital if the patient is admitted, and then continues for three to six months after they're discharged, Francombe-Pridham said.
The goal is to use the moment in the hospital as an opportunity to improve access to care in the community, help find housing for people on the street, and help prevent re-admissions.
Canadian research consistently shows that housing has a direct effect on health.
Access to stable housing is also linked to improved health outcomes, including reduced hospital admissions, lower transmission rates of infectious diseases, and better overall well-being, according to the Canadian Public Health Association.
There are roughly 15,000 unhoused people in Toronto, and up to 20% of St. Michael’s emergency visits come from people experiencing homelessness, Francombe-Pridham said.
"Acute care hospitals aren't necessarily funded to provide community care, even if we all know it's really important," said Andrew Longwell, a campaign manager at the Foundation.
"We want to be the hospital that does that, and the Foundation that enables it."
In Stanley's case, after the ED visit and hospital stay, a navigator might be able to help him find a primary care provider, complete an application for income assistance, and search for longer-term housing.
The navigator might help Stanley get more information about his referral to a specialist and ensure he knows important details about his upcoming appointment. She might even be able to attend the appointment with him.
While supports exist at the hospital and in the community for people experiencing homelessness, the outreach workers at St. Michael's are embedded into the clinical team, a rarity for hospitals in Ontario, Francombe-Pridham said.
"The biggest difference for us is that the navigators are hired as hospital staff members," she said.
"In this program, hospital staff and physicians see outreach workers as team members from the get-go, and it breaks down the traditional boundary between the hospital and community services."
So far, the Toronto program has served roughly 1,000 clients. Two other pilot programs are now up and running in hospitals in Vancouver and Montreal, guided by the team at St. Michael’s.
The long-term dream, Pridham said, is to have the same program running in every hospital in major cities in Canada.
With help from the new funding from TD, the program hopes to connect 800 more people with the services they need over the next five years.
"The overlapping crises of housing affordability, homelessness, and limited access to primary care means some of the most vulnerable people in our society aren't getting the support they need," said Richard Lennon, Corporate Citizenship Manager, Donations, at TD.
"A gift like this can help these programs continue and give more people a chance to connect with care and resources that have the potential to make a real difference in their lives."
With input from an interview with St. Michael’s Hospital, Toronto