ShelterCare: The Integration of Health and Housing Services as an Evidence-Based Shelter Model
Ayshia Baile, April 23, 2023
Homelessness is a multifaceted issue which is incredibly prevalent across Canada. It was estimated in 2016 that at least 35 000 individuals experience homelessness on any given night, with more than 235 000 Canadians every year (Gaetz et al., 2016). This estimate does not include ‘hidden homelessness’ which is thought to be up to 50,000 people per night nationwide encompassing those who do not have permanent housing and temporarily stay with friends, relatives, in their vehicles, or other undocumented spaces, avoiding unsheltered homelessness (Gaetz et al., 2013). Due to the Covid-19 pandemic, routine homelessness enumerations have been delayed, although studies have projected a rising incidence in homelessness since the onset of the pandemic with estimated continued growth considering the impeding recession if no effective interventions are implemented (Falvo, 2020). This issue runs deeper than lack of stable housing as there are many social, economic, and systemic barriers faced by individuals who experience homelessness, making it a complex problem which requires comprehensive solutions. Of utmost concern, are the severe health impacts of poor housing and homelessness. Homeless populations have been described in literature as being vulnerable to the ‘tri-morbidity’ of social marginalization being mental illness, addiction, and physical illness highlighting the main health risks associated with homelessness (Gicas et al., 2020). Lack of stable housing decreases overall quality of life, exacerbates chronic health conditions and medical complications, and presents significant barriers to health access which negatively impacts individuals who experience homelessness and public healthcare systems. Homelessness requires immediate interventions and should be a priority for all governing bodies in Canada but, as housing is a key social determinant of health, it should be a critical priority for health and healthcare decision makers. With the multitude of proposed models and pilot projects being conducted to address health inequities afflicting the homeless population, which solutions have promising measurable benefits and should be prioritized by health policymakers?
ShelterCare is a housing intervention that was originally thought to be a utopian model for ending chronic homelessness but was given the opportunity to demonstrate its potential as an incredibly impactful evidence-based intervention due to the COVID-19 pandemic. These pilot projects have exemplified the need for the program to address systemic barriers to housing for homeless populations and drastically improve the health of marginalized individuals. Demonstrating similar positive outcomes to other evidence-based housing interventions like Housing First, but while considering the state of housing and escalating opioid crisis, this model can fill significant gaps and better support individuals who have experienced chronic homelessness to secure and maintain permanent housing.
This paper reviews current housing and shelter interventions and evaluate the overall improvements to health and quality of life of the homeless population. Based on currently piloted housing initiatives and comparing to previously explored solutions, the ShelterCare model will be reviewed in-depth for its impact on health. The perspectives and impact of key stakeholders will be considered including municipal and provincial governing bodies, regional public health, hospital, and community health officials, related non-profit and community advocacy leaders, social services sector, and clients themselves, as cross-sector collaboration is required to effectively implement this intervention. An approach to engaging with these stakeholders as well as a model for continuous evaluation of its impacts will be outlined, highlighting the gaps this service would fill and how it could be implemented effectively.