Mitigating the spread in Toronto shelter settings
RNAO’ commitment to vulnerable populations precedes this pandemic and will continue forward, as we tackle together the social inequities exposed and deepened by the virus. In doing so, we will be inspired by examples of tremendous strength. One of those is the work of Inner City Health Associates (ICHA). We share with pride and gratitude the progress presented next by our colleagues Leigh and Andrew. Leigh Chapman, RN, PhD is Director, Clinical Services, and Andrew Bond, MD, CCFP, FCFP, MHA(c), is Medical Director of ICHA.
Inner City Health Associates (ICHA) was a group of more than 100 physicians working in over 50 shelters and drop-ins across Toronto until March 2020. Since the onset of the COVID-19 pandemic in Toronto, registered nurses (RNs), registered practical nurses (RPNs) and nurse practitioners (NPs) have joined ICHA in an effort to mitigate the spread of COVID-19 in Toronto shelter settings.
The COVID Recovery Site is a collaboration between the City of Toronto Shelter Support Housing Administration, Parkdale Queen West Community Health Centre, The Neighbourhood Group, University Health Network, and Inner City Health Associates. At the Recovery Site, Inner City Health Associates clinicians provide acute episodic care for individuals and families who are unable to isolate without supports due to homelessness (including those living in shelters, those who are unsheltered, and some people in precarious or congregate housing).
Many of ICHA’s clients have complex health needs including untreated chronic and complex multi-system diseases, an elevated risk of acute health emergencies, and serious and persistent mental illness and substance use. The COVID Recovery Site provides 24/7 medical supports, delivered by a team of nurses, harm reduction workers, peers, client support workers, and physicians.
To date, over 2000 clients have been supported to isolate at the COVID Recovery site. Given the high community prevalence of COVID, urgent need for the site persists. In addition to the COVID Recovery Site, ICHA RNs, RPNs and NPs provide transitional primary care and specialist (i.e. psychiatry, addictions) care to those who do not otherwise have access to care who are living in physical distancing hotel-based shelters as well as those living in encampments.
Many of ICHA’s clients have complex health needs including untreated chronic and complex multi-system diseases, an elevated risk of acute health emergencies, and serious and persistent mental illness and substance use. Nurses use their knowledge, skill and judgment to assess and care for clients who may present with complex health issues in addition to COVID-19 such as unmanaged chronic conditions, infectious diseases, skin conditions and wounds, mental illness and substance use issues. Services provided by the nursing team use a holistic, client-centred model of care with an emphasis on trauma-informed primary care, harm reduction and conflict de-escalation.
At this time, with the rising community prevalence of COVID-19, we are at a critical juncture in our pandemic response. We are working hard to meet the surge in cases of COVID-19 and ensure we have the capacity to care for those in need of isolation supports. We continue to actively recruit RNs, RPNs and NPs to address urgent health human resource challenges to be able to effectively respond to the crisis before us.
We have pivoted our primary care services to support several hotel-based shelter programs that are on suspect or confirmed outbreak. Our small team of encampment nurses work to address urgent cold-related injuries as they support people by meeting them “where they are at” to provide low-barrier clinical supports and care. We urgently await the COVID-19 vaccine and have a team of over 100 nurses strong ready to deliver the vaccine to the population of people experiencing homelessness.
The COVID-19 crisis has laid bare many of the structural inequities in society that persisted long before the pandemic. We hope it is a moment of reckoning for society at large about the need to provide housing for all and invest robustly in homeless healthcare. Nurses are keen to engage in this work on a sustained basis, but need continued post-pandemic funding to be able to do so.