vulnerable tenants research study · the most deprived ne lhin nosda forum –june 8 2016 8...

Vulnerable Tenants Research StudyNE LHIN/NOSDA FORUM – MOVING FORWARD ON INNOVATIVE HOUSING WITH SUPPORTS IN NORTHEASTERN ONTARIO

JUNE 8, 2016

Overview of Presentation

Study Purpose and Approach

Research Context

Summary of Research Findings

Key Messages Next Steps

NE LHIN NOSDA FORUM – JUNE 8 2016 2

Some Background….


Study Purpose

To create a better understanding of the support service needs of vulnerable persons living in social housing, and to evaluate these needs within the current capacity of housing providers and support agencies.

To recommend a methodology for the development of a service delivery system, aimed at maintaining housing for vulnerable tenants, that would form the basis of a funding submission to the Poverty Reduction Fund.


Approach to the Study


Scan of the Literature

Need & Gap Analysis

Stakeholder Engagement

Research Report

Context for Research: Vulnerability across the NE LHIN



Material deprivation - Quintiles

1 - least marginalized

2

3

4

5 - most marginalized

missing data

Material Deprivation in the NE LHIN

The Most Deprived


Nipiss ing Temiskaming

Greater

Sudbury Manitoul in

Sudbury

West

Sudbury

East

Parry

Sound

Quintile 4 27% 27% 30% 43% 34% 38% 32%

Quintile 5 (most marginalized) 31% 39% 16% 3% 44% 48% 25%

Material deprivation quintiles

Proportion of Local Population among the 40% Most

Marginalized in Ontario

NE LHIN HUB REGIONS

Hub Planning Area Total Population % of NE LHIN

Nipissing & Temiskaming 117,370 21.22

Sudbury, Manitoulin & Parry Sound 236,782 42.81

The Most Deprived, cont’d


Algoma

North Sault Area

Algoma

Central

Algoma

East

Cochrane

South/Timmins

Cochrane

North

Quintile 4 31% 22% 29% 31% 35% 38%

Quintile 5 (most marginalized) 15% 27% 25% 58% 27% 25%

Material deprivation quintiles

Proportion of Local Population among the 40% Most

Marginalized in Ontario

NE LHIN HUB REGIONS

Hub Planning Area Total Population % of NE LHIN

Algoma 115,870 20.95

Cochrane 76,856 13.90

Overview of NE LHIN, cont’dCompared to the rest of Ontario, NE LHIN residents have a:

Shorter life expectancy, both among men and women

Higher rate of circulatory system disease deaths 100,000 population

Higher rate of neoplasm (cancer) deaths

Higher premature mortality rate (deaths per 100,000 prior to age 75


Acute Care Hospital Use


LHIN Sub-Planning Region Major Hospital Top 3 Most Common Reasons to Visit Estimated Number of Cases

Sudbury-Manitoulin Health Sciences North (Sudbury General)Obstetrics - Delivery 7000

Circulatory System - Heart Failure / Arrest, Irregular Beat, Surgery 3700

Digestive Surgery - Appendix or Upper / Lower GI, Hemorrage, Obstruction, Infection 2000

Respiratory - COPD 1600

Parry Sound West Parry Sound Health Centre Cardiac - without Coronary Angioplasty 490

Obstetrics - Delivery 440

Digestive - Obstruction, Hemorrage, Infection, Minor GI Intervention 230

Respiratory - Pneumonia 100

Nipissing-Temiskaming North Bay Regional Health Centre Obstetrics - Delivery 3800

Cardiac - without Coronary Angioplasty 2000

Digestive - Obstruction, Infection, Hemorrage, Surgery - Appendix 1000

Respiratory - COPD, Pneumonia 1200

Algoma Sault Ste. Marie General Hospital Obstetrics - Delivery 3800

Circulatory System - Heart Failure / Arrest, Irregular Beat, Surgery 2300


Other - Convalescence, Awaiting Placement 700

Cochrane Timmins & District General Hospital Obstetrics - Delivery 2800

Cardiac - without Coronary Angioplasty 1300

Digestive - Obstruction, Infection, Hemorrage 300


Can this be explained in part by health behaviours and access?


North East

LHINOntario

Proportion of Aboriginal Identity 9.5% 2.0%

Proportion of Francophones 22% 4.4%

Proportion of people living in rural areas 30.2% 14.1%

Proportion of people over the age of 65 18% 14.6%

Unemployment rate for ages 15+ 8.4% 6.4%

Proportion age 25 and over who do not

have a post-secondary degree, diploma or

certificate

18.4% 13.5%

Percentage of smokers 25.4% 19%

Percentage of drinkers reporting heavy

drinking19.9% 16.2%

Percentage of adults (age 18+) who are

overweight or obese61.7% 52.3%

Prevalence of high blood pressure 22.5% 17.4%

Percentage of residents with multiple

chronic conditions21.5% 15.2%

Proportion of the population who have a

regular medical doctor 85.20% 90.90%

As shown in the LHIN’s 2013-2016 Integrated Health Service Plan.

Who is the most vulnerable?Literature says that the most vulnerable are “populations for whom social conditions often conspire to both promote various chronic diseases and make their management more challenging.”

Aboriginal people - particularly youth and women;

Single parents, especially single mothers and those who identify as part of a visible minority group;

Newcomers and refugees, particularly visible minorities and women and children;

Middle-aged and older Caucasian men who are depressed, especially those with low levels of education, who may also use substances and be at risk of suicide;

The homeless and formerly homeless, those with histories of precarious housing and those living in core housing need;

Seniors living alone, especially seniors aged 85+ years with impaired autonomy, living on a fixed or low income and in rural communities, with unmet health and social care needs;

Those identifying as LGBTQ, including youth and seniors, who are at greater risk for victimization and mental health issues, including suicide.



Person doesn’t have access to

appropriate housing (e.g. homeless, living

in shelters)

71

Person is transient, but has access to

appropriate housing

6

Risk of losing housing/unsafe living

conditions

21

Person doesn’t have access to

appropriate housing (e.g. homeless, living

in shelters) & risk of losing

housing/unsafe living conditions

1

Person is transient, but has access to

appropriate housing & risk of losing

housing/unsafe living conditions

1

TOTAL 100

Source: Community Mobilization Sudbury Risk-Driven Tracking 2016.

Canadian Mental Health Association.

Number of Situations with Housing Risk Factors

%

Mental health 86

Criminal involvement 54

Suicide 52

Antisocial/negative behaviour 49

Drugs 49

Basic needs 47

Physical health 46

Alcohol 43

Physical violence 29

Threat to public health and safety 28

Negative peers 23

Poverty 23

Crime victimization 19

Self-harm 19

Unemployment 16

Parenting 13

Missing school 10

Emotional violence 6

Gangs 4

Missing 4

Social environment 4

Risk Categories Identified in Combination with Housing

Note: Risk categories > 3% represented.

Source: Community Mobilization Sudbury Risk-Driven

Tracking Database. June 2016. Canadian Mental Health

Association Sudbury/Manitoulin.

Case Study: Sudbury RMT

Homelessness in the SaultOn February 18, 2016 a point-in-time count of the homeless in Sault Ste. Marie was conducted.


0

5

10

15

20

25

Sault Area Hospital Detox Centre Algoma Treatment and RemandCentre

Co

un

t o

f In

div

idu

als

Site

Homeless - No Fixed Address Sault Area Hospital Profile10 participants ages of 25-58 (58.9%)6 of the participants were age 60+ (35.3%)11 of 17 Male (64.7%)

Detox Centre Profile:4/5 age 20-264/5 (80%) Male

Treatment and Remand Centre Profile:13/22 (59.1%) age 31-659/22 (40.9%) age 19-3021/22 (95%) Male

Supportive Communities Access to quality health services and social support networks are also determinants of health. They also help maintain housing.

In Canada, family, friends and neighbours provide 70% - 90% of care in the community and there is growing recognition of the need to take care of caregivers so that they can continue to care as long as possible.

And when informal care is not available, and community infrastructure is lacking to fill the gap, a person whose health or functional status is tenuous may continue to decline or find themselves in crisis.

In such cases, people often call 9-1-1 and are taken by ambulance to the hospital, where they may stay for a prolonged period if a suitable discharge destination, other than home, is not available.


People want to stay home, but struggle to get the home care they need

According to the 2012 General Social Survey, as reported by Statistics Canada:

Seniors age 65+ most likely to receive home care in Canada and least likely to have unmet needs.

Baby Boomers are most likely to have unmet care needs.

Persons with a disability are most likely to have partially met needs.

Having a household income below $20,000 per year is associated with unmet needs.

Immigrant status is also associated with unmet home care needs.

35% of caregivers with unmet needs were providing 10 hours of care per week or more.


Unmet Needs in Northern OntarioWhile recipients living in a CMA or CA are more likely to have unmet home care needs, an earlier study by McMaster University researchers found that rural home care recipients:

particularly in northern Ontario, were more likely to receive government-funded home care, especially nursing care, than urban dwellers

were less likely to receive non-government funded nursing care and be more reliant on informal caregivers.

This suggests that non-government funded nursing care may be less available and/or less affordable to rural recipients and also suggests that cut-backs to CCAC services may hurt more.



Wait TimesAccording to CCAC Data, prepared by the LHIN.


Days Waiting Rank Days Waiting Rank Days Waiting Rank Days Waiting Rank Days Waiting Rank

Black River-Matheson 42 17 22 2 17 3 5 10 20 4 4 15 68 3

Blind River 42 17 12 4 7 9 7 8 10 8 30 1 66 5

Burk's Falls 56 8 23 1 9 7 9 6 12 7 14 5 67 4

Chapleau 251 2 4 12 6 10 8 7 21 3 23 2 62 6

Cochrane 59 7 8 8 12 5 7 8 17 5 16 4 60 7

Elliot Lake 67 5 11 5 6 10 10 5 6 12 12 7 45 13

Englehart 35 19 5 11 8 8 8 7 9 9 3 16 33 19

Espanola 50 12 10 6 7 9 9 6 8 10 8 11 42 15

Greater Sudbury / Grand Sudbury 56 8 6 10 8 8 9 6 13 6 10 9 46 12

Hearst 79 3 10 6 4 11 6 9 7 12 27 21

Hornepayne 49 13 9 7 21 1 30 20

Iroquois Falls 44 16 6 10 18 2 3 11 23 2 5 14 55 9

James Bay and Hudson Bay Coast 779 1 68 1 13 3 81 2

Kapuskasing 46 14 7 9 9 7 7 8 50 1 12 7 85 1

Kirkland Lake 42 17 10 6 9 7 11 4 2 15 6 13 38 17

Manitoulin Island 55 9 7 9 11 6 10 5 10 8 12 7 50 11

Mattawa 41 18 5 11 3 12 6 9 7 11 9 10 30 20

North Bay 51 11 9 7 6 10 5 10 9 9 9 10 38 17

Parry Sound 54 10 18 3 8 8 8 7 12 7 11 8 57 8

Sault Ste. Marie 49 13 7 9 6 10 7 8 4 13 16 4 40 16

Smooth Rock Falls 61 6 9 7 8 8 6 9 8 10 13 6 44 14

Sudbury East 73 4 8 8 6 10 6 9 20 4 12 7 52 10

Temiskaming Shores 33 20 8 8 7 9 9 6 3 14 7 12 34 18

Timmins 45 15 12 4 6 10 6 9 21 3 17 3 62 6

Wawa 42 17 8 8 8 8 18 2 7 11 3 16 44 14

West Nipissing / Nipissing Ouest 54 10 1 13 16 4 7 8 8 10 10 9 42 15

2015 Days

Waiting

2015

RankCommunity

OT PT Speech Social Work2014 Days

Waiting

2014

Rank

Nutrition

Other Options for Housing with Supports

For Seniors, depending on need:- Assisted Living / Supportive Housing

- Retirement Home / Seniors Village

- Long-Term Care Home

- Seniors’ Apartments

- Congregate Living

- Boarding and Lodging Houses

- Co-Housing

- Campuses of Care

- Hub and outreach models

For Persons with a Disability, including mental health and addictions:- Group Homes

- Assisted Living / Supportive Housing

- Domiciliary Hostels

- Homes for Special Care

- Boarding and Lodging Houses

- Long-Term Care Home


What We Heard•Homelessness not seen as a major driver of ALC Days currently. The bigger barriers are a lack of affordable, supportive discharge options when people cannot return to home.

•Many ALC patients awaiting discharge to LTC homes as one of the only options, but wait longer in hospital than applicants in the community who are more likely to be prioritized; this is a challenge for hospitals

•Responsive / aggressive behaviours a major driver of ALC days, with LTC homes often refusing placement, although financial and housing barriers, and needs, are also significant

•Many people who present in the ER, possibly among those diagnosed as ‘failure to cope’ are active CCAC clients


What We Heard, cont’dThere is a need to:

• Expand the supply of supportive housing options; especially providing intensive support for specialized populations

• Make retirement homes more affordable, or increase number of congregate settings, with cluster care from CCAC

• Expand the supply of basic long-term care beds to more quickly discharge low-income patients from hospital

• Enhance home and community care, including CCAC services, across the NE LHIN; look to proven models

• Support informal caregivers, with caregiver burnout being a key driver of admission and barrier to discharge

• Support with transition from hospital to home or long-term care home; fund hospital outreach teams


Key Drivers of ALC Days in TimminsHospitals track and report on their ALC days, and maintain information about the barriers and needs that are preventing discharge.

So far, we know that in Timmins:

In 2015/16, as of May 19 2016, there were 58 ALC patients with barriers to discharge.

In 20 cases, medical care requirements were barriers to discharge and in another 19 remaining cases, neurological – behavioural – mental health issues were barriers to discharge.

In 11 cases, social requirements, including housing issues (4) and lack of social support (4) were barriers to discharge. One also had a financial barrier, while another’s barrier was unspecified. Social requirements are very common ‘needs’ among ALC patients; if not barriers to discharge.

This highlights the need for accessible home and community care options, including intensive supportive housing options, to facilitate discharge from hospital in Timmins.



According to hospital data, prepared by the LHIN.

Community

% of total hospital

days as ALC

(Average FY)

Rank 2014/15

% of total

hospital

days as ALC

(Average FY)

Rank 2015/16

Black River-Matheson 38.3% 15 36.5% 15

Blind River 50.5% 5 55.3% 7

Burk's Falls 35.7% 16 34.7% 16

Chapleau 69.2% 2 77.6% 1

Cochrane 45.5% 8 52.4% 9

Elliot Lake 43.3% 12 45.5% 11

Englehart 95.2% 1 31.3% 19

Espanola 38.4% 14 52.0% 10

Hearst 57.5% 4 60.1% 5

Hornepayne 43.9% 11 39.9% 14

Iroquois Falls 45.3% 10 42.4% 12

Kapuskasing 57.5% 3 65.7% 2

Kirkland Lake 35.7% 18 32.5% 18

Manitoulin Island 17.7% 21 29.0% 20

Mattawa 45.3% 9 55.5% 6

Parry Sound 35.7% 16 34.7% 16

Smooth Rock Falls 49.4% 7 61.8% 4

Sudbury East 25.0% 20 25.0% 21

Temiskaming Shores 34.5% 19 41.0% 13

Wawa 42.2% 13 63.2% 3

West Nipissing / Nipissing Ouest 50.0% 6 55.0% 8

ALC Days in the Smaller Communities


According to the northeast LHIN in 2011, $842 / day.However, sources indicate that Acute Care Beds specifically cost $918 / day. This table shows ALC days in Acute Care beds, specifically, and therefore does not include ALC days in Complex Continuing Care beds, regional mental health beds, etc.

Hospital Hub Region ALC Days 2011

(4059) HEALTH SCIENCES NORTH-LAURENTIAN Sudbury-Manitoulin 26,593 24,412,374.00$

(4407) SAULT AREA HOSPITAL-SAULT STE MARIE Algoma 15,572 14,295,096.00$

(3414) TIMMINS & DISTRICT GENERAL HOSPITAL Cochrane 7,578 6,956,604.00$

(3729) WEST PARRY SOUND HEALTH CENTRE Parry Sound 6,076 5,577,768.00$

(2058) ST JOSEPH'S GENERAL HOSPITAL Algoma 5,693 5,226,174.00$

(2088) SENSENBRENNER HOSPITAL (THE) Cochrane 4,955 4,548,690.00$

(2211) KIRKLAND AND DISTRICT HOSPITAL Nipissing-Temiskaming 4,048 3,716,064.00$

(2207) TEMISKAMING HOSPITAL Nipissing-Temiskaming 3,730 3,424,140.00$

(2812) WEST NIPISSING GENERAL HOSPITAL Nipissing-Temiskaming 3,654 3,354,372.00$

(2057) BLIND RIVER DIST HLTH CTR/PAVILLON SANTE Algoma 2,628 2,412,504.00$

(2204) ENGLEHART AND DISTRICT HOSPITAL Nipissing-Temiskaming 1,836 1,685,448.00$

(2082) HOPITAL NOTRE DAME HOSPITAL (HEARST) Cochrane 1,787 1,640,466.00$

(2076) LADY DUNN HEALTH CENTRE Algoma 1,714 1,573,452.00$

(4730) NORTH BAY REGIONAL HEALTH CENTRE Nipissing-Temiskaming 1,592 1,461,456.00$

(2094) SMOOTH ROCK FALLS HOSPITAL Cochrane 1,423 1,306,314.00$

(2174) ESPANOLA GENERAL HOSPITAL Sudbury-Manitoulin 1,309 1,201,662.00$

(2078) LADY MINTO HOSPITAL (THE) Cochrane 1,064 976,752.00$

(2126) MATTAWA GENERAL HOSPITAL Nipissing-Temiskaming 1,049 962,982.00$

(2121) MANITOULIN HEALTH CENTRE-LITTLE CURRENT Sudbury-Manitoulin 726 666,468.00$

(4698) WEENEEBAYKO AREA HLTH AUTH-MOOSE FACTORY Coasts 705 647,190.00$

(4770) BLIND RIVER AND DIST HLTH-THESSALON SITE Algoma 581 533,358.00$

(2173) SERVICES DE SANTE DE CHAPLEAU HLTH SERV Cochrane 492 451,656.00$

(2123) MANITOULIN HEALTH CENTRE-MINDEMOYA UNIT Sudbury-Manitoulin 488 447,984.00$

(2061) HORNEPAYNE COMMUNITY HOSPITAL Cochrane 480 440,640.00$

Total 95,773 80,640,866.00$

What does this cost the system?

Vulnerable Tenant Research Study: Summary of Key Findings


Findings from the LiteratureDefining Vulnerability:

“Anyone who needs additional support – for any reason – to maintain a successful tenancy

Tenants may be, or may become, vulnerable because of a mental or physical illness or disability, an addiction, trauma, dislocation, isolation, experience of violence or a history of homelessness or institutionalization. A tenant’s need for support may be episodic or increase or decrease over time, and may be exacerbated by the absence of support or a reluctance to accept support when offered.”

(ONPHA, 2015)


Findings from the LiteratureSocial Housing and Mental Health

Seniors in Social Housing

Aboriginal, First Nations, Metis Population in Social Housing

Northern, Rural and Remote Communities

Lesbian, Gay, Bisexual, Transgendered (LGBT) Persons in Social Housing


Gap Analysis: Social Housing Inventory


4,859

2,430 2,310 2,285

850 571 453 396

Greater Su

db

ury

Sault Ste

. Marie

Co

chran

e

Nip

issing

Timiskam

ing

Algo

ma

Man

itou

lin-Su

db

ury

Parry So

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d



Family23.4%

Senior27.3%

All/Mixed44.9%

First Nations/Aboriginal4.5%



29.5%39.4%

14.0%

43.7%32.7%

19.4% 15.1% 18.0%

29.2%

31.3%

13.8%

21.3%

26.0%

24.6% 28.2%12.7%

41.2% 29.4% 72.3% 35.0% 41.4% 56.0% 56.7% 69.3%

Algo

ma

Co

chran

e

Greater Su

db

ury

Man

itou

lin-Su

db

ury

Nip

issing

Parry So

un

d

Sault Ste. M

arie

Timiskam

ing

Seniors Families Single Adults & Couples

Gap Analysis: Support Services Inventory

Sector

Community Care Access Centre Sites 6

Community Health Centres 10

Community Support Service Agencies 124

Hospitals 20

Mental Health & Addictions Supports 62

Public Health Unit Sites 11

Total 233


Gap Analysis: Estimating Vulnerability in Social Housing

Total Number of Units1

Estimated Number of Social Housing

Tenants2

Estimated Number of Tenants with Serious and Persistent Mental Illness3

Estimated Number of Seniors Requiring

Supports4

Estimated Number of

Tenants with a Disability5

Estimated Number of Vulnerable

Tenants7

Measure 1.5 3.0% 7.0% 15.0% 18.0% 15.4% 54.6%

Algoma 610 915 27 64 101 121 141 500

Cochrane 2,281 3,422 103 240 491 589 527 1,868

Greater Sudbury 4,596 6,894 207 483 633 760 1,062 3,764

Manitoulin-Sudbury 453 680 20 48 77 92 105 371

Nipissing 2,285 3,428 103 240 264 317 528 1,871

Parry Sound 396 594 18 42 82 98 91 324

Sault Ste Marie 2,234 3,351 101 235 448 537 516 1,830

Timiskaming 850 1,275 38 89 129 155 196 696

All LHIN 13,705 20,558 617 1,439 2,224 2,669 3,166 11,224


What We Heard

Housing Providers

Support Agencies

Tenants


What We Heard: Housing Providers Key Challenges:

Lack of support for life skills

Need for more affordable housing, more accessible housing

Greater collaboration, communication among housing and support providers

Not enough supports! Lack of family and/or peer support Lack of crisis care, intensive care Lack of support for tenants leaving hospital Long waiting lists in general Particular challenges for rural/remote communities Lack of support for mental health and addictions


Often tenant is living on their own for the

first time

What We Heard: Housing Providers


Q6: What do you feel is most needed by tenants at risk of losing their housing to help them maintain their housing?

6

5

7

13

15

Other

Tenant Counselling / Case Management

Increase Financial Aid / Affordability Options

Medical Care / Personal Support

Life Skills Coaching (ie. education, budgeting,employment)

What We Heard: Support AgenciesKey Challenges:

Supports for persons with severe and persistent mental health issues

More intensive care support

Lack of family support and ‘caregiver fatigue’

More life skills support for tenants

Need for more supports in place at time of discharge from hospital

Many communities have no support or no access to the right services


What We Heard: Support Agencies


14

4

7

8

9

18

Other

Funding for Services

Support Staff/ Tenant Advocate

Affordable/ Accessible/ Supportive Housing

Case Management

Home/ Personal Support Services

Q12: In your opinion, what is most needed to help vulnerable residents maintain successful tenancies?

Lessons Learned: Windsor Case StudyPartnership between University of Windsor and Windsor Essex Community Housing Corporation

Engagement of university students to facilitate leadership and volunteerism among neighbourhood residents


Key Themes & Opportunities1. Needs assessment tool

2. Care Teams/Peer Support/Tenant Advocates

3. Life skills supports

4. Access to support options in all communities

5. Intensive care/support

6. Connecting partners

7. Access to on-site support

8. Transitional support

9. Affordable housing


Next Steps


Next Steps: Our Challenge

What does a regional service delivery system for vulnerable tenants look like?

How do we get there?


Questions?


Thank you!FOR FURTHER INFORMATION ON THE VULNERABLE TENANTS RESEARCH STUDY, PLEASE CONTACT ED STARR AT [email protected]


vulnerable tenants research study · the most deprived ne lhin nosda forum –june 8 2016 8...

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