Supportive housing units, like this one, may offer a roof over people's heads but more needs to be done to help them get their health issues dealt with effectively.

(BEN BULMER / iNFOnews.ca)

A new study shows that the vast majority of residents in supportive housing complexes are not getting the medical attention they need and some are turning to substance use for the first time.

But Interior Health says since the research was done almost three years ago, changes have already been made and more are on the way.

"The study was done in 2020 at the height of lockdown when accessing health services was a challenge for everybody, not just marginalized people," Danielle Cameron, interior Health's executive director for clinical operations in the Central Okanagan, said in an email to iNFOnews.ca. "There has already been an expansion of supportive housing services in Kelowna since the study was done."

Key findings of the study, published in the May 2023 edition of the BC Medical Journal, show that 72% of respondents felt they had unmet health needs.

That was complicated greatly by the fact that many also had addiction issues that prevented them, or limited their ability, to get treatment for physical ailments.

The study was conducted with 42 residents (38%) and 30 staff (75%) at three supportive housing complexes run by the same operator in Kelowna from Aug. 1 to Sept. 2, 2020.

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The results are shocking, with 93% of residents having some form of chronic disease and 76% having two or more chronic diseases.

The health care system, the study says, is not set up to deal with people with a background of homelessness and addiction along with mental and physical illnesses.

“When people are experiencing a concurrent disorder, they are often turned away from one health service because of the other concern,” one staff member told researchers. “So, if you are having a mental health issue that could be substance use related, then you’re turned away from actual support around your mental health until your substance use clears.”

The majority of residents (51%) said they didn’t know of health care services being available to treat chronic conditions.

“I don’t know what the resources are,” one resident said. “I don’t know what my options are or accessibility or anything like that. I feel like I’ve been housed and that was it. I guess I appear to be high functioning so they think I can do it on my own, but I’m having a lot of trouble. I just don’t even know how to start or where to start, what to do.

“It was a huge transition going from the shelter, where they pretty much wait on you hand and foot, to independent living where you just got to do it all by yourself. I’m just losing my mind here. It feels like I’m on the street again. It doesn’t feel like I got any help. I’m struggling, quite a bit.”

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"Since the study was completed, we have changed our model," Cameron wrote. "The service delivery of health care to individuals who live in these houses can come in a range of formats. Many clients will receive outreach services where we have outreach teams of nurses and social workers attend the housing sites on a regularly scheduled basis to interact with clients who are attached to our services. Individuals may also receive services at some of our locations like Outreach Urban Health which opened after the study was done."

The shortfall in health care for physical conditions in 2020 was complicated by the exposure to open drug use in what are often referred to as “wet” facilities that may have things like overdose prevention sites.

Some residents reported starting drug use after moving into the housing complexes.

“In all honesty, I never smoked (meth) before I moved here,” one resident told researchers. “What’s the saying? If you sit in the barbershop long enough, eventually you’re going to get a haircut.”

Staff and residents talked to researchers about how hard it is to prevent people from starting on drugs and how equally difficult it is for former users who are trying to stay clean.

“Wet houses and harm reduction, I understand the need for it but it frustrates me,” one staff member said. “What I see is a very narrow group of people that I know and have worked with, (and) I don’t know anyone that comes out the other end clean or sober from that scenario. It’s frustrating.”

“I think there needs to be more of a second stage house,” said another. “I’m talking about alcoholism and recovery, mental health . . . to start off in the supportive housing units that we have, that’s great. But it would be nice for people to be able to grow and move into a space where there’s maybe more programming or assistance.”

The authors suggest tenants should be screened so the housing better matches their needs.

“Other supportive housing sites should have a lower tolerance for substance use and be able to offer ‘clean’ units for clients who are returning from detox or are actively trying to abstain from substance use,” the report suggests.

Health care workers need to better understand the complex needs of this population, the study says.

“I’ve been told by clients that their experience going into hospital is night and day whether I’m with them or not,” one staff member told researchers.

Another staff member confirmed that having an advocate in the emergency room means residents are “more likely to get attention, much quicker, and be taken seriously.”

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But stigma is not just an issue in hospital ER rooms.

“The system is still designed in a way that punishes people for not making appointments . . . so if (tenants) miss three dentist appointments, (they are) cut off from the free clinic, for example,” one staff member said. “That is not super realistic for the folks that we work with.

“I have had clients that have a regular GP and, if they miss an appointment, they’re charged. You can’t charge an $80 cancellation fee to a person that’s on a limited income and expect them to ever go back, but all their records are with you and they were comfortable with you, so that’s problematic.”

There also needs to be supportive long term care facilities for older residents and changes to how home support services are provided.

One staff member talked about the perception that people “grow out of mental health and substance abuse,” which is not the case as they know many users in their 60s and older.

“There is a gap in housing that provides support for seniors with substance use issues, but also with physical conditions such as incontinence and aspects of end-of-life care,” the report says.

On the home support side, there’s a system in place to help people who need assistance with daily living, such as washing and dressing.

“This service offers a range of support from care aides who can assist with personal hygiene, nurses who provide medication management, specialists for issues such as diabetes and chronic obstructive pulmonary disease,” the report says. “However, home health care has refused service to tenants for being intoxicated, smoking cigarettes on the premises or having substance use paraphernalia in the unit.”

“Our seniors’ care facilities, which are totally competent in meeting health care needs and doing the bathing and feeding without falling and all that stuff, have no tolerance for substance use,” one staff member said.

“I have a client who has, since I’ve worked with her, been through a scattered site, a supportive housing placement, and to seniors’ homes, and she’s facing an eviction and will likely end up spending months again in hospital because they don’t know where to take her or what to do with her,” the worker added. “So, there’s just . . . no overlap between the ability to tolerate substance use and to tolerate some of those behavioral issues and the ability to manage somebody’s complex health needs.”

The study’s authors do have suggestions on how the system can be improved that don’t just include more and different types of housing.

“Attitudes toward mental health and substance use need to shift before we can expect better treatment of the people we serve,” they wrote. “We believe that the best way of addressing this issue is to provide service providers with education and training on mental health and substance use and on the unique challenges faced by street-entrenched populations.

“Tenants and staff suggested that solutions to this issue could include providing a mobile health care team, an on-site multidisciplinary team, or increased access (including evenings and weekends) to existing health care services.”

Even though the study is somewhat dated, it's still valuable, Cameron wrote.

"The study is an important body of work and reinforces the need for a range of supportive housing options to meet the needs of our community," she said. "It’s informative and will help us address and acknowledge some of the gaps in our system."

The full study, which was authored by researchers at UBCO and the Journey Home Society, can be seen here.

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