Baby Step Progress in Improving Supportive Housing

By Marvin Ross

Baby Step Progress in Improving Supportive Housing

The City of Hamilton has just approved the recommendations from a research study looking into what are called Residential Care Facilities (RCF’s). These are subsidized group homes for vulnerable residents in the city. Funding will shift from blanket per diem funding to support models that take into account models that recognizes the need for different tiers of support for the residents.

This category of housing cares for about 1000 vulnerable adults with a range of problems and has been fraught with numerous tragedies from subpar property standards, poor meals, violence and coroners inquests. Earlier this year, I talked about the problem of RCF’s in one of my blogs after the Social Planning and Research Council (SPRC) in Hamilton made a number of recommendations. I pointed out that these residences are often run by private entrepreneurs. I’ve been in a number and some are dumps with unqualified staff providing meals and supervising medications. Some are adequate and some of the owners show considerable care and affection for the residents. There is little or no programming and residents are often found panhandling on local streets.

Because the residents receive room and board, they only get $149 a month to pay for all their other needs like clothes, transportation, sanitary supplies, etc and, in terms of spending power, this amount has declined 50% since 1992.

Another problem with this model as pointed out by Hamilton’s housing service director, Michelle Baird, “residents with different needs — whether addiction, mental illness or challenges with preparing meals — can all live under the same roof. That’s an issue.” Andrea Horvath, Hamilton’s mayor, said this system just does not work. With the new model, funding and staffing will be tied to the complexity of needs in a three tier system. More workers including those with expertise in mental illness and addictions will be hired.

In addition, residents will begin to get more money. The proposal calls for an increase to $396 per month for those who get meals and $581 for those without food.

All of these recommendations flow out of a three year research project co-ordinated by the Juravinsky Research Institute in Hamilton.

I think it is interesting to look at some of what they found. 75% of the residents had a mental illness, 47% addiction and 42% were cognitively impaired. The combination of groups with differing problems resulted in “ the high prevalence of trauma, mental health concerns, and substance use (and) increases the threat of harm. At one RCF, a resident was assaulted while sleeping in a common area, which deeply unsettled the entire home. Another resident described the ongoing emotional and physical toll: I sleep with one eye open.”

The research made six recommendations ranging from integrated care to standardized intake to modernized oversight and regulations. That can be read about on P 18 of their document.

That last point, oversight and regulation is what I’ve been ranting about for ages on this blog. My focus has been on Supportive Homes whose buildings combine those with severe mental illnesses, addiction, recent incarceration, encampments, age and disability all under one roof. This is often accompanied by numerous horrific tragedies from murder to assaults, and even a stand off with armed police.

There are no standards or inspections for this group of housing!

The City of Ottawa Auditor General found that “Ottawa like other jurisdictions, has not established baseline standards for the provision of supports within supportive housing facilities. This results in inconsistencies and varying formality across service providers. Finally, the audit found that the City is limited in the ability to holistically understand and assess whether its investments in supportive housing are “moving the needle”. The City has not established any outcomes and has limited measures to assess progress and, overall, lacks the necessary data to support decision making as it relates to supportive housing.”

The Auditor General of Ontario recently wrote that “The mental health housing program serves a vulnerable group of the population. In order to ensure that agencies consistently deliver high-quality housing and support services to clients with mental illness, it is critical that the Ministry and the LHINs appropriately monitor these agencies and collect sufficient information about the program. We found that the sector still lacks outcome data decades after this was raised as an issue. As well, there is no provincial aggregation of client satisfaction surveys, complaints, serious incidents and best practices to identify practices worth sharing and areas needing intervention.”

But guess what? These supportive housing agencies are not considered to be residential care facilities. I know this because when this Hamilton research began, I asked the researchers if they were including them and I was told no. These buildings called support housing are apartment buildings with standard supports or enhanced supports. With enhanced supports in some, one meal a day is provided but their main benefit is affordability.

According to a paper by the City of Hamilton, they should be regulated. The paper states that (P 22):

“Housing with Supports: means public, private or non-profit owned housing with some form of support component, beyond economic support, intended for people who need support services to live independently in the community, where providers receive funding for support services. The tenure may be long term. Housing with supports includes special needs housing as defined by the Provincial Policy Statement”

It also states (P 5) that “A residential care facility (RCF) is a facility which accommodates residents in bedrooms with shared dining and common areas and there is 24 hour onsite support. The minimum capacity can range from 3 or 4 residents to a maximum of 50, depending on the location of the facility and the Zoning Bylaw in which it is located.”

Should they not have standards to follow and regular inspections?

Day care does.

Long term care does.

Nursing homes do.

Hospitals are accredited.

Why isn’t supportive housing?

One group of support buildings has a 24 hour phone line for emergencies – like a live in superintendent for apartment buildings but much cheaper. One person on duty and one phone line rather than live in supers in each building.

The other night, a 72 year old woman with mobility problems called to say that her toilet was backed up and plunging did not help. She was told that is not an emergency and someone would come the next day to unplug it. When she was asked what she is expected to do in the interim, she was told to pee and poop in her shower.

The matter has been reported to the City of Hamilton By-Law standards office.

There is work to be done!

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