Housing as Healthcare
Policy, Program, Intervention or other types of research evaluation
Issues : Saskatchewan rates of HIV are 4x the national average. The majority also suffer from mental illness, addictions, homelessness and poverty. Homeless persons have high rates of physical illness, mental illness, substance abuse, and early mortality. They are more likely to be admitted to hospital, have increased length of hospitalization, and present a substantial burden on the resources of safety-net hospitals. Homelessness and unstable housing are consistently linked to greater HIV risk, inadequate HIV health care, poor health outcomes and early death. In many cases those who do have housing, the location has been “red flagged” by the health region thereby prohibiting the provision of home health care for that individual. The supportive housing services currently operating in the region are neither familiar nor comfortable with managing individuals who suffer from HIV, mental health, addictions or poverty-related issues. The majority of personal care homes refuse to accept HIV positive persons into their homes. Therefore, while different agencies are able to manage poverty and homelessness or mental illness, few, if any, are able to manage HIV-positive populations who are also affected with poverty, homelessness, and mental health issues. In 2009, 77% of all female cases diagnosed in 2016 were of a childbearing age (15-44 years). From 2011 to 2014 there were 0 perinatal transmissions and in 2015 there was an increase to 3 perinatal transmissions.
Description : In 2013 two frontline service providers, a physician and a social worker recognized that the conventional health provision was not meeting the needs of a population who actively use illicit substances, are homeless, HIV positive, and have undiagnosed trauma, and mental illness. In 2013, we responded by forming the non-profit Sanctum Care Group Inc. In 2015, Sanctum opened a ten-bed hospice and transitional care facility that offers hospice, respite and transitional care and housing to people living with HIV and AIDS through an intergrated, hard reduction approach to care. Sanctum provides care that addresses the medical, psychological, emotional, social, environmental, and spiritual needs of people living with HIV in Saskatchewan.
Sanctum Care Group is expanding this model and opening Canada’s first HIV prenatal home, Sanctum 1.5. This home targets the same vulnerable population group, but provides specialized service for pregnant women who are HIV positive. A similar multi-disciplinary care approach will be taken to provide stable, supportive housing that will address maternal and mental health needs, addictions and the multiple socio-economic disparities of pregnant women. This approach will mitigate the risk of vertical HIV transmission and will optimize positive outcomes for both mother and baby. Currently, in Canada, there are no preventative prenatal support homes. Sanctum 1.5 is opening in July 2018. Sanctum’s core operations are funded by the Regional Health Authority based on a business model of cost savings. This model of care improves patient outcomes and decrease costs in the healthcare system.
Lessons learned : Majority of residents reported history of sexual trauma, violence, emotional abuse, death of family member, serious accident or physical, concurrent mental health, suicidal ideation, victim of crime, physical assault, parental abuse of drugs/alcohol, addictions and chronic homelessness.
Improved health outcomes in all areas including, increased CD4 count and viral suppression on discharge
Increase in community supports including, including HIV physician, specialist and Case Management
Improved housing status
Significant cost savings to the health care system
Recommendations : * Expanded model to open up the BEEHIVE - Saskatchewan first transitional apartment for people living with HIV
* Piloted HART ( HIV/AIDS Response Team)
* Peer support staff and programming
* Implementing this alternative model of care for people living with HIV across the province
* Opening Canada's first HIV Prenatal Care Home in July 2018