Homeless in Toronto Emergency Wards FWD

Tom Boland (wgcp@earthlink.net)
Wed, 10 Dec 1997 03:52:37 -0800 (PST)


 Homeless end up on the street, then the emergency wards

 By John Richmond, richmond@smh.toronto.on.ca


     The results of a study (to be published elsewhere) conducted
     during the winter of 1996 in a downtown Toronto hospital indicate
     that the Harris government's massive cuts in welfare and social
     services have greatly increased the numbers of homeless people in
     the city. The government's failure to tackle the underlying
     causes of homelessness, such as the lack of affordable housing,
     has resulted in many of these victims ending up in the emergency
     departments of hospitals.

     The study involved screening patients at one hospital for a wide
     variety of social problems. The study was confined to patients
     who came (or were carried) to the emergency department between 3
     p.m. and 11 p.m. over the course of 60 days between January 1 and
     April 30, 1996.

     Of the 1,622 patients screened during the study, 31% were found
     to have at least one serious social problem. Only 29%, for
     example, had jobs, and over 400 had no source of income at all.

     Whether these 1,622 people were representative of the population
     in Toronto's inner city may be debatable, but the findings
     clearly suggest that thousands of people must be falling through
     the holes in the province's disintegrating social safety
     net--including the growing numbers of homeless people on the
     city's streets.

     Of the patients in this survey, a dozen without any source of
     income were elderly. One other man, aged 79, was employed as a
     tradesman in the underground economy, but was not making enough
     to pay rent. He was living in a van.

     The study found that 278 of the patients had no place to live,
     not even with families or friends, and that nearly half of them
     had no source of income. Even though it was the middle of winter
     at the time of the survey, only 90--or less than 30%--of these
     homeless people had any kind of shelter.

     While this study was being done, 2,362 people were cut from the
     welfare rolls in Toronto. No one seems to know for certain where
     these people went, but the study's findings suggest that many of
     them ended up on the street, and a significant number in hospital
     emergency wards.

     Lack of income, however, is not the only cause of homelessness.
     Canadian experts, such as Prof. David Hulchanski of the
     University of Toronto, also argue that many of the working poor
     are being squeezed out of the rental market. No longer able to
     afford rental housing, the very poor have come to rely on
     friends, family, and the state (through social housing).

     Considering the 21.6% cut in welfare rates inflicted just two
     months prior to this study, the harsh measures taken since to
     reduce "welfare dependency," the lack of new social housing
     starts since 1995, and the abolition of rent control, even those
     on some form of income assistance are finding it increasingly
     difficult to hold on to their homes or to cope with rising rents.
     More and more people are being forced to seek refuge temporarily
     in public shelters (use of which has increased dramatically in
     recent years) and eventually onto the street.

     Once on the street, even healthy people are more prone to
     illness, and for needed health care people with no fixed address
     inevitably go (or are taken) to a general hospital's emergency
     department. The emergency department which provided the locale
     for this study is also the source of many other hard-to-access
     resources for the homeless: food, clothing, bus and subway
     tokens, and even taxis for those unable to walk.

     But hospitals are expensive sources of care for the homeless. A
     visit to the emergency department may cost several hundred
     dollars, while a stay in the hospital for a relatively minor
     ailment (which would normally be treated at home for those with
     homes) will cost thousands of dollars. Hardly an effective and
     efficient use of a province's resources.

     Unfortunately, the ideologically-driven conservative politicians
     who now govern Ontario seem to have forgotten the infamous law of
     unintended consequences, which serves to remind us that simple
     policy "solutions" to complex social problems never work.

     Laissez-faire social policies, such as those favoured in Ontario
     and other parts of Canada (and in the United States), don't
     alleviate social problems; they make them worse. So we see higher
     prison incarceration rates, higher rates of illiteracy, extended
     family breakdowns, and of course growing number of homeless
     people begging in the streets.

     All these social problems, left to fester, cost society far more
     in the long run, in terms of increased social, medical and legal
     services, than would have been the case had steps been taken to
     prevent or moderate them.

     The Harris government has not only failed to create jobs, but has
     also gutted the programs and services that were designed to help
     those denied jobs. The only steps the government has taken have
     been negative ones, and the result has been to leave many more
     people dependent--not on low-cost social programs such as co-op
     or social housing, but on expensive services such as ambulances
     and hospital emergency departments.

     This is a policy disaster of monumental proportions, one that is
     not being mitigated by the government's most recent attempt to
     download responsibility for social services onto the
     municipalities. The cynical hope seems to be that, when the whole
     system falls apart, the city and town councils will be blamed
     rather than the chief architects of the disaster at Queen's Park.

     In these times of globalization and growing corporate power,
     social policy has become a mine-field. No level of government in
     Canada has had the foresight or courage to devise even a
     sensible--never mind a progressive--approach to social policy
     reform. Instead, most governments, driven by a right-wing
     ideology, have tried to change social programs in ways that move
     them away from being a collective responsibility to forcing
     people to fend for themselves. Associated with these damaging
     "reforms" have been tax cuts for the well-to-do, subsidies to
     inflate business profits, and wage restraints and other measures
     to reduce the incomes of working people.

     This study of homelessness in Ontario's largest city is but one
     indicator of the abject failure of right-wing social
     policies--failure, at least, in terms of the larger public
     interest. The Harris government's corporate backers apparently
     remain quite happy with such an approach.

     The Tories now plan to extend and enforce workfare, to
     fingerprint welfare recipients, and make it even harder for the
     poor to access social assistance. These additional harsh measures
     are bound to put more homeless people on the streets, and
     increase the number who succumb to serious illness and even death
     during the coming winter.

     With food banks and other charities already stretched to the
     limit of their resources, more homeless people will end up
     needing expensive services such as emergency departments, thus
     offsetting any "savings" that might be made by the deeper cuts in
     social services.

     There is no escaping the cost of modern cutthroat capitalism.
     Either we pay up front for the welfare state, or we pay later for
     the unwell-fare state in the form of more unemployment, more
     crime, more illness, and more homelessness.

 (John Richmond, MSW, CSW, is a clinical social worker and researcher
 with the Inner City Health Program at the Department of Emergency
 Medicine, St. Michael's Hospital, Toronto.)

 Taken from The CCPA Monitor, November 1997.