Preventing homelessness after hospital discharge

Fall 2019

In Canada, approximately 235,000 people experience homelessness each year and the number is rising. Studies have shown that homeless patients are four times more likely to be readmitted to hospital within a month after discharge, when compared to those who have a home.

A research team from Lawson Health Research Institute, the research institute of LHSC and St. Joseph’s Health Care London, is tackling the issue of homelessness from within hospital walls. No Fixed Address (NFA) is the first strategy of its kind that aims to reduce the number of hospital patients being discharged to homelessness.

“Many patients tell us their journey with homelessness started after a hospital discharge,” says Dr. Cheryl Forchuk, Scientist and Assistant Director at Lawson. “They are often experiencing major transitions in life and are unable to access necessary supports to find a place to stay before leaving the hospital.”

Created by Dr. Forchuk and her team, along with various community partners and people with lived experience, the NFA strategy is focused on supporting patients at risk of homelessness during the crucial transition when they are being discharged from hospital and re-integrated into their community. Patients are offered timely and accessible support in finding appropriate housing, employment services and financial assistance.

NFA is built on partnerships with service providers and non-profit organizations. Staff members from the Canadian Mental Health Association (CMHA) Middlesex, Salvation Army’s Housing Stability Bank, and Ontario Works provide direct, in-hospital support to patients.

The NFA strategy has been developed and tested through several phases. The initial project offered support services to people being discharged from psychiatric programs at LHSC and St Joseph’s. Over the past two years, 326 patients at risk of being discharged to homelessness accessed those services.  The success rate was about 85 per cent, meaning that 276 of those patients were able to find housing.  

Through funding from the federal Homelessness Partnering Strategy, the second phase of the NFA project was extended to medical units at LHSC’s University and Victoria hospitals in a nine-month demonstration study. It ran from July 2018 to March 2019.

During that time, 74 patients experiencing medical health issues accessed supports through NFA. Of those, 54 per cent were also experiencing mental health challenges.

All participants were in imminent danger of homelessness, but half were able to arrange housing before discharge. Of the patients interviewed three months after discharge, none who were discharged with housing experienced a hospital readmission. Meanwhile, 60 per cent of patients who had not secured housing before discharge experienced a readmission.

“While we were able to help a significant number of people, we want to do more,” adds Dr. Forchuk. “With the results and feedback from this study, we have learned plenty on how we can make the NFA strategy work even better for patients in medical units.”

The team found that patients in medical units who are at risk of homelessness tend to have highly complex needs that often include mental health challenges. The length of stay for patients in a medical unit tends to be short, meaning there is not as much time to facilitate a housing arrangement before discharge.

“To best serve patients at risk of homelessness, we need to provide additional housing supports in the community after discharge,” says Dr. Forchuk. “Our goal is to keep refining and growing the NFA strategy, helping as many patients as possible.”


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