The Emergency Department at St. Michael’s Hospital sees more than 4,000 visits each year from people experiencing homelessness. Many have medically and socially complex needs. The challenging health care landscape both inside and outside the Emergency Department results in a lack of continuity of care, leading patients to return to the Emergency Department again and again for primarily unmet social needs. The Emergency Department worked with community partners to develop the Emergency Department Outreach Worker (EDOW) program, to improve navigation and connection to community resources for people experiencing homelessness. 

The core component of this project – funded by private donors – is to support people experiencing homelessness in the Emergency Department with immediate needs, and coordinates necessary referrals and support for their discharge back to the community. Following discharge, Outreach Workers maintain contact with their clients to assist with the coordination, navigation, and follow up of health care and community services. Since the launch of the program in June 2021, the EDOW Program has cared for more than 300 patients, with 200 of these patients receiving long term, in-depth supports. 

* To protect their privacy, some of the patients featured in this story had their names replaced by pseudonyms.

An ambulance is seen entering the bay of St. Michael’s Hospital’s emergency department. With winter temperatures dropping, an increase in the number of individuals experiencing homelessness coming to the ED is expected.
Outreach worker LP Pavey talks to a client over the phone at her St. Michael’s Hospital office.
Josh, left, one of Pavey’s clients, chooses a new jacket from the various donations stored in her office. Originally from a small town in Ontario, Josh came to Toronto almost two years ago in search of better support for his opioid addiction. Unable to find shelter upon his arrival, he slept outside for over a week before seeking help at St. Michael’s, where Pavey and her colleagues were able to find him temporary shelter.
Pavey offers Josh some snacks while they chat and catch up. In addition to providing shelter, she also helped Josh find a safer opioid supply program in Toronto. Following that, Pavey and a colleague filled out an application on his behalf for a transitional housing program, and within one month, he was given the keys to his new apartment.
Josh also demonstrated a strong interest in becoming an outreach worker. Pavey then connected him to a peer training program and he has already started a paid internship in the field.
A few days after meeting Josh, Pavey is on her way to meet Steven, another client she’s been helping through the EDOW Program. Steven is in his early 70s and arrived at St. Michael’s a little more than two years ago after being evicted from his apartment. Pavey and her colleagues found Steven a shelter and immediately began the process of finding him permanent housing. After one year, they were able to secure an apartment through a community-based organization.
Pavey and Steven chat in the living room of his permanent housing. Whenever Steven needs assistance, she helps him navigate paperwork and other tasks, such as finding help to clean his apartment or do his laundry. Finding a place to live was essential to provide Steven, who has some mobility issues, with more independence in his daily routine. Situations like Steven’s — older adults experiencing homelessness for the first time — are becoming more and more common, says Pavey.
According to the 2021 Street Needs Assessment Report, 7,347 people experience homelessness in Toronto, however, more recent estimates put that number close to 10,000. The study also says that 742 people live on the streets or in parks, such as Allan Gardens Park in the downtown area (pictured).
A few weeks after meeting Steven, Pavey meets two other clients, Michelle, centre, and Chad, left, at the weekly drop-in program, located not far from St. Michael’s. Michelle was referred to Pavey by a social worker two years ago when she needed help preventing an impending eviction. Pavey connected her with the Neighborhood Legal Services office, and they successfully avoided eviction.
Unfortunately, one year later, Michelle is facing another potential eviction but Pavey is once again working with her to prevent it. Pavey worries about Michelle’s health. When they first met, she had just suffered a serious fall, broke her leg and had to undergo surgery. Now Michelle relies on her motorized wheelchair when the pain becomes unbearable.
Some of the artwork created by Michelle on display at the drop-in centre. According to Pavey, there is a pathway to a new housing opportunity for Michelle, but it all depends on resolving her financial situation. In the meantime, she refuses to go back to her apartment because she doesn’t feel welcome there.
Michelle tells Pavey she has just learned that the weekly drop-in centre will close in a few weeks. Drop-in centres play a vital role within the unhoused community because they provide a place to rest, eat, meet friends, and talk to support workers.
Pavey listens to Chad as he and Michelle tell her about the closing of the drop-in centre. Chad is also one of Pavey’s clients and volunteers at the centre. He spent some time living in a rooming house, but now he has his own apartment, which Pavey and her colleagues helped him find.
Pavey, right, points out the address of an ID Clinic where Michelle, left, can get the documents she needs to reapply for her new housing.
Pavey and Michelle leave the drop-in centre which closed permanently shortly after their meeting.
Pavey in her office at St. Michael’s Hospital.

Photos and story by Eduardo Lima

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