St. Michael’s pilot project provides social and psychiatric support for an aging homeless population

From L to R: Nicole Ilyin, Susan Wang, John Mailhot, Michael Tau, Daniel Elder, Llijah Pearce

Fifteen per cent of the homeless population in Toronto is over the age of 55, but there are few programs available to support vulnerable older adults with housing and mental health concerns. A four-year pilot program at St. Michael’s Hospital is filling this gap.

Project Dignify is a homeless outreach program that provides psychiatric care and social supports to people over the age of 60 who have a mental health diagnosis and are experiencing or at risk of homelessness. It’s the only program of its kind in the GTA and one of only two psychogeriatric community treatment teams in the city.

“There are a few teams in Toronto that provide short-term mental health support for older patients but they aren’t suited to supporting patients with severe mental illness, like schizophrenia or bipolar disorder,” says Dr. Michael Tau, medical lead of Project Dignify and geriatric psychiatrist at St. Michael’s and Providence Healthcare. “There are a lot of older adults in the city who need more substantial supports and that simply doesn’t exist in the geriatric realm.”

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Many of the city’s mental health programs are geared towards patients between the ages of 18 and 65 – a result of provincial funding allocations and wariness among clinicians to manage the complicated medical needs of older adults, says Tau.

“Older adults are the fastest growing cohort of people experiencing homelessness, which makes this a growing social and public health challenge,” he says.

Established in 2022, Project Dignify is led by an operations leader and four case managers – an occupational therapist, homeless outreach counsellor, registered nurse, and social worker – who work with Tau to provide individualized care and supports to meet the needs of each client. The program uses an intensive case management model, which provides clients with tailored services directly in the community.

Clients of Project Dignify are seen wherever they’re at – in hospitals, shelters, community spaces – approximately once a week for as long as they need support. The program has an open referral process, which means that clients can be referred from both inside and outside of Unity Health Toronto, as long as they reside in the program’s catchment area – Yonge Street to Victoria Park Avenue, and Bloor Street to Lake Ontario.

“One thing about community mental health is that every program has a different, client-centred approach to providing mental health services,” says Nicole Ilyin, operations leader for Project Dignify. “Many of our clients don’t have access to a phone or a computer, which makes it difficult for them to attend clinic appointments or access virtual care.”

Upon receipt of a new referral, the team will review the information provided to make sure that the client meets the program’s criteria. If they do, the case manager will meet with the client to introduce themselves and provide an overview of the services that Project Dignify can provide. If the client is interested in proceeding, the team will arrange an assessment with Tau.

From there, the case manager works closely with the client to establish a plan to meet their goals. This includes concerns with their mental health but also social determinants of health, such as access to funding, food security, medical care and prescriptions, says Ilyin.

“With every new client, we spend a lot of time getting to know them, building a therapeutic relationship and understanding where they want their life to go,” she says. “It’s pretty broad but any way we can support the older population in our area, we try to do that.”

Since 2022, the team has supported more than 60 unique individuals, helping them find temporary shelter, complete their taxes, arrange accompaniment for medical appointments, apply for funding for glasses, better manage their mental and physical health, and more.

It’s been rewarding, says Susan Wang, occupational therapist for Project Dignify, but it’s not without its challenges. Older adults, particularly those experiencing homelessness, are severely under resourced, she says. One area in which the team has been particularly challenged is finding and securing affordable housing – an important health intervention for older adults experiencing homelessness.

A recent report released by St. Michael’s researchers unaffiliated with Project Dignify found that shelters and other temporary accommodations aren’t equipped to meet the physical or mental health needs of older adults. But in the midst of an ongoing housing crisis, few other options exist in the GTA.

“It can be really frustrating,” says Wang. “One of our main goals is to help clients secure housing but we don’t have access to any specialized affordable housing for people with mental health concerns. The waitlists are several years long. It’s disheartening – for us and for our clients.”

Given their advanced age, many of the program’s clients are on limited incomes, pensions, welfare or old age security, which means that even if they could afford housing in the GTA, they’d have little – if anything – leftover for other necessities.

While more affordable housing options exist outside of Toronto, moving away from the downtown core isn’t always an option for people experiencing homelessness, says Wang.

“People experiencing homelessness are more likely to need specialized medical care and social services than people who are housed,” she says. “We have such a concentration of hospitals and services in downtown Toronto, it’s hard for people to think about leaving and losing that access.”

Project Dignify is made possible by The Louis L. Odette Family Urban Angel Fund for Homeless People, which provides support for innovative solutions to address the homelessness crisis. Teams at Unity Health are invited to put forward proposals for projects to better support people experiencing homelessness, and successful applicants are provided with funding to advance their project over a period of four years.

Throughout the pilot project, teams conduct several evaluations to understand potential gaps and successes. For Project Dignify, Tau and a team of investigators are trying to understand patterns of service use. They’re conducting interviews with team members and clients about their care experience, and following clients long-term, collecting feedback through surveys and questionnaires. 

“The feedback has been really positive,” says Tau. “Many of our clients have complex problems, which require complex solutions. Our case managers are very adept, very creative, very skilled at solving complex problems. They’ve been able to move mountains for many of our clients.”

Project Dignify is slated to conclude in 2026, though the team says they hope to see it continue.

“My sincerest hope is that through our findings, our evaluation program, and the advocacy of myself and our department, we can find a way to secure funding for this team for the future,” says Tau. “There are so many clients – current and future – who need our help. If we can’t help them, I don’t know who will.”

By: Anna Wassermann