WCH CONNECTMay 20, 2020

Supporting underhoused and homeless patients during COVID-19

  • May 20, 2020
  • BY Jen Brailsford

L-R: Tessa Colthoff, Lesley Hughes, Marlene Duarte-Giles, Nolan BlodgettL-R: Tessa Colthoff, Lesley Hughes, Marlene Duarte Giles, Nolan Blodgett

A dedicated team of Women’s College Hospital (WCH) social workers and psychotherapists is diligently working behind the scenes to provide integral support to underhoused and homeless patients coming to the COVID-19 Assessment Centre.
To prevent further spread of the virus, patients awaiting their COVID-19 test results cannot be discharged to the street, shelters or drop-in centres where self-isolation is often not possible. Instead, they are brought to WCH’s Acute Ambulatory Care Unit (AACU) to safely isolate with a team of clinicians to monitor their care. During this time, a WCH social worker/psychotherapist, works with the patient, clinicians and community partners to ensure a continuum of care, whether the patient’s test results come back negative or positive.
Coming from diverse programs across the hospital, social workers Nolan Blodgett, Tessa Colthoff, Marlene Duarte Giles and Lesley Hughes, with back up support from Holly Miles, work with underhoused and homeless patients from the moment they access the Assessment Centre and AACU.
“The patient population that our social workers are supporting have an immediate and urgent need for case management to ensure they get safe access to shelter and support during this extremely challenging period,” says Vicky Noguera, clinical director of perioperative services and the COVID-19 Assessment Centre.
Individuals seeking care can include homeless and underhoused individuals, newcomers to Canada who are staying at refugee shelters, as well as those experiencing domestic violence. “Those fleeing their home situations might come to us for testing before they are allowed into the shelter system,” explains Tessa Colthoff, a psychological associate in the Trauma Therapy Program (TTP). “They have nowhere to go.”
Nolan Blodgett, a social worker in the Transition-Related Surgeries program, adds, “I have seen a high prevalence of folks who are experiencing domestic violence, mental health concerns and health comorbidities. Each of these social determinants of health is adding an additional layer of complexity to their care and their risk for contracting COVID-19.”
To promote physical distancing, the social workers/psychotherapists communicate with their patients via the phones installed in each room of the AACU, as well as through the nurses and physicians who are providing care. Through these conversations, the social workers can identify any additional needs the patients may have and connect them with available resources once they have been discharged.
“Part of this role includes providing information about mental health, community and social supports that may be of assistance to the patient,” says Marlene Duarte Giles, a social worker and psychotherapist in TTP and the Women Recovering from Abuse Program (WRAP). “This can include identifying food banks, drop-in shelters and meal programs, among other resources.”
In the most straightforward cases, patients who test negative can return to their shelter. However, often individuals have nowhere to go and the AACU can act as a doorway to a safe place.  

“When our patients test negative but don’t have a home or shelter to return to, it takes hours – if not days – to find them a bed. We call central intake every hour to see if a bed came available,” explains Colthoff. “There’s no way that patients could do that on their own, especially without a phone plan, money for transportation to the shelters or the contacts that we have as healthcare providers.”
For patients who test positive for COVID-19, the social workers/psychotherapists ensure that there is a safe place for them to isolate and focus on recovery with access to regular meals as well as nursing, physician and psychiatric care. 
“If a patient who is underhoused or homeless tests positive for COVID-19, our social workers collaborate with Inner City Health Associates to locate a community accommodation that can provide a private room and bathroom, as well as monitor the patient’s care,” explains Dr. Sheila Riazi, anesthesiologist and medical director of COVID-19 Assessment initiatives such as the Walk-In Assessment Centre, Online and Fast-Track Assessment and the Mobile Assessment Team. “This team has been instrumental in addressing the needs of some of our most vulnerable patients.They not only help with the placement of these patients but also, through highly organized and effective communication with shelters and case workers, provide us with latest medical and medication history of the patients. Their work is priceless.” 

Meeting the needs of these patients is a complex process and relies on collaboration between the social workers and the teams of physicians and nurses in the Assessment Centre and AACU. As Duarte Giles points out, working in a supportive team environment that fosters effective communication is more crucial now than ever. 
“I am so grateful to this incredible team of social workers/psychotherapists who have stepped up to provide immensely valuable care to some of our most vulnerable patients,” adds Cris Barrett, clinical director of Specialized Medicine, Mental Health, Pharmacy and the COVID-19 Mobile Assessment initiative. “The work that they are doing is very complicated and requires hours of communication between various partners. By taking on these roles, they are also providing much needed support to the clinicians in the COVID-19 Assessment Centre and AACU, who can focus on managing other aspects of patient care.”
This collaborative approach to care extends beyond the walls of WCH, where the social workers/psychotherapists have also built strong relationships with shelters and community partners in a short period of time. With consent from patients, the social workers are in close contact with shelters to inform them when their residents have been admitted to the AACU and of any isolation plans. They also work with shelters and Inner City Health Associates to find beds and safe spaces for patients who have no place to go.
These relationships have allowed the versatile team to enhance care for their patients. “Patients who are swabbed and test positive cannot return to the shelter to collect their belongings,” explains Lesley Hughes, a social worker in the Women’s Mental Health Program, TTP and WRAP. “We’ve been able to adapt by reaching out to known shelters and requesting that they advise residents to bring some personal belongings and a 14-day supply of medications when they come to the Assessment Centre for testing.”
Beyond supporting with housing needs, some of the social worker/psychotherapist team’s greatest impact stems from their shared goal of treating each individual with dignity and respect. They are conscious of the stigma and suffering many of their patients face daily, and which is now compounded by the global pandemic. Their commitment to compassionate care is reflected in small interactions, as Blodgett recounts the words of a patient leaving the AACU after testing negative for COVID-19: “As he got into the car, he said, ‘It feels good to be treated like a person.’”

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