Sistering A Woman s Place Improved Quality of Life for Homeless and Marginalized Women A Marker for Making a Difference Angela Robertson Executive Director
Overview of Sistering Organization Started in 1981 through partnership & sponsorship by St. Christopher s House Mission to serve women who are homeless, isolated, underhoused and hidden-homeless Funded by Ministry of Health and Long-Term Care, United Way, City of Toronto and fundraising Three programs (2 Drop In Centres, Housing and Pre- Employment & Self- Employment projects Services Basic needs (food, clothing, shower and laundry services, transportation and housing supports Advocacy and counseling (brief counseling, crisis intervention, access to primary health and long-term case support) Supplementary Income and pre-employment training supports
Profile of the Women Served Sistering serve over 2,500 women annually 75% have experienced hidden homelessness (streets ) 43% have experienced absolute homelessness (couch surfing ) Majority of women between ages 35-45 and 60-75 67% have experienced childhood and/or adult trauma and violence 72% are living with a mental health issue (most not formally diagnosed) 56% of the women served hospitalized for mental or physical illness 73% in receipt of social assistance 100%have earnings well below the average $15,000 annual poverty line income 52% are mothers (child lost to care or adult children) Diverse racial and ethno-cultural representation
Impacts of Poverty & Homelessness on Women s Health Higher levels of stress and anxiety, crushing depression and isolation (75% of homeless women have serious and persistent mental health problems) Higher than usual rates of physical illness and morbidity Greater risks of infectious diseases (TB, HEP C, HIV/AIDS), premature death, acute illness (Hypertension, malnutrition, anemia, cardio vascular diseases, respiratory ailments, chronic liver and renal disease) Women in particular vulnerable to re-victimization and abuse (sex-trade and assaults) Higher risk of suicides, mental illness and higher likelihood of experiencing violence, trauma and drug or alcohol addictions
Impacts This reality confirmed in a 2004 article in the Canadian Medical Association Journal on women s homelessness. Article revealed that young homeless women between the ages of 18-44 are dying at 10 times the rate of their housed counterparts in Toronto That HIV/AIDS and drug overdose are the most common cause of death in this group, and Reconfirmed that there is a higher prevalence of depression and mental illness among homeless women.
Implications for Health Care System Urban and rural realities produce differential impacts on access to care for marginalized communities and requires tailored strategies Rural Health and Aboriginal Health Strategies Complexities of Toronto s urban health issues requires specific integration framework to address these needs Health Planning Tables, Institutional and Community partnerships, and targeted intervention and advocacy Value of adopting Urban Health Framework for» System» Community» Individuals
Cost to System Working in Silos Gaps, inequity, inaccessibility and poor coordination means homeless and marginalized often access most expensive parts of system for primary care Estimated monthly cost for one person s care is: General Hospitalization $4,500 (excluding specialized care) Psychiatric Facility $10,800 Correctional Facility $3,720
System Partnerships & Relationships amongst providers - Sistering s Attempts to Break Silos Portable Services opposed to the referral cycle E.g. CHC and Public Health services Building purposeful partnerships with health systems E.g. Hospital discharge planning partnership Link organization s success to improving quality of life, hence integrating social determinants of health framework E.g. Housing Partnership and Pre-employment / Income Security initiatives
Examples of System at Work Mary s hospitalization and discharge Joanna s chronic hospitalization, homelessness, accessing homecare and long-term care Ellen s deterioration, incarceration, and housing Susan s homelessness, institutionalization, and stabilization
Markers for Making a Difference Investment in health prevention strategies Affordable Housing Income Supports National Violence Against Women Prevention Strategy LHINs adoption and willful implementation of Social Determinants and Health Equity policy framework