When unhoused people in Toronto run out of options, they turn to the city’s overcrowded emergency departments for shelter.
The result is a collision of two crises, emergency department overcrowding and homelessness, that will risk lives, physicians, social workers and advocates for unhoused people say.
“We are going to see higher rates of people dying and more severe health impacts. For example, people are going to experience frostbite and people are going to have more amputations,” said Jesse Jenkinson, a postdoctoral fellow at the MAP Centre for Urban Health Solutions at St. Michael’s Hospital’s Li Ka Shing Institute.
Emergency department overcrowding is at a critical level, according to experts. A wave of respiratory illnesses, including COVID-19, has swamped ERs already struggling with hospital bed-block and nursing shortages. At the same time, the city is closing temporary hotel shelters opened during the first year of the COVID-19 pandemic to aid social distancing.
Some of the hotel occupants are being placed in permanent housing. But others are left to join the shelter bed queue and when those are full, some turn to emergency departments to stay warm. The triad of too little affordable housing and too few temporary shelter spaces and social services further adds to the strain.
Sylvia Gomes, an emergency department social worker at the University Health Network’s Toronto Western Hospital, along with her colleagues have been sounding the alarm since August.
People without homes come to the ER for shelter and warmth, but when social workers try to help them, there are no shelter beds available, she said.
“We are having tremendous difficulty in the emergency department supporting unhoused people and in ensuring that they leave to a place where they are warm and safe,” said Dr. Aaron Orkin, an emergency physician at St. Joseph’s Hospital and the population health director for Inner City Health Associates.
Shelter beds are allocated through a 24/7 city-operated telephone-based service that refers people to dormitory-style congregate shelters and other overnight accommodations. Congregate shelters sleep up to 20 people per room.
City data shows the number of calls to central intake continues to climb. In January, there were 411 calls to central intake; the numbers mounted to 749 in October.
The data also shows that in October, an average of 186 unhoused people per day went unmatched. This is almost eight times the rate in October 2021 rates. Gomes believes that’s a conservative estimate. Many people don’t call because they can’t tolerate the conditions in congregate shelters or have given up because they know they won’t find a spot.
Between January and October, 3,418 people were moved out of the shelter system to permanent housing, according to an email from the City of Toronto’s Shelter, Support and Housing Administration (SSHA).
Despite that, there is a rising demand for shelter beds, said Milton Barrera, project director of homelessness initiatives and prevention services at SSHA. “People are getting evicted from their rentals,” he said. “There are also more refugees.”
According to a November briefing by Gordon Tanner, SSHA general manager, 27 per cent of those currently in shelters are refugees, with 60 to 90 new people accessing the shelter system each week.
Meanwhile, the city is continuing to relocate people from the temporary hotel shelter beds that housed 2,500 people, sleeping one or two per room. Two sites with about 225 residents closed in the spring, another site with 250 beds will shutter by the end of this month and one is being converted to permanent affordable and supportive homes.
The SSHA’s stated goal is to find permanent housing for all former hotel residents, but Barrera admits there is not enough to go around.
According to city data, at one site alone, 251 people are losing their temporary hotel rooms and it is projected only 48 will find permanent housing. The remaining 203 will be out on the street and forced to seek shelter elsewhere.
Not all of the hotel bed closures are within the city’s control, according to Dr. Stephen Hwang, an internal medicine physician at St. Michael’s Hospital and the director of the MAP Centre for Urban Health Solutions. “Many owners are not willing to renew their leases,” he said. Most signed leases with the city during the pandemic when hotel occupancy was low and are now resuming their pre-pandemic businesses.