The number of homeless people is increasing. And the older they get, the more care adapted to their reality tends to become rare. The duty discovered that in Quebec, there is only one floor dedicated to homeless people in a residential and long-term care center (CHSLD). We are the first media to have visited this unit which accommodates particularly vulnerable residents. A model that would benefit from having children, believe several speakers.
“It’s a radical change,” confides Réal Larochelle, comfortably seated on a chair in the common area of the CHSLD du Manoir-de-l’agence-d’or, affiliated with the Integrated University Health and Social Services Center ( CIUSSS) of South-Central Montreal Island. He’s only been here three months.
He says he lost the habit of living indoors. “There were rats where I used to sleep. We couldn’t leave anything because my things were stolen,” says the man, who overall sees several positive elements in his change of lifestyle.
At 57, his age does not match that of a typical CHSLD resident. Here, patients have a certain physical autonomy and there are not, for example, beds equipped with a lever as in a more traditional center. But people “age” more quickly on the streets and develop problems that will affect others 10 or 15 years later — dementia, in particular.
“Their lifestyle catches up with them, with consequences on their functioning and their cognitive abilities,” explains Dr.r David Barbeau, doctor at the CHSLD du Manoir-de-l’agence-d’or. Consumption of alcohol or drugs, poor diet, repeated trauma, lack of sleep and exposure to infections leave deep furrows.
“These are people who have always managed on their own, who have been very alone in their lives, with an emptiness around them,” continues the doctor. “Many have no contact with their families and find themselves completely isolated in their loss of autonomy. You need a place to welcome these people. »
The floor, which has around twenty beds, is the only unit of this type in Quebec, confirmed to Duty the Ministry of Health and Social Services (MSSS). Residents’ names are written on the white doors of the small rooms with views of the city. Inside, there is a single bed, a television and some decorations.
“It’s an atypical clientele, which doesn’t fit in with the classic accommodations we know,” mentions Pascale Dunlop, head of unit at the CHSLD, who describes the place as a “microenvironment”. “If we introduced a person with all their color – their language, their problems related to alcohol, drug addiction, and all that – into a CHSLD, that would have caused a lot of problems. »
“It is certain” that more units of this type are needed, she believes, noting that managers are sometimes contacted by other CIUSSS curious about the operation of the unit. “When they are referred to us, it’s because they are too vulnerable. They are aging, they no longer have the same physical defense capabilities. So, returning to the streets is not possible,” she says.
Residents are identified by CLSCs or arrive from a hospital, and are transferred to them through the accommodation access mechanism. For the Dr Barbeau, a unit like this prevents the condition of residents from deteriorating and prevents significant trauma as well as deaths. “Almost all of them have quite serious cognitive disorders, and they are not independent. So, from a human point of view, leaving them outside doesn’t make sense, it’s not socially acceptable,” he says.
Alcohol consumption permitted
Residents experience chronic alcoholism in particular, and it is on this problem that the unit focuses. A nurse and a specialized educator are assigned to the floor daily, and the team also includes a social worker.
Residents’ drinking plans are stuck on a wall in an office: the approach is harm reduction, to convince them to minimize their consumption. “We allow consumption, until it does not exceed the limits,” explains Mme Dunlop, adding that there is a code of life. “They have the right to drink, but not gang. They drink in their room and not in common places. »
The unit therefore aims to improve their quality of life, and can help reduce health system costs: before their arrival at the center, residents found themselves in the emergency room and then came out once stabilized. “But it started again, inevitably”, underlines the Dr Barbel. “To stabilize their conditions, give them a roof over their heads, make them eat, that their consumption is more or less controlled, that greatly avoids this revolving door phenomenon.”
It took a certain period of adaptation when the unit opened its doors in 2010, confides Jessie Lachaud, team leader of beneficiary attendants, whom she describes as a “very close-knit” group. “Initially, when they came in with the project, everyone in the building was scared,” she says. “We see them, but we don’t really know them… And, in the end, it’s a clientele to which you become attached in another way. »
She confides that when the new unit was installed, there were white codes, these measures triggered when there is aggressive behavior causing fear for the safety of a resident or another person. “But eventually, everyone got used to it,” she says. “They adapt to the situation and the environment. Those who come see how the situation is. »
Force care?
Several of the residents encountered by The duty are well settled and comfortable. They are free to come in and out, and the CHSLD asks them to make a phone call if they ever decide to sleep elsewhere. While the majority are here on a voluntary basis, a quarter of residents are subject to a shelter order issued by a judge, which forces them to stay there because they are deemed too ill to return to the streets or in a shelter.
Navigating between convincing a patient to give them the care they need — but don’t necessarily want to receive — and respecting their wishes, all without doing too much or too little, is a particular challenge at the site, admits the Dr Barbel. “How far do we go?” » he wonders out loud.
And if a CHSLD is generally the symbol of the end of a life journey, everyone still believes in the potential for rehabilitation. “Sometimes, they arrive damaged and afterwards, they are no longer the same person, they shine,” says Pascale Dunlop. “If all inappropriate behaviors have been managed, they can be directed to a regular living unit. »
The unit currently focuses on alcohol use disorders among its residents, and drug use by injection or inhalation is not permitted. A flaw that excludes potential patients? “It could be an innovative idea to open a shelter for drug users,” believes the head of unit.