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Remedies for homeless ER users

Ottawa expert testifies at Sinclair inquest

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Ottawa has some answers for offering health care to the homeless, says a nationally recognized expert.

It adds up to better health care and millions of dollars in savings, Dr. Jeffrey Turnbull, an expert in inner-city health, told an inquest looking into the 2008 death of Brian Sinclair in the waiting room of the Health Sciences Centre emergency department.

Turnbull said Ottawa's innovative approach to the homeless, designed to offer better health-care outcomes while stopping repeated emergency-room visits, is working and is recognized internationally.

"It saves money, but our primary driver is care of the patient," he told provincial court Judge Tim Preston Wednesday.

Turnbull said they send hospital-based care directly to the city's five shelters instead of having the homeless clog emergency rooms.

He said the care is provided by nurse practitioners and nurses backed up by doctors when needed.

He said it costs between $80 and $170 per day, but that's cheap compared with the $1,200 per day to have a homeless patient be cared for in a hospital ward or the $2,800 per day in an intensive-care unit.

On Monday, 230 patients were being treated in shelters, Turnbull said. "That's the size of a modest hospital." he said.

He said before the program was created, one homeless person who now uses it had visited the ER 191 times in six months.

Turnbull said it also makes sense to save money by treating them in shelters because they know 2.5 per cent of Ottawa's population uses $1 billion in health-care dollars, and 43 per cent of them have drug and alcohol addictions.

And Turnbull, who has worked in poverty-stricken areas of the world, said poverty doesn't come without a cost to the people in its grip.

"People who live in shelters have comparable health outcomes to people in the developing world," he said.

"People pay for poverty with their health. Eighty-two years of age is the average life span in Canada, but in a shelter the likelihood of getting to 75 is 25 per cent. That's less than Africa in some settings.

"When I drive from the richest part of Hamilton to the poorest area, the average life span goes down 21 years."

Sinclair, 45, died after waiting 34 hours in the emergency waiting room of HSC.

He had a treatable bladder infection and may have been dead up to seven hours before being found.

The inquest is expected to finish today after holding hearings on and off for months since last August.

Turnbull said another project helping the homeless sees health-care staff in supported-living housing give five ounces of alcohol per hour to alcoholics who have failed abstinence programs. It is located in a former 55-room hotel in a supportive-housing setting with nurses.

"We had an outcry from abstinence supporters when this started, but the other programs weren't working," he said, adding the alcohol is given in a monitored setting.

"They're drinking one-ninth of what they were drinking before," Turnbull said.

"Then they said 'I need more than this. I need my family. I need to start a plan. I want to work. I want to reconnect with my past.' "

Turnbull said removing frequent users of ER services doesn't solve all flow problems in the department, but it helps.

He said there can still be patients who are stuck in the ER for hours, but it's rare for them to spend 24 hours there.

Republished from the Winnipeg Free Press print edition June 12, 2014 A8

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