With nowhere to go, homeless people spend more time in Sask. hospitals, data shows

People experiencing homelessness in Saskatchewan stay in hospital far longer than other standard stays, data shows, illustrating how a lack of shelters and housing is adding strain to already overcapacity hospitals.

According to data from the Canadian Institute for Health Information (CIHI), people who reported experiencing homelessness in Saskatchewan from April 2022 to March 2023 stayed in hospital for an average length of 22 days, compared to a standard stay of about 7.5 days.

Across Canada, the gap is narrower: about 15.4 days for a person who reported experiencing homelessness compared to eight days for a standard stay.

Longer stays can hold up beds in a province where issues of overcapacity hospitals have prompted the Saskatchewan Health Authority to lay out capacity action plans in its two largest cities. Officials say there's still more work to do.

"Community care, community mental health care, is important for everybody, but it may be particularly important for this population," said Geoff Hynes, manager of population health at CIHI.

"It's not inappropriate visits — these folks need that care — but it's a result of not getting that care that they possibly need, in the community."

According to the Saskatchewan Health Authority, in the 2023-24 fiscal year, there were about about 800 patients with no fixed address who visited Saskatoon emergency departments. They accounted for 1,776 visits, and of those 211 led to admissions.

Supportive housing needed, says Salvation Army director

Several people who told CBC they were homeless shared their own stories of being in hospital for long periods because of illness or mental health concerns. They all said it was difficult finding shelter.

Gordon Taylor, executive director at The Salvation Army in Saskatoon, said those kind of stories are typical for cities he's worked in, like Saskatoon and Winnipeg, and at other Salvation Army locations across Canada.

The Salvation Army operates a 75-bed shelter in Saskatoon. Taylor said hospitals are one of the parties that regularly send people to stay there.

Historically, people were rarely turned away, he said, but it happens more frequently lately, since capacity stayed high through the winter and into the spring. Even when the shelter is not at capacity, it can't take everyone.

"In our shelter here, if there's someone being released from hospital who still needs help — for example, going to the washroom — we don't have the staffing and the ability to help with that type of thing," Taylor said.

"Someone going home who has a family member to help them, that's different."

He said the solution would be more supportive housing in the community. For now, he can't see an alternative other than hospitals for people who can't find shelter.

"Until a solution is found, what else are you going to do?" he said. "There's not much choice."

The lengths of hospital stays for these patients are often extended by other ailments stemming from their living situation, or other medical conditions like diabetes, heart- or lung-related problems or infections that have gone untreated.

The most common reasons for hospitalization in Saskatchewan were substance use disorders (16.8 per cent), schizophrenia (10 per cent) and pneumonia (6.7 per cent), according to CIHI data.

In Saskatoon, Sanctum Care Group takes hospital patients who are HIV positive and also have addiction or homelessness issues and provides more wraparound services for them, including setting them up for income assistance.

Executive director Katelyn Roberts said more than 80 per cent of the patients they serve are homeless. At discharge, she said, the vast majority of patients in the program are discharged to homes.

She said those who aren't discharged into homes have made the personal choice that they don't want housing, or there's no affordable housing stock, but the policy is not to discharge people back into homelessness.

However, provincial funding to the program is only enough for 10 beds across the city, Roberts said.

Discharging patients more complicated

John Ash, vice-president of integrated Saskatoon health for the Saskatchewan Health Authority, said that homeless people are given the same treatment in hospital as anyone else. 

But discharging those patients can become a more complex process. 

"If I have a fixed address and a family and people that can kind of care for me in the community and I'm able to have a place where home care can come visit me, or whatever it may be, I will be discharged from the hospital a bit sooner," Ash said.

With no consistent fixed address, patients are held until doctors can ensure they are healed or until the hospital can co-ordinate somewhere for them to stay — at a shelter, with family or friends, or with supports from other organizations.

Once healed, if they have nowhere to go, they are sent back out onto the street. Ash said the hospital works with them to see if they understand what kind of self-care they will need and if they're in a position to access community resources.

The longer they stay — whether because of poor health or no fixed address — the more the cost of care rises. In 2022-23, the average cost for a stay in Saskatchewan for someone experiencing homelessness was $22,516.

That's compared to a standard hospital stay of $8,809 in 2021 to 2022, the most recent available data from CIHI on standard stays. 

Gaps in data collection

The statistics CIHI has gathered on homelessness in hospitals is an incomplete snapshot, Hynes said. While there is a mandated code used to identify and report on people experiencing homelessness — code Z59.0 — it's not always documented on intake and records can vary from hospital to hospital.

Ash said that in Saskatchewan, a patient isn't usually asked whether they are homeless when admitted. The questions are more focused what help they need, but the housing situation is recorded if the patient volunteers the information.

Patients may also lie because of the stigma around homelessness, or for other reasons, he said.

CIHI data shows 951 hospitalizations in Saskatchewan used code Z59.0 in 2022-23. Canada-wide, there were nearly 30,000.

Hynes said physicians have reported that the true number is likely three or four times higher. He believes the statistics need to be better tracked.

"What we're seeing more and more in health care is a realization that a person's social circumstances have a big influence on their health and their health care, so I think that information is important for physicians," Hynes said.

It can help them determine if they can afford medication, if they have safe housing to return to or if they have a phone for a follow-up, he said.

"What we think is important is using data to make these invisible populations visible, because at the end of the day, only when you can be counted, do you truly count."