Monthly Archives: March 2016

What Do Homeless People Think About Death and Dying?

John Song and colleagues conducted research that asked people who are homeless about their thoughts and experiences surrounding death and dying. The following post is a summary of that research.

What is this research is about?

Many people who are homeless are not treated in the same way as the rest of the population. This study explored what homeless people think about death and dying and what their experiences are with death and dying.

What you need to know

People who are homeless have specific needs when it comes to coping with their own mortality and those they have lost. Typically, being exposed to death early on in life and also in their present lives leads to further problems. Issues such as mistrust of health care workers, risky behaviours, isolation, serious illness or injury and overall fears of death can inform how their end of life care is addressed, or not addressed.

alone

What the researchers did

The researchers went to six different agencies that serve people who are homeless and recruited 53 people over 18 years old. They used both focus groups and in-depth interviews with people who are homeless over a 5-month period to understand their thoughts, feelings, desires and experiences about death.

What the researchers found

After transcribing the information from the interviews and focus groups, the researchers found two different themes that arose, which were personal/internal experiences and relational/external experiences.  Personal themes that were common included the experience of loss early on in life, death of loved ones both past and present, life-threatening experiences, many fears and uncertainties about death, unhealthy coping strategies, and behaving in risky ways or more cautiously in life.  Relationally, the researchers found that people who are homeless are influenced by their experiences with health care practitioners, most claimed to have had negative experiences.

Using this research

Knowing the attitudes and experiences of people who are homeless can help us to better understand ways to prepare them for death and to cope and advocate for themselves. Researchers suggest using this information to improve end of life care by addressing issues of trust of health care providers and legal documentation.

About the researchers

John Song Center for Bioethics, and Department of Medicine University of Minnesota
Edward Ratner Department of Medicine, University of Minnesota
Dianne Bartels Center for Bioethics, and Department of Medicine University of Minnesota
Lucy Alderton Division of Chronic Diseases, Philidelphia Department of Public Health
Brenda Hudson Office of Clinical Research, University of Minnesota
Jasjit Ahluwalia Department of Medicine and Office of Clinical Research, University of Minnesota

Reference

Song, J., Ratner, E. R., Bartels, D. M., Alderton, L., Hudson, B., & Ahluwalia, J. S. (2007). Experiences with and attitudes toward death and dying among homeless persons. Journal of general internal medicine, 22(4), 427-434.

 

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Homeless Deaths Motion at City Hall

There is a motion recommended by Paul Ainslie and Joe Cressy regarding homeless deaths in the Toronto community.

The following is a list of their recommendations from the City of Toronto website.  City council will be considering this motion on March.31st, 2016.

UPDATE: Motion passed 36-1!!

Recommendations
Councillor Paul Ainslie, seconded by Councillor Joe Cressy, recommends that:

1. City Council direct the City Manager to instruct the appropriate City staff to collect all relevant data related to the deaths of homeless individuals for occurrences within and outside homeless shelters.

2.  City Council direct that the data collected be shared with the public, agencies, City divisions and Provincial Government ministries for the purposes of influencing decision making through policy and legislation.

3. City Council direct the City Manager to correspond with the appropriate staff within the Government of Ontario in support of introducing a provincial mandate to track all deaths of homeless individuals for the purposes of data collection to introduce policy and legislation.

Homeless Youth: Problems and Solutions to Finding Employment

Stephen Gaetz and Bill O’Grady did some research by examining the role that employment training has on homeless youth and how social exclusion plays a part as well.  Here is a research summary of that work.

What is this research about?

The research is about questioning the beliefs and current processes surrounding youth homelessness and work. Specifically, the researchers look at the role of employment training programs and their effectiveness by looking at existing literature and then offering ways in which those programs can become better.

What you need to know

Current employment training solutions and informal money making strategies for homeless youth are problematic. In order to be effective, training programs must address issues surrounding social exclusion, meeting basic needs, and understanding around the instability of everyday life. Programs must offer solutions that will be successful in the long-term.

What the researchers did

The researchers compiled existing research that explains the many issues involving street youth and work. They offered a new framework for organizations to consider in order to make employment training programs more effective.

social exclusion

What the researchers found

The researchers looked at the informal money making strategies outside of the traditional market. They found defining features that inform how homeless youth engage in the work force, which include social characteristics, background, and highly flexible cash-in-hand jobs. With these come negative consequences such as risk of criminalization and stigma. Past research showed an overwhelming percentage of homeless youth with the desire and motivation to want to work.

There are three main approaches to the employability of youth that currently in effect; the informal learning from family and community, obtaining education, and improving human capital by teaching hard and soft skills such as computer training or interview skills.

Employment programs rarely address how social exclusion collides with the ability to find and maintain jobs for homeless youth. Social exclusion can restrict people’s access to spaces and institutions, structural factors can limit people’s participation in society, and it informs myths about how people perceive youth which can gloss over inequalities.

The limits of employability were broken down by researchers to include the following: housing and shelter, lack of income, unstable education, compromised health, chaotic lifestyle, weak social capital and an interrupted adolescence.

When programs fail to see beyond stereotypes of street youth, they weaken the effectiveness of employment training.

Using this research

Researchers offer a social inclusion framework to provide a philosophical basis that suggests activities must support the developing adolescent, address barriers that prevent participation in employment and employment training. They also suggest structural supports are needed such as stable housing, a basic income, appropriate health care and social supports. Program components need to include marketing skills, personalized case management, supporting special needs, mentoring, job shadowing and opportunities for educational advancement. Institutional components must include ongoing funding, strategic partnerships, ongoing program evaluation and corporate engagement.

About the Researchers

Stephen Gaetz is a professor and the director of the Canadian Observatory on Homelessness. He is also the President of the Raising the Roof Campaign. His interests focus on youth homelessness and using evidence based research to inform policy and practice.

Bill O’Grady is a sociology professor at the University of Guelph and is currently a member of Raising the Roof’s advisory board.

Keywords

Neoliberalism
Panhandling
Squeegeeing
Human Capital
Social Exclusion
Hard Skills
Soft Skills

Reference

Gaetz, S., & O’Grady, B. (2013). Why Don’t You Just Get a Job? Homeless Youth, Social Exclusion and Employment Training. Youth Homelessness in Canada: Implications for policy and practice, 243-268.

 

Better Stay Healthy: Sleep and Homelessness

Poverty to Professional

I never fell asleep in class until I lost my home.

I felt awful because I was a very good student. Good students don’t fall asleep in class. It’s disrespectful to the teacher. But my brain had other plans. It was sixth period – after two o’clock – and I was in Physiology Honors. Even the twang of my instructor’s plucky Kentucky accent couldn’t keep me alert. Fortunately, my desk partner noticed me crashing before the teacher did.

“Are you feeling okay?”

No one had asked me that before. That’s also when it clicked how unusual this was for me. I wasn’t “on my game” and that shook me up. I answered something along, “I’m fine.”

Of course, if I were a fabled little boy made of wood my nose would’ve grown three feet and sprouted a bird’s nest at the end. It was spring semester, my family had been…

View original post 1,340 more words

Commemoration Events And Causes of Death

The Stone and Glass Art Installation launch was beautifully done.  Artist Rebecca Houston had a vision along with the Myseum Intersections project. How can we tell stories that reflect the culture of Toronto while including historical dimensions?

Rebecca chose to highlight the numerous homeless deaths that have occurred over the past few decades. Names, initials, Jane and John Doe’s were projected onto the Church of the Holy Trinity’s front façade. This is where the Toronto Homeless Memorial happens every second Tuesday of the month at noon, to remember those who have passed away.

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To open the night, a few remarks were made by Rebecca, Britt Welter-Nolan, street nurse Cathy Crowe, and Reverend Sherman. Andrew Wesley began smudging and recited a prayer and then the Smoke Trail Singers began drumming to initiate the projection of the names.

Visitors were then encouraged to stand vigil as the names scrolled across the church wall. Otherwise, people could go inside and experience other interactive pieces. There was an audio installation where you could hear stories about people’s lives and the intersections of homelessness, as well as a reading of the names.

Cups were placed on a table next to the list of people who have died and you could write one of the names on the cup in memoriam to that person, which was placed on the carpet to act as a “headstone.”  Art pieces and a reflections board were displayed where people could write down any thoughts about the night or about homeless deaths in general.

 

What are the causes?

I have written previously on how death is widespread within the homeless community. However, I want to bring to light the causes of death.  Before I get into some of the research, I will say right up front:

People who die when they are homeless, die because they were homeless.

You may be thinking, “what do you mean? They die from stabbings, and alcohol and other things!” Well, those “other things” are actually just symptomatic. Other researchers have also suggested that homelessness itself is the main risk factor for death that needs to be addressed (Hibbs et al., 1994:308, Barrow et al., 1999:533, Condon & McDermid, 2014:3). Let’s explore further.

We know that both individual AND structural factors are involved with why people become homeless in the first place (Fazel et al 2015:1). We also know several times over that people who are homeless die younger than the general population (Hibbs et al., 1994:307; Cheung & Hwang 2004:1243; Barrow et al., 1999:529; O’Connell 2005:13). In British Columbia, “[t]he median age of death for a homeless person…is between 40 and 49. The average life expectancy for the general population in British Columbia is 82.65 years” (Condon & McDermid, 2014:4). In Copenhagen “[h]omeless people staying in hostels, particularly young women, are more likely to die early than the general population” (Nordentoft & Wandall-Holm 2003:81).

When homeless people are at almost half the life expectancy as the general population, then we have a major crisis that needs addressing.

For people who are homeless, many die from violence and trauma from being on the streets (Wright et al., 1999:244). “In the USA…younger people die disproportionately from external causes of death (suicide, accidental overdoses, and homicide) and infectious diseases, and there is also a spike in older homeless people” (Fazel et al. 2015:5). Some researchers suggest that “[d]rug overdose has replaced HIV as the emerging epidemic” (Baggett et al., 2013:2). The St.Michael’s Hospital Centre for Research on Inner City Health recently released this quick read guide that highlights health problems and mortality rates. Mental illness is a major factor in homelessness, but I will be writing about that in more detail in a future post.

Numbers, numbers and more numbers

The 2015 Annual Review of Statistics on Deaths of Shelter Residents was recently released. This report provides rough estimates of deaths since 2007 specifically of shelter residents, which does not include many others who choose not to go to shelters. People have suggested that we need a count of the number of people who are homeless at a particular point in time. Researchers say that, “…without sufficient provincial data it is difficult to determine the necessary steps to minimize homeless deaths across the country” (Condon & McDermid, 2014:18). I understand how policy makers like to use evidence based decisions to tackle social issues. As a graduate student, I also understand the need for research and providing evidence in order to strengthen arguments.

numbers

However, in this case, do we really need a count? We know people are dying. The government needs a number? How high must the number be in order for these deaths to be seen as a significant issue? For me, one death would be enough. Apparently there needs to be many, but we don’t know what that number is since the government is not making this a priority, nor are its citizens. A child gets shot, we fight for gun laws. A child is hit by a car, we fight for road laws. A child dies on the streets and apparently we don’t give a shit.

Prevention

Researchers have not only mentioned that homelessness itself is a risk factor for death but also that homeless deaths are largely preventable (Hibbs et al., 1994:304,Condon & McDermid, 2014:3). Hwang et al. maintain that “[a] large part of the premature mortality in people living in shelters, rooming houses, and hotels was potentially avoidable” (2009:6).

For individual circumstances, we need to “… include behavioural health integration into primary medical care, public health initiatives to prevent and reverse drug overdose, and social policy measures to end homelessness” (Baggett et al., 2013:2).  For young people it is suggested that they receive “…psychiatric treatment, detoxification treatment, medical treatment, social advice, and accommodation. The prevention of social exclusion should start early in life” (Nordentoft & Wandall-Holm 2003:81). For older homeless people “the management of chronic diseases, geriatric conditions, frailty, and end-of-life issues is more prominent” (Fazel et al. 2015:5).

prevention

In order to prevent people from dying way earlier then they should, we need a national housing program and social supports that include counseling, better access to health care, decriminalization, employment help and training programs. These must be used together. If you only have housing first programs or only have employment training, then they will fail.

Tackling stigma is another factor in preventing homeless deaths from happening in the first place. Some common stigmas include racism, sexism, AIDS, autism, homophobia, and ageism, among others. Attitudes and beliefs can make the difference between someone being housed or homeless.

The fight will be a tough one and we need more people that can speak out against the crisis of homeless deaths. People are needlessly dying. We need to notice and we need to care. Ending homelessness in our towns is not some esoteric unattainable concept, others have done it. So why don’t we?

 

Featured Image artwork by Jim Houston

 

References

Baggett, T. P., Hwang, S. W., O’Connell, J. J., Porneala, B. C., Stringfellow, E. J., Orav, E. J., Singer, D.E., & Rigotti, N. A. (2013). Mortality among homeless adults in Boston: shifts in causes of death over a 15-year period. JAMA internal medicine, 173(3), 189-195.

Barrow, S. M., Herman, D. B., Cordova, P., & Struening, E. L. (1999). Mortality among homeless shelter residents in New York City. American Journal of Public Health, 89(4), 529-534.

Cheung, A. M., & Hwang, S. W. (2004). Risk of death among homeless women: a cohort study and review of the literature. Canadian Medical Association Journal, 170(8), 1243-1247.

Condon, S., & McDermid, J., (2014). Dying on the Streets: Homeless Deaths in British Columbia. Street Corner Media Foundation. https://d3n8a8pro7vhmx.cloudfront.net/megaphone/pages/7/attachments/original/1415231881/Dying_on_the_Streets_Homeless_Deaths_in_British_Columbia.pdf?1415231881, accessed Mar.10, 2016.

Fazel, S., Geddes, J. R., & Kushel, M. (2014). The health of homeless people in high-income countries: descriptive epidemiology, health consequences, and clinical and policy recommendations. The Lancet, 384(9953), 1529-1540.

Hibbs, J. R., Benner, L., Klugman, L., Spencer, R., Macchia, I., Mellinger, A. K., & Fife, D. (1994). Mortality in a cohort of homeless adults in Philadelphia. New England Journal of Medicine, 331(5), 304-309.

Nordentoft, M., & Wandall-Holm, N. (2003). 10 year follow up study of mortality among users of hostels for homeless people in Copenhagen. Bmj, 327(7406), 81.

O’Connell, J. J. (2005). Premature mortality in homeless populations: A review of the literature. Nashville, TN: National Health Care for the Homeless Council, 1-16.

Wright, R. D., Wright, S. E., & Jones, A. (1999). Dying homeless but not alone: Social support roles of staff members in homeless shelters. Illness, Crisis & Loss, 7(3), 233-251.