Homeless get help managing chronic conditions

Calgary’s ‘DI’ builds trust, shows how to access health care

Story and photo by Chris Simnett

CALGARY — Calgarians living on the streets can get the care, information and support they need to manage their chronic health issues thanks to an innovative partnership between Alberta Health Services (AHS), the Calgary Drop-In and Rehab Centre (DI) and the Mosaic Primary Care Network.

The Homeless Chronic Disease Management Program began in 2008 as a pilot project dealing with diabetes, a significant issue amongst the homeless population. After great success, the program became fully-funded by the Mosaic Primary Care Network and AHS in April, 2010, then expanded to include other chronic conditions such as high blood pressure, chronic pain as well as mental health and addiction issues.

"There are extensive needs and challenges around chronic disease in the homeless population," says Bronwyn White, the AHS Registered Nurse who runs the program at the DI, Calgary' largest homeless shelter, which shelters up to 1,100 people per night. "One of the biggest challenges is developing relationships and trust with this population."

White says many homeless people don't know how to access health care services in their community, or are reluctant to because they've had bad experiences.

"A big part of this program is helping them develop positive relationships with our health care system," adds White. "If we do that, we can get them to access the services they need."

White and AHS dietitian Ruchi Chopra work full time at the Drop-In Centre to provide care, information, support and, sometimes, just a listening ear for their clients at the DI.

The pair works in conjunction with the DI's own medical clinic, with its two doctors and two nurses from the Mosaic Primary Care Network.

While clinic staff treat day-to-day medical issues as they arise, White and Chopra's goal is to empower the people who access the DI to self-manage their chronic conditions.

For instance, they give diabetics a safe place to store their insulin.

"Something like insulin is a basic need for a person with diabetes," says Chopra. "If a homeless person went to a clinic and got some insulin and was told to take some every day and store it in a fridge, where would they find a fridge? Here at the DI we provide a safe storage place and clients have easy access to their medical supplies."

White and Chopra are constantly moving about the centre, talking to people, hearing their concerns.

"We really try and seek these people out because many of them will just suffer in silence," says White. "It's so much beyond caring for their disease; it’s caring for them as people."

White and Chopra's caring has been a godsend to Anne, a 70-year-old who has lived off and on at the DI since last September.

A diabetic who also suffers from kidney disease and depression, Anne was a regular at Emergency Departments and hospital psychiatric units until she began working with White and Chopra.

"If it wasn't for Bronwyn and Ruchi I don’t think I would be here (alive)," says Anne.

"I need support," she adds. "I can't do it on my own. In the past I would end up in the hospital. Now, I just need to find Bronwyn and she can help me check my blood sugar."

Left unchecked, an insulin-dependant diabetic like Anne could suffer blindness, kidney failure, endure wounds that don't heal properly and even lapse into a coma and die.

"A lot of diabetics can go into depression very quickly," says Chopra. "They tend to reach emergency levels of care really fast. We're trying to provide basic everyday medical services and trying to reduce the visits to emergency clinics.

"We want to keep these people as healthy as possible," Chopra adds. "It's not only better for them, obviously, but it's a huge stress off our health system if we can keep them managed and keep them out of emergency."

Anne participated in a Row Your Own Boat chronic-disease management course at the DI and says it helped her realize the importance of taking care of herself.

"As you get old, you need to care about your health," she says. "When I was younger, I thought I was invincible. Between the ages of 24 and 30 I did a lot of things to jeopardize my health. I'm paying for it now."