Meeting Crisis with Opportunity - Reimagining Toronto's Shelter System - FULL RESEARCH REPORT

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Meeting Crisis with Opportunity - Reimagining Toronto's Shelter System - FULL RESEARCH REPORT

Meeting Crisis
with Opportunity
Reimagining Toronto’s
Shelter System
The Impact of COVID-19 on Toronto’s 24 Hour Emergency
Homelessness System
June 2021
Meeting Crisis with Opportunity - Reimagining Toronto's Shelter System - FULL RESEARCH REPORT
This report was made possible thanks to the contributions of hundreds of shelter users, shelter service
providers and other key stakeholders who donated their time, experience and expert knowledge.

First, TSN and Dixon Hall would like          We would like to thank the individuals        We are also grateful for the insight
to thank the 230+ shelter users who           who shared their time and expert              provided during consultations
completed surveys. From their generous        knowledge regarding the direct and            held with the following:
contributions, we gained valuable insight     indirect impacts that the pandemic has        ■   Researchers from the MAP Centre for
into their experiences with homelessness,     had on the emergency shelter system:
                                                                                                Urban Health Solutions (The Covenant
the impact that the pandemic has had          ■   Abigail Bond, Executive Director,             Study), Covenant House Youth
on them, their ideas about changes that
                                                  Housing Secretariat                           Shelter, and Unity Health Toronto
could be made to the shelter system           ■   Emily Martyn, Community Development       ■   TSN Women’s Sector Table and
to improve their access to housing and
                                                  Officer, Social Development Financial         TSN Men’s Sector Table
suggestions for improving access to
                                                  and Administration - Tower and            ■   Emily Martyn, Community Development
housing in Toronto more generally.
                                                  Neighbourhood Revitalization (SDFA)           Officer, City of Toronto - Tower and
                                              ■   Gord Tanner, Director of                      Neighbourhood Revitalization
In addition, our thanks to the many shelter
                                                  Homelessness Initiatives and
staff who participated in focus groups or
                                                  Prevention Services, SSHA                 Lastly, we would like to thank our funders
surveys for the study, as well as those who   ■   Laural Raine, Director of Service         at SDFA and Dixon Hall, the project trustee.
helped with coordinating or conducting
                                                  Planning and Integrity, SSHA
service user engagement in the midst          ■   Shaun Hopkins, Manager, The               Photo credits
of the second and third waves of the
                                                  Works, Toronto Public Health
COVID-19 pandemic. The Meeting Crisis                                                       ■   Cover:
                                              ■   Terry Pariseau, Coordinated Access
with Opportunity study could not have                                                       ■   Page 12:
                                                  Engagement Coordinator, Toronto
been conducted without their support.                                                       ■   Page 16: PNW Production from Pexels
                                                  Alliance to End Homelessness (TAEH)
The participating organizations include:                                                    ■   Page 30: Sean Benesh on Unsplash
                                              ■   Valesa Faria, Director,                   ■   Page 45:
■   COSTI                                         Housing Secretariat                       ■   Page 55: Priscilla Du Preez on Unsplash
■   Christie Ossington                                                                      ■   Page 62:
    Neighbourhood Centre                      We would like to thank Community
■   Christie Refugee Welcome Centre           Animators, Althea Galloway, Bridget           ■   Page 80: Berkay Gumustekin
■   City of Toronto – Birkdale Residence,     Babirye and Shoeb Ahmed. Their
                                                                                                on Unsplash
    Women’s Residence, Robertson House,       assistance and dedication to this project
    Scarborough Village, Roehampton           were vital to its successful completion.
                                                                                            Report design by Green Living Enterprises
    Hotel and Streets to Homes                Much gratitude to the TSN family, Soha
■   Dixon Hall Neighbourhood Services         Mohammed (TSN Coordinator), Shafeeq
                                                                                            Meeting Crisis with Opportunity
■   Eva’s Initiative for Homeless Youth       Armstrong (Welcome Home Project
                                                                                            was written by:
■   Fred Victor Centre                        Coordinator) and Gabriela Russek (Pipeline
■   Good Shepherd Ministries                  Project Coordinator) who were always          ■   Sonja Nerad (Executive Director,
■   Homes First Society                       ready and willing to roll up their sleeves        Toronto Shelter Network);
■   Horizons for Youth                        and jump in at a moment's notice to           ■   Haiat Iman (Research Coordinator,
■   Kennedy House                             assist with this project. Thanks to Caitlin       Toronto Shelter Network);
■   Red Door Family Shelter                   Thompson (Research Analyst, Salvation         ■   Carmelle Wolfson (Community
■   The Salvation Army                        Army), who supported quantitative data            Researcher, Toronto Shelter Network);
■   Sistering                                 analysis. Special thanks to the members       ■   Tanzil Islam (Data Coordinator,
■   Sojourn House                             of the Meeting Crisis with Opportunity            Dixon Hall).
■   St-Felix Centre                           Advisory Committee: Colin Bains
■   Street Haven at the Crossroads            (Executive Assistant Director, Salvation
■   Turning Point Youth Services              Army); David Reycraft (Director, Dixon
■   Warden Woods Community Centre             Hall); Deborah Gardner (Executive
■   YMCA of Greater Toronto                   Director, Streets Haven); Keith Hambly
■   YWCA                                      (Chief Executive Officer, Fred Victor); and
                                              Kirk McMahon (Senior Manager, Good
                                              Shepherd) for their support and guidance.

FULL RESEARCH REPORT | Meeting Crisis With Opportunity: Reimagining Toronto’s Shelter System                                          2
Meeting Crisis with Opportunity - Reimagining Toronto's Shelter System - FULL RESEARCH REPORT
Executive Summary
Vulnerable populations, including people experiencing homelessness, have been hard
hit during the COVID-19 pandemic1. In Toronto, a rapid emergency response to protect
homeless populations was undertaken, resulting in a significant restructuring of the
24-hour emergency homelessness system (shelter system). In order to document the
impact of this transformation, the Toronto Shelter Network (TSN), in partnership with
Dixon Hall Neighbourhood Services (Dixon Hall) embarked on a six-month exploratory
study called “Meeting Crisis with Opportunity: Reimagining Toronto’s Shelter System”.

TSN is an umbrella organization that is                                                            This report identifies findings and highlights
composed of approximately 35 member                                                                considerations that can improve the delivery
organizations that together operate more                                                           of housing and homelessness services
than 100 emergency shelter, respite, 24-hour                                                       and supports for people in Toronto, build
drop-in and COVID-19 response programs2.                                                           capacity and infrastructure for future waves
TSN believes that housing is a human right                                                         of COVID-19 and other emergencies and
and envisions a City where everyone has a                                                          inform the permanent transition of the
home that enables them to live with dignity.                                                       shelter system into one that is people-
                                                                                                   centered and housing-focused.
Meeting Crisis with Opportunity was
funded by the Social Development, Finance                                                          Methodology
and Administration (SDFA) department
at the City of Toronto. The study aimed                                                            Meeting Crisis with Opportunity was conducted
to achieve the following objectives:                                                               using mixed research methodologies as follows:
■   To better understand the impact of                                                             ■    A review of grey literature.
    COVID-19 on the shelter system.                                                                ■    A survey of 239 current service users
■   To describe the experiences of shelter                                                              at shelters, respites, 24-hour drop-
    users (clients)3 since the onset of COVID-19,                                                       ins, and COVID-19 hotels across the
    and to better understand the impact the                                                             City. People from diverse populations
    pandemic has had on diverse populations                                                             including Black and Indigenous, families,
    using Toronto’s shelter system, including                                                           LGBTQ2S+, men, refugees, women and
    those who moved into hotels and those who                                                           youth were included in the sample.
    remained in legacy4 shelters and respites.                                                     ■    Three focus group sessions with 56
■   To develop recommendations that will help                                                           managers, front-line staff and shelter
    guide homelessness service providers and                                                            housing help workers/counsellors, as well
    decision makers to develop sound and                                                                as an online survey of four managers.
    actionable short- and long-term strategies for                                                 ■    Interviews with seven stakeholders
    improving emergency homelessness services.                                                          bringing expertise in homelessness and
                                                                                                        housing policy and operations, public
                                                                                                        health and community engagement.

1   The terms “COVID-19 pandemic”, “COVID-19”, the “pandemic” are used interchangeably throughout the report.
2   As part of the COVID-19 response, The City of Toronto has leased approximately 25 hotels providing more than
    3,000 spaces for physical distancing and for people to move indoors from encampments.
3   The terms “shelter user”, “client” and “resident” are used interchangeably throughout the report.
4   The term “legacy” is used to refer to shelter programs that are not located in hotels, but does not refer to respites or 24-hour drop-ins.

FULL RESEARCH REPORT | Meeting Crisis With Opportunity: Reimagining Toronto’s Shelter System                                                        3
Meeting Crisis with Opportunity - Reimagining Toronto's Shelter System - FULL RESEARCH REPORT
Executive Summary (continued)

Challenged at the outset with a very short                         Service User Survey Results
project timeframe, the research team’s efforts
                                                                   Survey participants reported having both
were further complicated by constant outbreaks
                                                                   positive and negative experiences with the
of the COVID-19 virus at various shelters and
                                                                   shelter system during COVID-19. In general,
resulting lockdown measures, service delivery
                                                                   shelter users felt well supported by shelter
priorities and research fatigue. Thanks to
                                                                   staff during the pandemic and reported
the cooperation and willing participation of
                                                                   satisfaction with infection control measures
shelter users and service providers, the project
                                                                   undertaken by shelters. Without doubt,
was completed on time and as planned.
                                                                   hotel clients appreciated the increased
                                                                   privacy and safety available to them.
Review of the Literature                                           At the same time, restrictive rules, mask wearing
                                                                   and program reductions were difficult for many of
Existing literature describes how the lack of                      those surveyed. The survey findings indicate that
sustained investment in housing and social policy                  COVID-19 and the related changes implemented
by federal and provincial levels of government                     in the shelter system have had a differential
has contributed to the current homelessness                        impact on different populations. They highlight
crisis in Toronto. Systemic inequities, propelled                  strengths and deficits of the shelter system
in large part by anti-Indigenous and anti-Black                    and the lack of supports available outside of
racism, have made particular populations                           shelters for many communities. Notably, hotel
vulnerable to homelessness. The COVID-19                           program users and Black survey participants
pandemic has amplified inequities for diverse                      reported a lack of access to housing supports.
socio-demographic groups that experience                           For Black shelter users, this may be attributed
intersecting barriers, and which comprise                          to both systemic racism and bias within the
shelter using populations in Toronto, including                    shelter system and on the part of landlords.
Indigenous peoples, women, LGBTQ2S+                                In addition, childcare has been eliminated for
people, families, Black people, refugees, youth                    many families, youth have been challenged to
and men, as well as some of the pathways                           secure employment supports and women need
into homelessness for these populations.                           gender-informed harm reduction services.

The literature shows that there is a unique policy                 Shelter users made many suggestions for
moment to leverage. The City has committed                         improving homelessness services and for
to a vision of ending chronic homelessness                         ending homelessness in Toronto, with most
with the HousingTO Action Plan, the Province                       respondents advocating for robust housing
of Ontario is working towards a vision of                          supports to be embedded across the shelter
ending chronic homelessness by 2025 and the                        system and improved access and pathways
Government of Canada has committed to ending                       to affordable and supportive housing.
all chronic homelessness in Canada by 2028.

FULL RESEARCH REPORT | Meeting Crisis With Opportunity: Reimagining Toronto’s Shelter System                      4
Meeting Crisis with Opportunity - Reimagining Toronto's Shelter System - FULL RESEARCH REPORT
Executive Summary (continued)

Service Provider Focus Group Results                               Considerations for the
Management and front-line staff described                          Shelter System
the challenges and the successes that they
experienced during the pandemic. They spoke                        Human Resources and Sustainability
of facing significant human resources and                          This study has shown that a number of
financial pressures and raised questions about                     changes need to be made to ensure that
organizational and system-wide sustainability.                     shelters are equipped to mitigate and/
They expressed significant concern about                           or handle emergency situations.
the health, mental health and safety of staff                      ■   It is essential that individual shelters, and
and shelter users, and about increased rates                           the shelter system as a whole, have a) the
of overdose. They also highlighted the loss                            capacity to adequately recruit, retain and
of programming supports for clients, their                             compensate their staff, b) resources to
increased social isolation and disruptions to                          create workplaces that prevent burnout and
their social networks and sense of community.                          compassion fatigue and foster wellness, and
                                                                       c) a strategy to quickly skill up the workforce
On the other hand, they discussed positive                             to respond continuously to changing
experiences, such as the ease of transitioning                         demographics in the system or shifts in need.
shelter users into private accommodations at the                   ■   It is important to have staff – permanent
hotel programs and into permanent housing as                           and relief – who have the knowledge,
a result of rapid housing initiatives introduced                       skills, experience and resources to address
during the pandemic. They also described many                          challenges that may be amplified during
strengthened partnerships, most notably with                           emergencies and to work effectively
the health sector. Service provider accounts                           with populations who are particularly
help to paint a picture of the direct and indirect                     vulnerable during times of crisis.
ways in which the pandemic has both tested                         ■   To help stabilize shelter service providers,
and helped shelter users, service providers                            the Shelter Support and Housing
and the shelter system as a whole. Their                               Administration (SSHA) and other City
testimonies highlight the resilience of service                        divisions can deepen their work with
providers, their commitment to ensuring the                            shelter providers to transition the shelter
well-being of shelter users and their continued                        system to embody a more robust housing
efforts to find permanent housing solutions                            delivery focus. Immediate opportunities for
for shelter users during these trying times.                           enhanced collaboration include the roll out
                                                                       of the coordinated access system and the
                                                                       conversion of emergency homelessness
                                                                       programs into supportive housing.

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Meeting Crisis with Opportunity - Reimagining Toronto's Shelter System - FULL RESEARCH REPORT
Executive Summary (continued)

Program and Service Delivery                                       ■   Shelter service providers should build
                                                                       staff knowledge and skills, and/or invest
The pandemic disrupted program and service
                                                                       in additional housing workers, in order to
delivery across the shelter system. Enforced
                                                                       strengthen, reshape or introduce services
masking and social distancing coupled with
                                                                       and programs explicitly focused on preparing
service/program reduction and closures, and
                                                                       clients to achieve optimal housing outcomes.
the lack of access to friends, family, other                       ■   Funding agreements with SSHA
shelter users, shelter staff and community
                                                                       should appropriately resource and
service providers contributed to the rise in
                                                                       hold accountable shelter service
mental health and substance use related
                                                                       providers for housing outcomes.
crises across the sector. At the same time, a
most incredible outcome during this pandemic
                                                                   Human Rights Focused, Inclusive and
has been the range of partnerships forged
or strengthened across various sectors.
                                                                   Equitable Shelter Models
Further, feedback from shelter users and                           The pandemic triggered a system-wide
staff indicates that there is an opportunity                       shift from congregate to individual rooms, a
for housing to be a stronger and more                              change that enables people to live with more
fundamental feature of shelter programming.                        privacy and provides a sustainable solution
■   There is a need to embed programming                           for protecting people in the face of future
    that promotes wellbeing and fosters both                       health emergencies. At the same time, there
    belonging and community into the shelter                       are valid concerns to address regarding
    model, so that during emergencies and                          health, wellbeing and safety, particularly
    times of crisis there is capacity to prevent                   for shelters users who are most at risk.
    social isolation and promote mental health.
■   Tables that are working on the development                     Despite the complexity of the emerging
    of referral and service pathways between                       shelter hotel program, there is a need for
    health services (primary care, harm reduction                  these dignified settings and an opportunity,
    and mental health) and the shelters                            as communities and services begin to
    should hasten their efforts and should be                      stabilize, to perpetuate and elaborate on
    resourced adequately so that all shelter                       these programs for unique communities
    users, regardless of where they are in                         (i.e., LGBTQ2S+, Black , Indigenous, etc.).
    the shelter system, can receive equitable
    access to the services that they require. It is                The study findings also indicate that shelter
    time to double efforts at assuring ongoing                     service models and built forms/physical structure
    access to and sustainability of health care,                   can be improved to better address the unique
    harm reduction and mental health/case                          needs of distinct shelter using populations and
    management resources within the shelter                        to foster inclusive and welcoming communities.
    system coupled with follow up supports
    that lead to successful housing outcomes.

FULL RESEARCH REPORT | Meeting Crisis With Opportunity: Reimagining Toronto’s Shelter System                      6
Meeting Crisis with Opportunity - Reimagining Toronto's Shelter System - FULL RESEARCH REPORT
Executive Summary (continued)

■   SSHA, the Housing Secretariat and shelter                      ■   Shelter users should inform policy and
    service providers can work together                                program development as an important step
    more intentionally to ensure that human                            towards greater inclusiveness. Shelter service
    rights principles are consistently and                             providers can play an important role in helping
    equitably applied across all facilities                            to put forward effective models for doing so.
    that comprise the shelter system.
■   Shelter service providers should continue                      From Shelter to Housing
    to engage with funders, policy makers and
                                                                   Overwhelmingly, feedback from shelter
    health system partners to strengthen the
                                                                   users and service providers emphasized the
    foundation established during the pandemic
                                                                   utmost importance of increasing the supply of
    to ensure that a robust and comprehensive
                                                                   affordable and deeply affordable housing stock
    range of services (e.g., housing, primary
                                                                   across the City. They stressed the need for a
    care, mental health, harm reduction,
                                                                   range of housing options that meet people’s
    addiction, employment, etc.) are consistently
                                                                   diverse mental and physical health and harm
    embedded across the shelter system so
                                                                   reduction needs, and which support their
    ensure equitable access for all shelter users.
                                                                   education and employment goals. Inevitably,
■   The shelter system must continue to evolve
                                                                   they also identified the need for robust social
    to ensure that a range of options are available
                                                                   and housing policies that entail sustainable
    for diverse and emerging populations.
                                                                   long-term financial investment from municipal,
    »  First and foremost, SSHA and Indigenous
                                                                   provincial and federal levels of government,
       partners can continue to advance
                                                                   as well as the private sector. These findings
       accountability statements and action
                                                                   suggest that shelter providers can leverage
       items identified in the Meeting in the
                                                                   the unique moment afforded by the COVID-19
       Middle Strategy to meaningfully address
                                                                   pandemic and work collectively towards the
       Indigenous homelessness in Toronto.
                                                                   common goal of ending homelessness by:
    »  SSHA and the shelter system should also
       continue to work with Black leadership,                     ■   Engaging with SSHA and the
       within the shelter system and other Black                       Housing Secretariat to help inform
       serving organizations, to implement                             decisions about the future of the
       the recommendations of the COVID-19                             shelter system and the acquisition/
       Interim Shelter Recovery Strategy, which                        repurposing of shelters for housing.
       call for a distinct approach to serve Black                 ■   Ensuring that learnings from other
       people experiencing homelessness                                jurisdictions are leveraged, particularly in
       wherein the reality of anti-Black racism                        future decisions regarding hotel programs.
       is recognized and addressed.                                ■   Participating in collaborative and cross-
■   There should be an intersectional approach                         sectoral initiatives for increasing the
    to all shelter system planning whereby                             availability of supportive housing stock, such
    the unique experiences and backgrounds                             as the Supportive Housing Growth Plan.
    of diverse shelter users (families,                            ■   Advocating for rent subsidies, such
    LGBTQ2S+, refugees, youth, women,                                  as the new Canada-Ontario Housing
    etc.) are prioritized and accounted for.                           Benefit (COHB), more portable rent

FULL RESEARCH REPORT | Meeting Crisis With Opportunity: Reimagining Toronto’s Shelter System                            7
Executive Summary (continued)

    subsidies and rent controls.                                       shelter users and service providers.
■   Developing a strategy for engaging                             ■   Engagement with Indigenous shelter
    with the City, housing developers                                  service providers and Indigenous
    and landlords to create more (deeply)                              researchers to support their efforts to
    affordable and supportive housing.                                 document the differential impact of
■   Advocating for improvements to the minimum                         the pandemic on Indigenous shelter
    wage, Ontario Disability Support Program and                       users and service providers.
    Ontario Works Program, and for alternative                     ■   A study of the feasibility of converting shelter
    models for guaranteeing people a living wage.                      programs (i.e., legacy shelters and hotel
                                                                       programs) into permanent supportive or
Future Areas of Research                                               transitional housing for clients and defining
                                                                       the requirements for ensuring inclusive and
and Research to Action                                                 welcoming environments for diverse people.
Meeting Crisis with Opportunity provides a                         ■   A study to explore opportunities for
snapshot of the shelter system at an important                         integrating peer-based programming (i.e., with
point in time. The findings and considerations                         the expansion of harm reduction) and creating
presented should offer guidance on policies,                           good work opportunities for people with
procedures and future areas of research.                               lived experience across the shelter system.
With more time and resources, the following
areas deserve further exploration:
■   Further comparative analysis of Meeting
    Crisis with Opportunity data to better
    describe the unique experiences for diverse
    socio-demographic populations of shelter
    users and for people using different shelter
    programs (i.e., hotels, legacy shelters).
■   A study to better understand the impact
    of the pandemic on Black shelter users,
    who comprise more than 40% of all
    shelter users, and the intersection of the
    pandemic experience with anti-Black
    racism and the unique experiences of
    diverse Black populations, including
    women, youth and LGBTQ2S+.
■   A study to evaluate the long term impact
    of the pandemic for people using different
    shelter programs and on the health and
    mental health outcomes for diverse

FULL RESEARCH REPORT | Meeting Crisis With Opportunity: Reimagining Toronto’s Shelter System                         8
Executive Summary (continued)

         People experiencing homelessness have been hard hit during these past
         three waves of the pandemic – communities have been disrupted, people
         have become increasingly isolated, mental health challenges have been
         exacerbated and more lives than ever have been lost to overdose.

         The impact on service providers, who throughout the pandemic have shown
         remarkable commitment and resilience, has been significant. Despite daunting
         workplace circumstances and the risks posed to their health and their families’
         health, service providers rose to the challenge and enabled the shelter system to
         remain operational throughout the pandemic. The majority of shelter users and
         service providers see a silver lining, namely the increase in the number of people
         that have been housed this past year, the introduction of the hotel program and the
         overall success of measures taken to prevent the spread of COVID-19 in shelters.

         Sixteen months into the pandemic, it is time to turn our attention to the future of the
         shelter system. The TSN and Dixon Hall share this report to foster reflection, ongoing
         inquiry and change. Data from other jurisdictions shows that homeless individuals
         with even short stays in shelter hotel programs have greater successes once they
         transition to other forms of permanent housing. This is just one of many findings and
         considerations highlighted in Meeting Crisis with Opportunity which inspire hope
         and can help move us toward the eradication of chronic homelessness in our city.

         Finally, shelter users best understand what is required to improve their housing
         outcomes and can best articulate the needs of diverse populations using the shelter
         system. As a next step, shelter users, as well as shelter providers and decision makers,
         will be re-engaged to identify priority recommendations and actions so that this study

FULL RESEARCH REPORT | Meeting Crisis With Opportunity: Reimagining Toronto’s Shelter System        9
Table of Contents
     Acknowledgements.  .  .  .  .  .  .  .  .  .  .  .  . 2                5. Service Provider Perspectives . . 46
     Executive Summary.  .  .  .  .  .  .  .  .  .  .  .  . 3                     5.1 About the Service Provider Focus Groups

           Methodology                                                            5.2 Human Resources

           Findings                                                               5.3 Access to Financial Resources and PPE

           Considerations for the Shelter System                                  5.4 Services and Programs

           Future Areas of Research and Research to Action                        5.5 The Hotel Program

           Conclusion                                                             5.6 Housing

                                                                                  5.7 Partnerships
1. Introduction.  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  . 11
                                                                                  5.8 Conclusion
     1.1   About TSN and Funding Partners
                                                                            6. Considerations for the Shelter
2. Methodology . .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  . 13
                                                                               System .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  . 56
     2.1 Data Collection
                                                                                  6.1 Human Resources
     2.2 Data Analysis
                                                                                  6.2 Program and Service Delivery
     2.3 Challenges and Limitations
                                                                                  6.3 Safe, Inclusive and Equitable Shelter Models
3. Homeless in Toronto:                                                           6.4 From Shelter to Housing
   An Overview. . . . . . . . . . . . . . . . . . .17                             6.5 Future Areas of Research and Research to Action
     3.1 The Shelter System
                                                                            7. Conclusion .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  . 63
     3.2 The Current Policy Landscape

     3.3 A Year into the Pandemic                                                Appendix A.  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  . 64
     3.4 Homelessness among Diverse Populations                                   TSN Member Agencies

     3.5 Conclusion                                                              Appendix B.  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  . 65
4. Shelter User Perspectives.  .  .  .  .  . 31                                   Advisory Committee Terms of Reference

     4.1 About the Shelter User Survey Questionnaire                             Appendix C.  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  . 68
     4.2 Survey Participant Profile                                               Key Stakeholder Interview Participants

     4.3 Overall Experience of Homelessness                                      Appendix D.  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  . 69
     4.4 Positive Impacts                                                         List of Service Provider Focus Group Participants
     4.5 Negative Impacts
                                                                                 Appendix E.  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  . 70
     4.6 Program Changes & Impacts
                                                                                  List of Participating Organizations
     4.7 Impact on Shelter Users by Population                                    in Shelter User Survey
     4.8 Shelter User Recommendations
                                                                                 Appendix F.  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  . 71
     4.9. Conclusion
                                                                                  Shelter User Survey Sample

                                                                                 Works Cited .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  . 74

FULL RESEARCH REPORT | Meeting Crisis With Opportunity: Reimagining Toronto’s Shelter System                                                           10
1. Introduction
More than a year has passed since the onset of the COVID-19 pandemic,
and what a year it has been. The pandemic has had a profound impact on
Toronto’s society, with rippling effects that surely will be felt for generations
to come. Aside from the spread of the virus, which has claimed the lives of so
many, the on again, off again lockdowns and stay at home orders disrupted
families, separated communities and decimated countless businesses.

The pandemic exposed and exacerbated                                                          ■    To better understand the impact of
significant social and health inequities                                                           COVID-19 on the shelter system.
across Canada. Data has shown that people                                                     ■    To describe the experiences of shelter
who experience homelessness and other                                                              users since the onset of COVID-19, and
marginalized groups are those who most feel                                                        to better understand the impact that the
the impact of the pandemic. In Toronto, a rapid                                                    pandemic has had on diverse populations
emergency response to protect homeless                                                             using Toronto’s shelter system, including
populations using shelters5 was undertaken,                                                        those who moved into hotels and those that
resulting in a significant restructuring of the                                                    remained in legacy shelters and respites.
shelter system. Whereas in March 2020,                                                        ■    To develop recommendations that will help
35 organizations were operating shelter                                                            guide homelessness service providers and
programs at approximately 65 different sites,                                                      decision makers to develop sound and
by May 2021 these same 35 organizations                                                            actionable short and long-term strategies for
were operating programs at more than                                                               improving emergency homelessness services.
140 sites. For more than a year, 24-hour
emergency homelessness providers have                                                         This report identifies recommendations
stepped up, ever adapting their operations                                                    that can improve the delivery of housing
to better serve and protect shelter users.                                                    and homelessness services and supports
                                                                                              for people in Toronto, build capacity and
In order to document the impact of this                                                       infrastructure for future waves of COVID-19 and
transformation, the TSN in partnership                                                        other emergencies and inform the permanent
with Dixon Hall, embarked on a six-month                                                      transition of the shelter system into one that
exploratory study called “Meeting Crisis                                                      is people-centered and housing focused.
with Opportunity: Reimagining Toronto’s
Shelter System”. The study was designed
with the following objectives in mind:

5   The term “shelter” is an overarching term used throughout this report in reference to 24-hour emergency homelessness services,
    commonly including shelter, transitional shelter, respite, 24-hour drop-in and COVID-19 response (hotel) programs.

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Introduction (continued)

1.1 About TSN and                                                  collaborative planning, research and advocacy.
                                                                   TSN believes that housing is a human right
Funding Partners                                                   and envisions a City where everyone has a
TSN is an umbrella organization made up of                         home that enables them to live with dignity.
approximately 35 member organizations that                         Dixon Hall, a TSN member agency, was the
together operate more than 100 emergency                           trustee organization for Meeting Crisis with
shelter, respite, 24-hour drop-in and                              Opportunity, and the study was funded by
COVID-19 response programs. Please see                             the City’s SDFA Department. This project
Appendix A for a list of TSN member agencies.                      is aligned with TSN’s vision as well as its
TSN champions the best housing outcomes                            strategic priority of collaborating on research,
for people experiencing homelessness by                            policy and advocacy initiatives and the
enhancing the collective capacity of diverse                       development of alternative housing strategies
homelessness service providers in Toronto                          that expand housing options for member
through knowledge sharing and learning,                            organizations and the clients they serve.

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2. Methodology
Meeting Crisis with Opportunity is an exploratory study that was
conducted using mixed research methodologies. The overarching
research questions identified for the study included:

■   What are the demographics of people                                                       Literature Scan
    using different emergency homelessness
                                                                                              For insights into the COVID-19 context, a review
    programs (shelters, respites and hotels)?
                                                                                              of grey literature was conducted. The review
■   How has COVID-19 impacted (positive,
                                                                                              focused on the following: homelessness; the
    negative, neutral) people’s health and
                                                                                              housing and homelessness policy landscape;
    wellbeing, access to services, employment/
                                                                                              health and homelessness; COVID-19 related
    education, and social interactions / contact
                                                                                              changes to and impacts on the shelter system;
    with friends, family, or other loved ones?
                                                                                              unique needs of populations known to be
■   What is the differential impact of COVID-19
                                                                                              using shelter services6 (Black, Indigenous,
    on different populations of shelter clients?
                                                                                              LGBTQ2S+, Youth, Single Adult Women,
■   What has worked and not worked well in terms
                                                                                              Single Adult Men, Families, and Refugees)
    of the shelter system’s response to COVID-19?
                                                                                              and their experiences during the pandemic.
■   What factors have contributed to
    success for people using different
    shelter programs during COVID-19?                                                         Shelter User Surveys
                                                                                              To understand how the pandemic has impacted
Over the course of six months, between                                                        shelter users, 239 current clients were surveyed
November 2020 and April 2021, staff members                                                   at shelters, respites, 24-hour drop-ins, and
from TSN and Dixon Hall worked together to                                                    COVID-19 hotels across Toronto. Service users at
collect and analyze data and then author this                                                 both city-run and community/purchase of service
report. The research team was guided by the                                                   organizations of diverse size and geographic
Project Advisory Committee, formed at the                                                     location were surveyed. See Appendix C for
outset to provide input on the study questions                                                the list of clients’ shelter sites. As the study
and methodology and to illuminate the study                                                   is focused on the impact of the pandemic on
findings and considerations for the shelter                                                   diverse populations, surveys were conducted
system as identified by the research team.                                                    with men, women, youth, families, refugees, as
See Appendix B for Advisory Committee                                                         well as members of the LGBTQ2S+, Black and
Terms of Reference.                                                                           Indigenous communities. The surveys helped
                                                                                              capture their unique stories, provide insights into
2.1 Data Collection                                                                           the challenges and successes they experienced,
                                                                                              and identify factors that have contributed to
The task of collecting data was split into                                                    both positive as well as negative outcomes in
four parts: literature scan, shelter user                                                     their lives. The survey was pilot tested with ten
surveys, service provider focus groups                                                        clients in advance of being administered broadly.
and key stakeholder interviews.

6   The Toronto Street Needs Assessment (2018) was referenced to identify the main shelter using populations.

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2. Methodology (continued)

Sampling Strategy                                                  Service Provider Focus Groups
To ensure that there was adequate                                  To help understand how the pandemic impacted
representation of different populations in                         service providers, 56 staff members from across
the study, a stratified sampling method was                        the shelter system were invited to participate in
used. However, due to limitations imposed                          a series of focus group discussions. However,
by the pandemic and the transient nature of                        due to the outbreaks and the demands of
the shelter using population, a convenience                        adapting to a constant and rapidly changing
sample approach was used to engage clients at                      environment, we were only able to engage
participating shelter organizations. Accordingly,                  70% of our target. Over the course of three
the proportion of the survey participants from                     days, 56 managers, front-line staff and shelter
each socio-demographic group is not precisely                      housing help workers/counsellors participated
representative of the entire population currently                  in focus group sessions. To ensure adequate
using the shelter system. However, the stories                     representation of shelters from across the
highlight their unique characteristics and                         system, digital questionnaires were subsequently
experiences; give voice to some of the most                        sent to managers at organizations that did not
vulnerable members of society and emphasize                        attend the sessions. This exercise brought
the need for immediate and targeted action.                        the total to 60 service provider participants.
                                                                   Focus group discussions, held over Zoom with
Collecting the Data                                                these field experts, provided insights into the
                                                                   challenges they have faced in serving shelter
At the beginning of the data collection period,
                                                                   users during the pandemic. A discussion
the surveys were conducted in person by
                                                                   guide, composed of standard questions
Community Animators and the Community
                                                                   as well as a series of questions tailored for
Researcher. However, when shelters started
                                                                   each of the three staff groups, was used by
to experience outbreaks and the City issued
                                                                   facilitators. All discussions were recorded and
stay at home orders alternative strategies were
                                                                   later transcribed for analysis, along with the
implemented. Service providers volunteered
                                                                   questionnaire responses received by email.
to administer the surveys with clients and
shelter users were able to complete the
surveys independently, either by hand-to-paper
                                                                   Key Stakeholder Interviews
or digitally. Further, if clients had access to                    To gain insights and expert knowledge on the
technological devices such as phones or laptops,                   impacts of the pandemic on the homelessness
Community Animators were available to interview                    sector from perspectives outside the shelter
them digitally. All shelter user survey data was                   network, seven interviews were conducted with
entered into a Survey Monkey template for                          key stakeholders. Decision makers and subject
analysis with the help of a data entry specialist.                 matter experts in the housing and homelessness
                                                                   policy and operations, public health, community
Prior to completing the survey, all shelter                        engagement and service delivery planning
users read or reviewed and signed off on                           participated in these interviews. Unsuccessful
a consent form, and also were offered $30                          attempts were made to engage representatives
honorariums for their time. The compensation                       from the primary care and mental health
was delivered to them in the form of gift cards                    sectors. These perspectives would have added
from stores of the service providers’ choosing.

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2. Methodology (continued)

tremendous value to this report. All interviews                    Further complicating the study were the
were recorded and later transcribed for analysis.                  constant outbreaks of the COVID-19 virus at
Please see Appendix D for the participant list.                    various shelters and the lockdown measures
                                                                   imposed by the City. This meant, for example,
2.2 Data Analysis                                                  that the research team could not administer
                                                                   client surveys in person as had originally
A data analysis team was created to review                         been planned and a course correction was
the primary and secondary data collected.                          required to ensure participation targets
Results from the shelter user surveys                              were met through alternative means.
yielded predominantly quantitative data,
which was entered into a Survey Monkey                             Lack of time and funding also affected the
template. To compare experiences of different                      researchers’ ability to recruit and support study
subpopulations, responses were cross tabulated                     participants, as well as deliver and collect
and populated into an excel spreadsheet for                        documents to and from sites across the City.
analysis. A thematic analysis was conducted                        Shelter users have limited access to financial
of the transcripts produced from the service                       and material resources and opportunities.
provider focus groups and key stakeholder                          Additional support could have been provided
interviews. Subsequently, both quantitative                        in the form of training and funding for
and qualitative data were compared to                              technology or transportation, which would
information garnered from the literature scan.                     have avoided reinforcing marginalization and
The data analysis team carefully reviewed                          may have created a more efficient process.
all the documents for ideas and patterns
that emerged repeatedly and discussed the                          As stated, service providers were faced with
similarities and differences in their findings                     multiple and competing priorities, thereby limiting
to identify key themes for this report.                            the time available to participate in this study.
                                                                   The research team also found that research
2.3 Challenges and                                                 fatigue was being experienced by service
Limitations                                                        providers and shelter users. Due to the unique
                                                                   nature of the pandemic, researchers in different
                                                                   sectors have been scrambling to understand
The short time frame was a key challenge to                        the impacts on the City's most vulnerable
undertaking such a large and complex endeavor.                     populations and develop effective solutions to
As this was an exploratory study, with additional                  meet their needs during these trying times. As a
time the research team may have conducted                          result, shelter providers and shelter users have
qualitative interviews or focus groups with both                   been inundated with requests to participate in
shelter users and service providers prior to                       studies and information collection activities.
collecting quantitative data via the shelter user
survey to collect more detailed information.                       Nonetheless, thanks to the cooperation
                                                                   and willing participation of shelter users
Lack of time also limited the research                             and service providers it was possible to
team's ability to undertake a                                      successfully complete this project and provide
comprehensive comparative analysis                                 a compelling set of recommendations.
of the data for diverse populations.

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Highlights from
the Literature
In this section we briefly describe the homelessness
landscape, including the environment internal to and
surrounding the shelter system pre-COVID-19 and since
the onset of the pandemic. In some instances, the focus
group discussions with service providers are referenced to
supplement the literature.

FULL RESEARCH REPORT | Meeting Crisis With Opportunity: Reimagining Toronto’s Shelter System   16
3. Homeless in Toronto:
An Overview
By the 1990’s, the Central Mortgage and Housing Corporation (CMHC)7,
created to lead the nation’s housing programs in 1946, had supported
some 650,000 social housing homes in Canada. Beginning in the 1990s,
the federal government withdrew its funding and transferred responsibility
for administering affordable/social housing to the provinces.8

The dismantling of the social housing supply                                               system; the majority exited the system within
program meant that provinces and municipalities                                           three months. A smaller group of approximately
had to bear the indirect costs of inadequate                                              5,000 people (22%) are chronically homeless
housing and homelessness (Hulchanski, 2003).                                              and stay in the shelter system for six months or
                                                                                          more (City of Toronto/United Way, 2020). Once
In Ontario, between 1985 and 1995 the Province                                            fairly homogenous and comprised primarily of
played a significant role in adding to its social                                         single men, this population is very diverse and
housing stock and assisting with housing needs                                            includes many women, youth, LGBTQ2S+ people
in other ways (such as raising social assistance                                          and newcomers/refugees (Gaetz et al., 2016).
benefits and the minimum wage). By 2001, the
Province was downloading responsibility for                                               3.1 The Shelter System
social housing to the municipalities (Toronto
Board of Trade, 2003). Since then, provincial                                             Although the COVID-19 pandemic is not the
governments have rescinded subsidies for                                                  first health outbreak in the shelter system –
the construction of social housing, refused                                               there have been group A Streptococcus and
to assist in capital costs and eliminated rent                                            Tuberculosis (TB) outbreaks over the years
controls (City of Toronto, 2020). As a result,                                            (Crowe, 2019) – none has been as severe as
Toronto has been in the challenging position                                              the current global pandemic. Shelter service
of funding social housing construction with                                               providers, with guidance from SSHA and Toronto
costs exceeding the scope of its tax base. Low                                            Public Health (TPH), were quick to respond
vacancy rates and an aging and insufficient                                               to the pandemic, implementing emergency
rental inventory have further stressed availability                                       measures and adapting their operations
in the low and medium cost rental markets.                                                and service delivery procedures to protect
All this has led to a significant increase in the                                         shelter users and staff against worsening
number of people experiencing homelessness.                                               COVID-19 pandemic conditions. Some of
                                                                                          the most significant changes undertaken
As of 2016, the estimated number of Canadians                                             since March 2020 are described below:
who experienced homelessness was 35,000 per                                               ■    Over the course of four months during the
night and 235,000 over the course of the year.                                                 spring and summer of 2020 more than 3,000
It is estimated that in Toronto, approximately                                                 shelter clients were relocated from shelters to
10,000 people experience homelessness9                                                         COVID-19 response programs, mainly hotels.
each night (Fred Victor, Nov 2020). In 2019,                                                   There was continued relocation of homeless
26,000 different people used Toronto’s shelter                                                 people, mainly from encampments, into hotels
7   In 1979 the Central Mortgage and Housing Corporation changed its name to the Canada Mortgage and Housing Corporation.
8   Until the 1990’s the federal government was the primary funder of social housing in Canada.
9   According to the Homeless Hub, homelessness is defined as a state “being without stable, safe, permanent,
    appropriate housing, or the immediate prospect, means and ability of acquiring it.”

FULL RESEARCH REPORT | Meeting Crisis With Opportunity: Reimagining Toronto’s Shelter System                                               17
3. Homeless in Toronto: An Overview (continued)

      during the 2nd and 3rd waves in 2020/21.                     3.1.1. The Opioid Crisis
■   More than 1,570 clients were housed between
                                                                   While this study examines the impact of the
    March 2020 and August 2020 (City of Toronto/
                                                                   COVID-19 pandemic on homeless populations
    United Way, 2020), a 50% increase over
                                                                   in Toronto’s shelters, it must be noted that
    the same period during the previous year.
                                                                   at the same time a parallel opioid crisis has
■   The City leased space in 25 hotels,
                                                                   ravaged the shelter system. Since March
    including two hotels to operate two
                                                                   2020, there has been a 48% increase in
    COVID-19 isolation and recovery
                                                                   opioid-related deaths in Toronto’s shelters.
    programs (City of Toronto, Oct 2020).
                                                                   The opioid crisis can be attributed to the
■   To curb the rising rate of infection across the
                                                                   increasing toxicity of the unregulated drug
    shelter system, particularly during the 2nd
                                                                   supply, but the COVID-19 pandemic has
    and 3rd waves, shelter providers implemented
                                                                   exacerbated the crisis in the following ways:
    numerous guidelines and directives,
    including but not limited to the following:                    ■   More people consuming drugs alone
    »   the provision and mandatory use                                due to physical distancing.
        of Personal Protective Equipment                           ■   Some shelter users have been moved
        (PPE) for staff and shelter users                              to programs in areas of the City that
        (e.g. masks, shields, gloves;                                  are new to them, which means they
    »   mandatory completion of screening                              may be purchasing their supply from
        assessment tools for COVID-19 symptoms;                        dealers that are not familiar to them.
    »   restriction of outside visitors                            ■   The City has opened more hotel spaces,
        from entering facilities;                                      which afford privacy, but can be isolating.
    »   daily temperature checks for                               ■   Health-funded harm reduction services (i.e.
        shelter users and staff;                                       detox, withdrawal and mental health facilities)
    »   increased cleaning of facilities;                              reducing their service hours and capacity
    »   transportation and relocation of                               during the first wave of the pandemic.
        clients testing positive and their close
        contacts back and forth from shelter to                    3.2 The Current Policy
        isolation and recovery programs, and
        cancellation of all non-essential programs
        and gatherings.                                            3.2.1 Federal
                                                                   In 2019, Canada legally recognized housing as
By and large the shelter system has remained                       a human right through the National Housing
operational throughout the pandemic.                               Strategy Act (Morrison, 2019; Legislative
However, conversations with shelter managers                       Services Branch, 2021). In 2017, the federal
confirm that numerous program sites have                           government committed to the National Housing
experienced reduced capacity due to                                Strategy (NHS), a ten-year plan investing $55
outbreaks and some have temporarily been                           billion to build stronger communities and help
closed to implement new requirements, re-                          Canadians across the country access safe,
opening at a later date with increased physical                    affordable homes, prioritizing communities
distancing and other measures in place.                            facing distinct housing barriers such as the

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3. Homeless in Toronto: An Overview (continued)

 LGBTQ2S+ community, homeless women,                               renovate and purchase facilities to create longer-
women and children fleeing family violence,                        term housing solutions and to add to rent banks
seniors, Indigenous peoples, people with                           and support plans in preparation for potential
disabilities, mental health and addictions                         future outbreaks or emergencies (Ministry of
challenges, veterans and young adults. The                         Municipal Affairs and Housing, Dec 2020).
strategy aims to cut chronic homelessness in
half, remove 530,000 families from housing need                    3.2.3 Municipal
and invest in the construction of up to 125,000
                                                                   In its HousingTO 2020 -2030 Action Plan, the
new affordable homes (NHS, n.d.). During
                                                                   City of Toronto laid out an ambitious agenda for
COVID-19, CMHC introduced initiatives as part of
                                                                   supporting people to access housing over the
the NHS, including the Rapid Housing Initiative
                                                                   next 10 years, from homelessness to rental and
to create 3,000 new permanent affordable
                                                                   ownership housing to long-term care for seniors.
housing units for vulnerable populations and
                                                                   With the onset of the pandemic, the City’s focus
the Rental Construction Financial Incentive,
                                                                   on affordable housing was intensified. The
which provides low-cost loans to encourage the
                                                                   COVID-19 Housing and Homelessness Recovery
construction of sustainable rental apartments.
                                                                   Response Plan was developed to create 3,000
                                                                   permanent, affordable homes within the next 24
3.2.2 Provincial                                                   months for vulnerable and marginalized residents
The Province’s homelessness programs centre                        and requests that the federal and provincial
on the commitment to end chronic homelessness                      governments fast-track and expand initiatives
by the end of 2025. In 2018, the Ontario                           under the National Housing Strategy and other
government signed a bilateral agreement with                       existing federal and provincial funding programs.
the federal government to provide a Housing
Benefit, investing $1.4 billion to help low-income                 The Mayor’s Housing Action Team was
renters afford housing (Municipal Affairs and                      established to create a diverse set of affordable
Housing, 2019). Since the beginning of the                         and market rental housing opportunities. The
COVID-19 pandemic, the Ontario government                          COVID-19 Interim Shelter Recovery Strategy
has twice put a temporary halt to evictions of                     and Implementation Plan put forward immediate
formal rent arrangements and passed legislation                    priorities in the context of the pandemic and
to freeze rents at the 2020 levels (Hale, 2020;                    will provide guidance to SSHA and other
Ministry of Municipal Affairs and Housing,                         City divisions. This strategy recommended
March 2020). Changes made to the Residential                       enhanced capacity across the shelter system;
Tenancies Act include a new requirement that                       cross sectoral collaboration to handle
landlords work a repayment plan with tenants                       health care needs and future outbreaks; the
before filing for eviction for non-payment of rent                 opening of new facilities that offer dignified
(Ministry of Municipal Affairs and Housing, 2021).                 emergency shelter; investment in long-
In 2020, $120 million in funding was allocated to                  term deeply affordable housing, and distinct
help municipalities and Indigenous partners help                   actions for addressing Black and Indigenous
vulnerable individuals secure and keep housing                     homelessness (City of Toronto, 2020a).
during the pandemic. This funding was intended
to protect homeless shelter staff and residents,

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3. Homeless in Toronto: An Overview (continued)

In 2018, in response to the increased demand
for shelters in neighbourhoods across the City,
                                                                                                  3.3 A Year into the Pandemic
SSHA introduced changes to processes for                                                          3.3.1 Shelter Utilization
identifying new shelter locations as well as                                                      During the month of January 2020, prior to the
community engagement and neighbourhood                                                            start of the pandemic, approximately 11,322
integration processes. These have led to the                                                      people used overnight emergency homelessness
development of Community Liaison Committees                                                       services in Toronto; 901, or 9%, were new
(CLCs) in neighbourhoods where new shelter                                                        identified shelter users; 35% had either been
programs, especially hotel programs, opened                                                       homeless for six months or more that year, or had
during COVID-19. SSHA has also been                                                               “overnight stays over the past three years with a
moving forward with best practice design                                                          cumulative duration of at least 546 nights” (Gaetz
guidelines and the implementation of a new                                                        et al., 2014; City of Toronto, 2021c)10. During
housing focused shelter model, integrating                                                        the month of January 2021, 10 months into the
a housing first approach with client-centered                                                     pandemic, 8,835 people used the shelter system;
case management (City of Toronto, 2018). To                                                       647, or 8%, were newly identified users and 45%
this end, SSHA has also been advancing the                                                        were chronic shelter users. Between January
Coordinated Access System to streamline the                                                       2020 and January 2021, there was an increase
process for people experiencing homelessness                                                      in the percentage of men, transgender people,
to access the housing and support                                                                 seniors and chronically homeless people, and a
services needed to permanently end their                                                          decrease in the percentage of women, families
homelessness and ensure system adjustments                                                        and refugees using shelters (City of Toronto,
are data-informed and evidence-based.                                                             2021c) (Figure 1)11. Evidence suggests that job
                                                                                                  and income loss and the closure of the borders
Finally, SSHA is in the midst of completing                                                       to refugees12 may be contributing factors
a new Five Year Service Plan, which will                                                          to some of the changes in the populations
identify specific actions that SSHA needs to                                                      relying on emergency shelter services.
take to achieve the directions and outcomes
in the HousingTO2020-2030 Action Plan.

10   This aligns with the federal definition of “chronic homelessness” (Gaetz et al., 2014).
11   Information regarding Black and Indigenous shelter users is not currently available through City of Toronto data.
12   Female headed refugee families made up significant proportion of those using family shelters pre-pandemic.

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3. Homeless in Toronto: An Overview (continued)

Figure 1: Shelter use by demographic in January 2020 and January 2021
(Toronto Shelter System Flow Data)
                          Jan 2020               Jan 2021

          60%              64%


           30%                             34%
           10%                                                               12%                           13%
                                                             2%       10%
                       Men            Women         Transgender          Youth          Families     Refugees
                                                       People           (16-24)

According to Toronto Shelter System Flow                            people were living in encampments at the
Data, 2,757 fewer people used emergency                            time. The City put the estimate at closer to 400.
homelessness services in January 2021                              Finally, many asylum seekers have not been able
compared to January 2020, or before the                            to enter Canada as a result of COVID-19 border
pandemic began (City of Toronto, 2021c). There                     closures, which has led to a significant decline in
are several factors that may be contributing to                    the number of refugees using the shelter system.
this discrepancy. First, for a period of time the
number of spaces in shelters was reduced as                        3.3.2 Shelter and Health Systems
physical distancing measures were introduced at                    Collaboration
the onset of the pandemic. Second, each time an
                                                                   It has long been recognized that homeless
outbreak occurs at a shelter that shelter is closed
                                                                   people face significant health-care challenges,
to new intakes, resulting in overall reduction in
                                                                   including equitable access, experiences and
system capacity that fluctuates depending on
                                                                   outcomes. A survey undertaken by the TSN in
the number of outbreaks that are occurring at
                                                                   2018 found that clients were not receiving the
any one time. Third, throughout the pandemic
                                                                   same level of health services from shelter to
many people experiencing homelessness have
                                                                   shelter. Health service availability in any given
chosen to stay outside rather than in shelters
                                                                   shelter was largely relationship driven, and while
due to fear of acquiring COVID-19. In December
                                                                   some shelters provided a range of primary care
2020, a CBC News report noted that, according
                                                                   and mental health services, others had very little
to some homelessness advocates, up to 1,000
                                                                   available to offer their clients. It has also long

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3. Homeless in Toronto: An Overview (continued)

been recognized that a coordinated approach                         helped shelter service providers to adapt to
between health and shelter services providers                      the plethora of pandemic related changes
is needed to support the provision of health                       and services implemented over the past year
services that are user-centered, accessible,                       across the shelter system, most notably:
comprehensive, coordinated and sustainable for                     ■   Infection Prevention and Control (IPAC)
shelter users, while in the shelters and after they                    from TPH, Unity Health and other
have moved into permanent housing. In 2018,                            hospitals helped shelters manage
a framework for coordinated health services                            and minimize risks of outbreaks.
was developed by SSHA, the Toronto Central                         ■   The Inner City Health Associates (ICHA),
Local Health Integration Network (TCLHIN)                              instrumental in identifying and supporting
and Central East Local Health Integration                              shelters to protect clients at highest risk for
Network (CELHIN). However, the transition to                           COVID-19 infection, has been a key player
a new provincial government in 2018 stalled                            in bringing COVID-19 testing across the
the implementation of the framework.                                   system and has provided various health-
                                                                       related services and supports to shelter
The onset of the COVID-19 pandemic, coupled                            users (e.g., primary care, grief counselling).
with the worsening opioid crisis, particularly                     ■   Isolation and recovery sites have
in many of the social distancing sites (hotels),                       been operationalized by ICHA
accelerated collaborative problem solving                              together with Parkdale Queen West
between the health and shelter systems.                                Community Health Centre.

                                                                   ■   Harm reduction services and programs
         July marked the highest cluster                              have been implemented across COVID-19
                                                                       hotels by TPH, Parkdale Queen West
          of overdose fatalities since TPH                             and other health service providers.
          began tracking data three years                          ■   Mental health case management, harm
          ago.”                                                        reduction and primary care referral pathways
                       City of Toronto, 2020a                          are being put in place to ensure equitable
                                                                       access across the shelter system.
                                                                   ■   Mental health case management teams
The Toronto Region Homelessness COVID-19                               were made available to hotel clients
Working Group and the Health Services                                  through interdisciplinary teams of staff
Framework Steering Committee were formed                               from numerous organizations.
to address COVID-19 needs for homeless
                                                                   ■   ICHA, numerous Ontario Health Teams (OHTs),
populations and to revitalize and move forward                         including hospitals and community health
the health services framework (City of Toronto/                        centres (e.g., Unity Health, University Health
United Way, 2020). Three streams of work                               Network, Women’s College Hospital, South
were added to the framework, with primary                              Riverdale Community Health Centre) have
health care, mental health/case management                             been working to deliver vaccination clinics
and harm reduction coordinating tables                                 on-site at shelters and at community clinics.
established. Partnerships with the health sector

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