Not every community can afford to have (or wants to have) a Recovery-Oriented Housing-Focused Assertive Community Treatment team. Even if they did, not every program participant situation can be fully served through the ACT team alone. And while Intensive Case Management teams are more plentiful, they can be confronted with health, wellness and care needs that surpass the knowledge, expertise, or time availability of the ICM team. Many times I have had ICM staff approach me in training asking what to do with those program participants that have really complex health needs, struggle to maintain their apartment because of their health, or have even been working on a palliative care plan with a health provider.
Housing based case managers are brokers and advocates to other services, rather than the direct provider of health care services, counselling services, etc. As such, the limitation of housing supports is dictated, at times, by the overall wellness of the person. If there is not home-based health supports that cannot supplement the work of the Housing based case manager in an ICM program, the Housing Based Case Manager cannot be held responsible for the health and wellness of the participant. It is outside their expertise or job responsibilities.
The truth is, not everyone can manage independent living with certain health issues. Sometimes care homes, long-term rehabilitation housing, nursing homes, hospice care, and the like are more equipped to handle the health needs of certain program participants than a scattered site unit with supports that come to the home. Is that a failure of the ICM team or the program? No. It is the reality of how care is provided, to whom and how (which can be very different community to community) when it comes to people with compromised health.
This is not always easy to accomplish in a meaningful way in any community.
Needing more advanced health supports and having access to those supports is not the same thing. Many care facilities have long waiting lists. Some require private payment. Others have really stringent eligibility criteria and a health record verification process that almost requires an army of health professionals to navigate – and uses terminology foreign to a housing worker.
Then there is the matter of fit and expectations of people that use care facilities. Many communities do not have care facilities that tolerate the sorts of behaviours that the participants in a housing program may exhibit. You would be hard pressed, for example, to find a nursing home that is supportive of residents using crack cocaine or a long-term care facility that understands some residents are going to participate in sex work. These are communities that benefit from a core review of health services to be inclusive rather than expecting housing works to provide health care services.
Another concern is that housing workers start to disengage with any program participant with a health concern thinking it is automatically the job of care workers to pick up the slack and take the lead because of the health concern. Butting heads across system is NOT service. And it does not serve the best interests of the program participants either.
We cannot house our way out of appropriate health care, when a more medical treatment residential option is the more prudent course of action. We need to work with the health community to figure out the best support and residence models to meet the needs of our clients rather than laying blame or pointing fingers. And at the same time we cannot blame a housing case manager for not having enough health resources or knowledge when it is beyond the expectation of the position – and some program participants will need more health supports than they could ever broker or advocate to access.