Compassionate care for Toronto’s most vulnerable

The first thing that often comes to mind when we think of a hospital emergency room (ER) is critical medical cases— things like car crashes, heart attacks and appendicitis. But with more Canadians falling through the gaps due to systemic issues such as the housing crisis and challenges obtaining primary medical care, Canada’s ER workers are increasingly stretched as they try to meet needs that don’t fit the classic notion of emergency health care.

At University Health Network (UHN), a number of peer support teams are focused on addressing these challenges, putting “care” back into health care for people who need it most.

Health shaped by living conditions

“When we think of health care, we often picture hospitals, clinics, doctors and medicines. But what actually determines whether someone stays healthy, or how quickly they recover when they’re sick, has more to do with where and how they live than what any physician can prescribe,” says Dr. Andrew Boozary, executive director at UHN’s Gattuso Centre for Social Medicine. “In my experience, social determinants like housing are not just factors in health—they are drivers of it.”

“Housing in particular is the most powerful determinant of health,” Boozary says. And it’s not hard to see why. “Without a stable place to live, managing even basic health care needs becomes a monumental challenge. Medications that need refrigeration, follow-up appointments, wound care—none of these are manageable if you’re moving between shelters, couch surfing or sleeping rough.” When people don’t have secure housing, they’re forced into a constant state of triage, prioritizing survival over health. “What we see in the emergency room reflects this truth,” he says.

Support for those without resources

“The emergency department is the ultimate canary in a coalmine,” says Dr. Jennifer Hulme, an emergency physician at UHN. “Increasing rates of poverty, homelessness and substance use means that patients facing these challenges will inevitably come to the ER when they have nowhere else to go.”

Often, patients who face challenging issues in their lives present in worse condition—for example, they may not be able to afford antibiotics or remember to take medication for a simple infection that then progresses. “Delivering high-quality patient care requires that we recognize and respond to these circumstances,” says Hulme.

In Hulme’s ER, care teams include peer support workers who are focused on just that, thanks to yet another unique partnership between UHN’s Gattuso Centre for Social Medicine and the Neighbourhood Group Community Services—both the first of their kind and largest in the city. Peer support workers are part of the ER team, providing individualized care and helping ensure that all patient needs are met. “Peer support workers arenʼt just an add-on; theyʼre fully integrated into the medical team, working hand in hand with nurses, social workers and physicians,” Hulme says.

“The success of any medical care hinges on our ability to build a relationship with a patient, to understand their unique needs and concerns,” she adds. “Peer support workers help us bridge that trust. They can take the time to understand a patientʼs story, advocate for them, communicate with the team and offer resources that help patients achieve their goals.” Some patients disclose critical life-threatening information only to peers because they were the first people they felt comfortable opening up to. “Peers allow us to reach patients who are falling through the cracks of the health care system, and they help us deliver care that we can all be proud of.”

A connecting bridge for the vulnerable

For Patrick Esenerwa, a peer support worker in the program, the key to delivering care starts with building patient trust. “Our main focus is on those suffering from mental challenges, homelessness or are substance users—patients who visit the ER and need support. Because of the lived experience, we are able to connect with patients and offer genuine support without them feeling stigmatized or judged,” Esenerwa says.

While on shift, Esenerwa might be called to help with taking medical histories, finding a patient a bed in a shelter or detox facility, connecting them with other community support resources, food or warm clothing, or even tracking down long-lost family members. “The ER differs from other types of environments I have worked in because we are dealing with very vulnerable patients. They have nothing to lose. It’s about life and death,” Esenerwa says.

Having trusted support on hand enables emergency health care teams to better understand these patients’ unique medical needs and challenges, and identify vulnerabilities that might otherwise go unnoticed. “These patients experience barriers like stigmatization; lack of a listening ear, empathetic and compassionate care; fear of the security or medical teams, or being judged harshly,” Esenerwa says. “Peers create the connecting bridge between these patients and accessing care.”

Leading with empathy

Every member of UHN’s emergency health care teams approaches patients with the empathy and care they deserve. But having dedicated support workers on-site whose sole job is to provide the focus and attention these underserved patients need can make a world of difference—both for the patients themselves and for staff.

“Having a living/lived experience, being empathetic, having a listening ear and a compassionate, caring heart are some of the qualities and characteristics I use at work every day,” Esenerwa says. “My experience in this role has made me appreciate the gift of life, be more humble and increased my levels of empathy. I have been able to learn more about social work, the positive supportive resources we have in our community. I have learned that anyone can be in this situation, and if we don’t put our heads and hands together, we might be overwhelmed by the crisis.”

UHN is seeing measurable benefits from having workers like Esenerwa on-site. “Weʼve surveyed our clinical staff, who report that peers increase their efficiency and increase their job satisfaction,” Hulme says. “We also see that peer support workers help make the entire ER safer by supporting our security team and reducing workplace violence through their skills in emotional support and expert de-escalation. They’re the secret ingredient to help make the provision of emergency care more efficient and effective.”

This is especially important as we head into colder months. “During the holiday season, when ERs face increased pressures due to service closures and harsh weather conditions, the work of peer support workers becomes even more vital,” Hulme says.

“The winter months can be especially challenging for all patients, with the closure of services or limited appointments, increasing patient volumes. Then we add on the layer of cold weather, which is life threatening to the unhoused population who have no choice but to come to the ER when shelters are full. Indeed, many social and community services feel the pressure and moral distress more over the winter, with high need and the ethical imperative to provide shelter to those who need it.”

Thanks to peer support workers like Esenerwa, these are challenges Hulme feels more prepared to manage—during the winter and all year round.

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