Program for uninsured goes far beyond health care

As part of program at Access Alliance community health centre, vulnerable patients are assigned health coaches, who can them with problems involving such things as housing and immigration.

Thestar.com
March 18, 2018
By Nicholas Keung

The ongoing struggle to pay for food, shelter and medical supplies is as much a threat to Patricia's health as her chronic renal failure and an ostomy from inflammatory bowel disease.

For Patricia, an undocumented migrant who has lived in Toronto under the radar since 1993, meeting those basic needs are a daily struggle that has taken a toll on her health.

"It stresses me out more when I get sick and can't work because I don't have any coverage and have to pay for everything I need," said the 63-year-old woman, who only gave her first name to avoid the detection of immigration authorities.

In 2016, after she had surgery to remove part of her intestine and hook up to a pouch that collects bodily waste, her primary care physician referred her to the Health With Dignity Program at Access Alliance.

The community health centre, which has three locations in Toronto, assigned her a health coach, who meets Patricia regularly to connect her with other community support like housing and legal help, and assist her in navigating an often fragmented health system and set goals to improve her health.

"My health coach is my biggest cheerleader," said Patricia, a native of Guyana, who does not have family in Canada and works as a babysitter to earn a living. "I can tell my coach all my problems and she gives me advice on everything. She helps me have my self-esteem back. It's like a therapy."

The Health With Dignity Program was launched in late 2015 as a four-year pilot to help vulnerable clients navigate the health-care system and improve their capacity to manage their health. It's funded by Green Shield Canada, a not-for-profit organization.

The program targets the uninsured and underinsured population in the city, who often depend heavily on others for their health needs, have low health literacy and face other difficulties such as poverty.

Its two health coaches are the point persons to co-ordinate patients' health plans. However, their responsibility is not limited to a client's physical health; they collaborate with social workers and settlement counsellors depending on the person's needs.

"A doctor doesn't have a lot of time for patients. Here we work with a team positioned to take more time to get to the barriers faced by the client," said Sideeka Narayan, the program's nurse manager.

"For example, someone doesn't go to a cardiologist appointment. It's not on the agenda because he is struggling with other social determinants of health like employment, housing and food."

Last year alone, the program served 1,094 people, 71 per cent of whom did not have OHIP or any health insurance; the rest were underinsured without access to benefits such as dental, vision and prescription medication. People from Latin America, Europe, Africa and the Caribbean made up the majority of the clientele.

Candace Crawford, one of the program's two health coaches, said new referrals have their health needs and goals assessed at the first visit. Together, they will come up with a plan to achieve those goals and identify the barriers that may prevent them from achieving the objectives.

"We don't want them to depend on us. We want to empower them and give them the education they need to be independent, so they don't just come back for more and more," explained Crawford.

"We are here to get down to the roots. We are not fixers. We are here to identify what the issues are and explore the possible solutions with a team of experts."

Patricia said her health goals were to manage her medical appointments on her own, secure the supplies of ostomy bags that she wears and needs to change regularly, and work on getting her legal status in Canada.

She has already achieved the first two goals. While it's still a long way to get her immigrant status, her health coach has connected her with the legal aid to apply for permanent residency on humanitarian grounds. "My stress has eased up," Patricia said with a smile. "I feel like I'm in control and I see hope."