Terry Willis, a Victoria man of 50 with a rare cancer, denied treatment because of where he lives, is now a national headline. Willis was told that his oncologist would not start chemotherapy while he’s living in supportive housing, because his compromised immune system would put him at high risk of infection. While Island Health and the B.C. Cancer Agency have since determined that he can receive treatment while living in his housing, Willis’s story draws attention to the thousands more in our city who sleep on couches and in cars, in overcrowded dwellings or housing where their access to health care is limited or restricted.
For the past three years, our team at the University of Victoria has been engaged in research with homeless and vulnerably housed people living with advanced illnesses who, like Willis, face barriers to receiving health care because of where they live. Their stories demonstrate a crisis of disastrous proportions. Being homeless or poorly housed prevents our fellow citizens from obtaining access to the kinds of health-care prevention, treatment and support during severe illnesses that the rest of us expect.
Homelessness causes people’s illnesses to go undetected — or dismissed — and untreated longer, which contributes to their pain and needlessly early deaths. And not just medical needs are unmet: Homeless people with terminal illnesses or near the end of life do not get the kind of social and spiritual support that are crucial to minimize suffering. They have nobody to clean their soiled linen, get them to medical appointments or advocate on their behalf, as family and friends would normally do, if they had them.
Being connected to the social-welfare system in their daily lives, as Willis’ case demonstrates, does not mean that a homeless or vulnerably housed person will somehow receive early intervention that addresses their health problems. In fact, our research, now nearly complete, is showing the opposite is true.
As Willis has discovered, access to health care for those with life-threatening illnesses can be denied because of where they live. For instance, some of our participants were housed in single-room-occupancy hotels, supportive housing facilities or shelters that were deemed unsafe for home-support and/or home-care nurses to enter. A lack of appropriate, affordable and adequate housing, combined with risk-management policies, meant that people were moved out of whatever bare housing they had, most often into acute care, as their medical needs increased or as they approached death.
If people are not dying alone in a rooming house or even the street, they die alone in hospital.
The research is conclusive: Homelessness makes you sick and shortens your life. Homeless and unstably housed people are more likely to experience violence, accidents, overdoses, dehydration, heat exhaustion and exposure than other Canadians. Their life expectancy is half that of the general population — 40 to 49 years old in B.C., compared with the average of 82. Gender discrimination, racialization and criminalization of drug use compound the risks of homelessness.
It is easy to get wrapped up in the divisive politics of where homeless people should go, as in the case of those who are camped at Goldstream Provincial Park. Willis’s situation puts into perspective the need for safe, appropriate housing and access to health care for everyone who needs it, including those struggling with advancing medical conditions.
We are in the middle of a housing crisis that is also a health-care crisis. We need political will from all levels of government to respond in a co-ordinated way with leadership from homeless people and their advocates who are the experts in their own health, bodies and lives. If we do not act, we might as well add homelessness to the list of terminal illnesses we have been unable to cure.
Kelli Stajduhar, PhD, is a professor in the University of Victoria’s School of Nursing and Institute on Aging and Lifelong Health with more than 30 years’ experience in oncology, palliative care and gerontology as a practising nurse, educator and researcher.