An Alternative Care Model

HIV HOSPICE and transitional care home

The hospice and transitional care home provides around-the-clock transitional care for HIV positive persons who have social and high-risk behaviors and conditions, including homelessness, that prevent them from properly caring for themselves. In addition, this home provides end of life care (palliation) to individuals who are HIV positive and have a palliative diagnosis.

Sanctum’s vision is to provide a community for individuals requiring supportive care to attain their optimum level of health while maximizing their control and dignity. Incorporating the following existing community services in Sanctum’s safe and supportive environment, the hospice will meet the healthcare needs of the proposed population more effectively and efficiently, thereby decreasing the financial impact on the health care system through a reduction in acute care utilization.  

• Daily rounds by a Family Physician
• Nursing
• Intensive HIV Case Management
• Medication management
• Connection with detox services
• Opiate assisted recovery
• Peer support
• Access to housing and community support
• Spiritual care
• Mental health and addiction outreach services

Sanctum will ascribe to a harm reduction philosophy. Clients will not be required to abstain from drugs or alcohol to receive services, provided their behavior does not pose a risk to others. We will attempt as much as possible to control substance use without imposing conditions that make care inaccessible. Our philosophy is that substance abuse is like any other disease; therefore, we have an obligation to help the patron manage it.The program will set modest expectations for behavior and be respectful of street culture. Substance use cannot be a barrier to persons accessing supportive and respectful care.

Our goal is to help facilitate the best quality of life possible for our patrons for the days, months, or years that remain for them. We recognize and acknowledge client autonomy but will work with each individual  patron to improve or support their health and social needs.

Sanctum will attempt to bridge the gaps in the current system with a three-pronged approach to care at Sanctum:

Supportive Care

• Patrons are admitted for supportive, sub-acute or rehabilitative care
• concurrent homelessness, mental illness and addiction, level of care does not meet long term care, inability to access homecare
• Generally, up to 3 months 
• May involve wound care, home IV therapy
• Supportive care will consist of pain management, symptom control, wound management, home IV therapy, and medication management. Our medical team is specialized in treating HIV-related illnesses (such as lymphoma, mycobacterium avium complex, PML*, etc.), illnesses related to injection drug use (endocarditis, cellulitis), and comorbidities such as hepatitis C, diabetes, and mental illness. Supportive admissions are generally up to 3 months.

Palliative/Hospice Care

• Patrons with HIV/AIDS requiring end of life care will be admitted as a priority. Palliative care for these patrons includes pain control and symptom management. The hospice aspect to Sanctum will allow patrons to die in a familiar, supportive and peaceful setting. We will help to provide support to our patrons as they make their end of life decisions around their care. We will act as a support for family by providing supportive counseling through the grieving process.

Respite Care

•  There is one dedicated respite care bed for patrons who need to stay up to 14 days while either waiting for appropriate supports in their own home or if they are requiring a temporary short term stay. This bed may also be used for their post-op recovery.

• In 2009, the incidence rate of HIV infection in the Saskatoon Health Region was more than three times the national rate. Although the rate has decreased, the 2011 rate in the region was still double that seen nationally.
• Saskatoon Health Region has some of the highest rates of HIV/AIDS related deaths in North America.
• In 2009, the new cases were predominantly found to be IDU (77%); and of this group, 84% were of Aboriginal ethnicity (Saskatchewan HIV Strategy).
• A large percentage of persons living with HIV in the region also suffer from mental illness, addictions, homelessness and poverty.
• Research indicates that 75% of Homeless individuals living with HIV and without support will die within 5 years. (North American Housing and HIV research Summit, 2011)
• Homeless persons face numerous barriers to receiving appropriate health care. Research has demonstrated homeless persons have high rates of physical illness, mental illness, substance abuse, and early mortality. They are more likely to be admitted to hospital, have increased length of hospitalization, and present a substantial burden on the resources of safety-net hospitals and clinics. (JAMA)
• Housing status has a direct, independent and powerful impact on HIV incidence and on the health of people living with HIV. Homelessness and unstable housing are consistently linked to greater HIV risk, inadequate HIV health care, poor health outcomes and early death. (NAHHRS)
• Among persons who use injection drugs and visit a hospital, those who are HIV-positive are admitted substantially more often than those who are HIV-negative, and those who are HIV-positive have longer lengths of stay than those who are HIV-negative. (CMHA)
• Extended hospital stays are often a requirement for appropriate treatment for such diagnoses as endocarditis, but due to the environment and the complex issues faced by this patient population, treatment often is not completed. In many cases for persons living with HIV or other chronic illness who do have a place to stay, the location has been “red flagged” by the health region thereby prohibiting the provision of home health care services for that individual. There are currently 45 buildings and homes that have been “red flagged” by Home Care in Saskatoon.
• The supportive housing services (personal care homes, enriched living, long term care) currently operating in the region are neither familiar nor comfortable with managing individuals who suffer from HIV, mental health, addictions or poverty-related issues. Most personal care homes refuse to accept HIV-positive persons into their homes. Of the 82 personal care homes in Saskatoon, only eight will accept persons living with HIV, this number decreases if the individual is co-infected or has mental health issues.
• At a community level, a lack of palliative care services places an unnecessary burden on hospital and clinical resources. (WHO)

Therefore, while different agencies can manage poverty and homelessness or mental illness, few, if any, are able to manage HIV-positive populations who are also affected with poverty, homelessness, and mental health issues.

Sanctum provides a one-of-a-kind service to Saskatoon’s most vulnerable and marginalized population groups. It provides dignified care and treatment in a home setting, which reduces ER wait times, hospital admissions and the cost burden on the health care system. Sanctum  coordinates the provision of all service that this vulnerable group requires.

Sanctum has one dedicated respite care bed for patrons who need to stay up to 14 days while either waiting for appropriate supports in their own home or requiring a temporary short term stay. This bed may also be used for their post-op recovery

• Improved health and social outcomes for the patrons
• Decreased hospital readmissions
• Reduced costs for acute care
• Reduction in ER visits and lessening the burden on acute services
• Integrated care and reduced duplication of services
• Safe environment for outpatient care (home care, IV therapy, wound care)
• Improved care and quality of life for a population which has been underserved.
• Improved health outcomes for those living with HIV and a reduction in HIV Morbidity. With support, evidence shows a decrease in depression, improvements in immune functioning and 50x more likely to have a higher CD4
• Stability and dignity to the end of life for those who so desperately need it