Cathy Crowe





Newsletter No. 23  May  2006


I've been a street nurse in Toronto for 17 years. In the spring of 2004 I received the Atkinson Economic Justice Award which permits me to pursue, for up to three years, my passions for nursing and working on homelessness and housing issues.  In this newsletter I hope to report on my activities, create a link to a broader group of individuals who care about these social issues and encourage critical debate.


Further information about subscribing to the newsletter is found below.  I want to hear from you - about the newsletter, about things that are happening in the homelessness sector (what a sad term!), and about good things which will provide inspiration for all of us.



1. Nurses Week. Celebrating the Street Nurse?
2. Ontario budget update.
3. Federal budget update.



1. Nurses Week. Celebrating the Street Nurse?


This month Street Nurses are being ‘celebrated’ in print and television advertisements, as illustrated here.  The ads are sponsored by several nursing organizations in Ontario but paid for by the Province of Ontario. 


Here is a letter I sent to the Ontario Premier:


Premier McGuinty,


Thanks for highlighting the importance of the work of a Street Nurse in the Government of Ontario ad promoting nursing.


The ad says “today’s nurses are highly qualified, doing far more than you think.”  No kidding!  The ad depicts a nurse bandaging a man’s leg while he sits on the sidewalk.  Can you tell me why your recent provincial budget had no new dollars for housing?  Can you tell me why your government only announced a 2 per cent increase in social assistance rates which will only mean more economic evictions, more trouble finding housing and certainly a need for more Street Nurses? 


Most Street Nurses I know are proud of the work they do but find the necessity for it shameful, especially in a rich province like Ontario .


Cathy Crowe, Street Nurse



The continuing and growing need for Street Nurses seems to me like a continuing and growing violation of human rights.  Abundant research has proven that the real determinants of health are safe affordable housing, food, an adequate income, jobs, childcare, and social inclusion.


Ironically the motto for Nursing Week this year is Promoting Healthy Choices for Healthy Living.  This echoes back to the days of the 1974 Lalonde Report. It’s a slogan that suggests the primary role for nursing is to assist Canadians to make some simple and logical choices – and then we will achieve ‘healthy living.’  Choices?  I have yet to meet a homeless person who chooses homelessness.  The best testament to that – the former Tent City residents, not one of them chose to go back to the street once they were offered safe, affordable housing.


The very first Canadian school of nursing opened in 1874.  The Mack Training School for Nurses in St. Catherines had the motto ‘I see and I am silent’.  This motto was symbolic of the socialization that bred passivity and servitude in nursing back then.  No longer!  Nurses are speaking out and accurately witnessing what simply should not exist here in Canada .  They are demanding justice.  As Cathryn Domrose has noted,


“Nurses have been activists since medieval times, when members of religious orders and secular nursing orders looked after lepers, orphaned children, and poor men and woman whose families couldn’t or wouldn’t care for them.  Nurse activists of previous centuries, including Florence Nightingale, Dorothea Dix, and Margaret Sanger, pushed for and achieved tremendous health care improvements in their lifetimes.”   


All levels of government today are desperately in need of a reality check.  Journalist Michael Valpy has remarked, “Nurses have the highest believability quotient of all health care professionals”.  So here’s some real truth – as Street Nurses see it.


Back in 2002, film maker Shelley Saywell filmed a Street Nurses Network meeting in Toronto .  A segment is included in the film ‘Street Nurse’. 


 “We’re sending 2-3 people a night for mantoux (tuberculosis) testing.  We had somebody the other night coughing up blood - like classic markers of TB and people are sleeping with no air on church basements and it’s nuts, and for the first time in almost 30 years of doing different kinds of street work I’m really scared now. It’s getting scary.”  Cathy Newman, St. Elizabeth ‘home’ visiting nurse


 “I’m really, really angry and I’m really scared.  I just think, you know, someone said this is a micro epidemic - this is a friggin’ emergency.  We’re not talking about maybe there’s going to be a TB outbreak.  This is life and death.”  Barb Craig, Street Health


“My workday feels out of control that’s for sure.  It’s longer and longer and it just doesn’t feel sustainable.  People are so sick.”  Kathy Hardill,  Regent Park CHC


Today in 2006, the frustration of Street Nurse Kathy Hardill seems unbearable. Kathy sent me an email last month where she described herself as “drowning in the rolling sea of desperation which is east downtown Toronto ”.


I was outraged when I first saw the Ontario Government use a Street Nurse as a symbol to celebrate nursing, and with Kathy’s words, I was motivated to invite Street Nurses to comment on the real state of homelessness in Canada and the reality of their work.    

Kathy Hardill:

 I cannot keep up with the demand for food on a daily basis, from an unprecedented number of hungry people - food banks are empty or closed, soup kitchens are running out of food - I tell you, I have to steel myself in the mornings to go into the Friendship Centre because the desperation and volatility before they serve food is PALPABLE in there.

I am hearing about or assessing a flood of homeless people viciously assaulted by police on a weekly basis.


With the exception of my shelter-based clinic, I have virtually no clients who are "eligible" to stay in shelters, because they are so ill - frankly, if they live long enough to experience a pandemic flu, I will be ecstatic.   Where is the fight for emergency rent supplements for ill people, so they can get out of shelters before they get even sicker?


I have been pulling my hair out trying to find somewhere, ANYWHERE, for dying people to safely live out their days


I have people waiting for ODSP (Ontario Disability Support Program) decisions going on ten months now.


There is absolutely NOWHERE for substance using women to be, even if they are extremely ill; where is the women's annex-type (harm-reduction) program?  Where is even the call for a resource like this?  Where can crack-using women safely be?  The so-called concurrent disordered people?  (Better called the ‘why don't you just die already’ people.)


The ‘Streets to Homes’ people are harassing homeless people who cannot tolerate being around people, and forcing them to live in places like Fred Victor, for god's sake, which is shared accommodation.  As one of my clients said, "it's because I can't stand being around people that I ended up in the bush in the first place" - maybe he gets counted as a "housed" statistic but I can tell you it's going to last a nano second and then where is he?  People who got housed by the City with the special diet money are now losing that money and will be losing their housing.  Are they going to get counted when they end up homeless again, or will their "success stories" be the end of it?  We are out here picking up the pieces while politicians and bureaucrats congratulate themselves.” 


Anne Egger, Regent Park CHC, Toronto :

“In November of 2005, the provincial government in Ontario changed the Special Diet Supplement form. Whereas people on social assistance were accessing $250 to help purchase healthier food choices as well as help them stay housed and properly clothed; the new changes to the diet form made it extremely difficult for most people on social assistance to access the funds to feed themselves.  In addition, people have to disclose their medical information to their front line social assistance workers with this new form.  I hear of and see people daily who are being cut off, or nearly cut off, from accessing additional funds to feed themselves.  People are being forced to increase their use of food banks, go hungry and fear being evicted. They are hungry, angry and feel they are being targeted once again by the province for being on assistance. This punitive measure is placing people’s health at great risk once again and the province can look forward to paying the price in increased health care costs.

The province needs to increase the rates by 40%, or reinstate the previous Special Diet Supplement. People are going hungry, going without, using food banks more, back to no milk for the kids by the last week(s) of the month, and very afraid of not being able to pay bills and rent in some cases.    


Judith Taylor writes from Ottawa ’s Street Health Outreach:

 “Our situation here in Ottawa is still grim.  Having provided nursing outreach to the shelters and drop-ins for 18 years now, I am seeing disturbing trends.  Our old drinkers of the past are being replaced by young addicts with children.  Not only are we seeing a rise in the Hepatitis B and C rates, but those previously not infected with HIV are now co-infected in spite of our intense Public Health efforts to reduce the transmission of disease.  We are fortunate here in Ottawa to have such close collaboration of all of the outreach programs and services so we can work together and share resources to battle the homeless crisis we are facing.  We have a palliative care hospice attached to the Mission shelter for end of life so hospitals are not the only option for clients.  We will continue to provide the best nursing care we can …and will continue to advocate for the needs of our vulnerable clients.” 

Wendy Muckle,
Ottawa Inner City Health:

My frustrations of the day are the frail elderly, those with acquired brain injury, and dementia.  These are people with conditions which our health care system is specifically set up to care for, however, that only applies if they are not homeless.  All of the systems which are in place to recognize and protect these people who are vulnerable don't apply in the face of severe and persistent mental illness, addiction or anti-social behaviours.  These people are excluded from services because of poverty and challenging behaviours.  A history of violence is enough to insure that you will not be accepted into long term care even if you require that level of nursing care.  I fully appreciate that we cannot put other frail elderly in those facilities at risk to accommodate one individual but our obligation to them as a society still exists and we do not have alternatives. 


I cannot understand why it is ok to put someone who cannot reliably find the washroom adrift in a shelter simply because they drink or use drugs.  I would never want to take away someone's right to make choices for themselves unnecessarily, but the test for competency is so low that it is quite possible to pass it without having any intact survival skills.  Living in the shelters or on the streets requires survival skills or a better system of protecting the vulnerable.  I understand that these vulnerable people are part of our homeless community, and it is our dream to be able to provide the needed services and resources to them within a setting which understands and accepts their behaviours, which does not blame them for their illness and allows them to continue to be part of our community. “  


Deborah Hogan is a pediatric nurse who is a nurse-volunteer-interpreter at the Canadian Museum of Civilization’s exhibit A Caring Profession:  Centuries of Nursing in Canada .  She comments on her own and on the public’s reaction to the inclusion of a section that focuses on street nursing in the exhibition.

“Encountering role models like you has raised my awareness of human rights violations and social issues in my own backyard.  I have begun to more fully comprehend the distinct role that nursing must play in the political realm advocating for clients and for equity for all Canadians.  

The public’s fascination with you and with the plight of the homeless is insatiable.  I have witnessed every imaginable reaction to your work: shock, grief, awe, bewilderment, naivety, amazement and overwhelming pride.   What of the four year old’s reaction to my invitation to peruse Cathy Crowe’s packsack.  “Is it a Barbie packsack” she yelled!!   One particularly expressive French Canadian man stood watching while I spoke with his two sons about the contents of your packsack.  “So what is this packsack?” he asked.  I said “it is the equipment bag of the street nurse from Toronto who ministers to the homeless”.  He literally clutched his chest, bent at the waist and loudly exclaimed “THAT is SO important”.  He was right.  It is.  You are!

Interestingly, most discourse about the politics of healthcare has involved the children and youth who have visited the exhibit.   A nine year-old boy spontaneously decided to feature you at show-and-tell.  Together we prepared his message related to poverty, the need for a National Housing Program and our obligation as Canadian citizens to become advocates.  His parents were so enthusiastic and took a digital picture of their son standing next to the exhibit.  He wanted to share the 1% buttons and this picture with classmates.  These themes of social justice, equity and civic values recurred with youth who asked that I email you to tell you that they are grateful to you for doing such hard work!  It is comforting to know that the next generation is savvy about such political issues.   Volunteering allowed us to plant seeds for reform in our future change-agents.”  


2. Ontario budget update


In March I entered what is called a ‘budget lock-up’ – it was my first time.  My colleague and I, outreach worker Bob Rose, received the inch-thick Ontario budget about three hours before it was presented to the public.  Locked in a room with mostly ‘suits’, we waded through the thick document looking for any mention of housing or social assistance rate increases.  Housing? There was nothing to speak of, in fact less money than last year.  Social assistance rates?  A meager 2% increase despite documented hunger and a massive lobby by anti-poverty activists including members of the faith community and health care workers.


This was a dismal budget for people living in poverty.  Homelessness, hunger, illness and despair will simply worsen.  Ontario MPPs must hear from you.



3. Federal Budget Update

Ottawa news is marginally better.  The last federal election meant that the future of the $1.6 billion dollars negotiated in the Martin-Layton budget and passed by the House of Commons Bill C-48) was uncertain.  We knew the Conservative government’s election housing platform focused on tax incentives and the promotion of home ownership.


The Jim Flaherty budget of May 2 did not cancel these funds.  Our national lobby for these housing dollars was clearly heard.  But is it enough?


The budget allocates $1.4 billion for new affordable housing to the provinces and territories over a three year period. This is added to the $474 million in federal funding that has been allocated starting in 2001 but remains unspent.  This is one time funding and not the beginning of a national housing program that could truly put a dent in the housing crisis and homelessness. The new money will be divided into three trust funds to be spent over the next three years:


  • $800 million for the provinces;

  • $300 million for three northern territories;

  • $300 million for aboriginal housing (off-reserve);


The key work we all must do is to monitor the rollout of these dollars and ensure that some housing gets built.  Housing that will be truly affordable, open to non-profit delivery mechanisms, and above all delivered with speed.


My colleague Michael Shapcott, in his speedy budget analysis, asked the following questions within hours of the budget release:


  • Who will make sure that the $1.4 billion allocated to the three housing trust funds actually gets spent on new affordable housing (there is little information on accountability and standards)?


  • What has happened to the remaining $200 million in affordable housing funding from Bill C-48 (the federal budget only allocates $1.4 billion of the $1.6 billion in the legislation)?


  • What is the federal government planning to do with the huge and growing national housing surplus (the annual surplus of Canada Mortgage and Housing Corporation is variously calculated at from $892 million to $4.7 billion in the current fiscal year)?


  • What are the federal plans to speed up the flow of federal dollars in the pipeline (according to federal housing minister Diane Finley, the federal government still hasn’t allocated $474 million of the $1 billion in housing spending first promised in November of 2001)?



Worrisome is the absence of SCPI (Supporting Community Partnerships Initiatives) in the budget – the money that is the lifeline of so many organizations.  So, we have our work cut out for us. I urge nurses to add their voice, experience and efforts to the work of local housing and homeless advocacy groups to help make progress on the fight for a national housing program.  Nursing student Sara Cohen points to the words of Florence Nightingale who still challenges us to examine our role:


 "Unless we are making progress in our nursing every year, every month,
every week, take my word for it we are going back."

Let’s make some progress and never mind celebrating, let’s work to eliminate the need for Street Nurses.





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