No one is monitoring deaths inside Vancouver's supportive-housing projects and the numbers are going up
Throughout the Downtown Eastside and beyond, B.C.’s overdose crisis has taken a brutal toll. But a close look at fatalities in government-funded buildings suggests systemic shortcomings are also contributing to a troubling increase in deaths
Five people have died at the Woodward's Community Housing building since 2016, according to statistics obtained through a freedom-of-information request.
Karen Ward lives there and is well-known in the community. She knew and remembers all of them.
“Gary died. Gary was [one of] the last survivor of the Ironworkers Memorial Bridge [accident in 1958],” she began in a telephone interview. “He was a union man and an ironworker and he was on the bridge [when it collapsed]. And he died in my hallway.
“Pops died,” Ward continued. “My friend Dan died. He had a stroke and then he was trapped in his room....I knew Colleen, on the sixth floor. That really impacted everyone....Oh, god. There are too many. Hendrick was just taken off…”
The five deaths at Woodward's are a small sample of more than 330 deaths that the Georgia Straight has found occurred at government-partnered supportive-housing projects across the Lower Mainland between January 2016 (the oldest date for which statistics are available) and May 2019. (Woodward's operator has clarified that these deaths occurred in-hospital. It's also emphasized they were of natural causes and that staff responded appropriately and in a timely manner.)
Using freedom-of-information legislation, the Straight collected data for 90 addresses operated by the provincial government’s four largest social-housing partners: PHS Community Services Society (formerly the Portland Hotel Society), Atira Women’s Resource Society (and its property-management company), Lookout Housing and Health Society (formerly Lookout Emergency Aid Society and Keys Housing and Health Solutions), and RainCity Housing.
Deaths appear to be on the rise and, the Straight has learned, no one is counting them.
B.C. Housing is the arm of the provincial government that funds and works alongside those agencies and others to develop and manage supportive-housing in British Columbia. Each time someone dies inside a government-partnered building, it receives what is called a “critical-incident report” . But it doesn’t maintain statistics based on those reports. Neither does the B.C. Coroners Service.
Marilou Gagnon is a nurse, housing activist, and associate professor at the University of Victoria. In a telephone interview, she said that if no one is compiling or monitoring these numbers, authorities are missing an opportunity to save people’s lives. If the province were collecting this data, Gagnon argued, it could spot patterns, identify problematic trends, and react accordingly.
“It’s a safe guess that many of these [deaths] are related to overdoses,” Gagnon told the Straight. “If that is the case, then these deaths are preventable. My question, then, is what are we doing to prevent them? Are these places properly staffed? What are we putting in place to prevent deaths? Because there is no way that this should be happening.”
Gagnon said the numbers call into question common assumptions about government housing.
“We present this form of housing as better for people,” she said. “That if we bring people inside, it will be better for their health. But if they end up dying of an overdose, that is not better [than remaining homeless].”
At the 90 buildings analyzed, there were 62 deaths recorded in 2016, 106 the year after that (when B.C.’s overdose crisis intensified sharply), 109 in 2018, and then 62 during the first five months of 2019 (when the Straight first requested this information).
The numbers are discussed here with caveats. Because there is no central index of supportive-housing addresses that cleanly defines the words “supportive housing”, the numbers are incomplete. The lack of a strict definition allows for a wide variety of programs that are each tailored to unique tenant populations and communities. That’s a good thing. But it makes collecting and compiling statistics difficult.
The numbers must be interpreted with caution. For example, an apparently shocking increase in deaths in Lookout buildings is actually a reflection of the organization’s growth. Lookout’s numbers are up, but primarily because the number of rooms Lookout operates has increased in recent years. Meanwhile, a decline in numbers might be because another organization closed a building for renovations. The data has significant shortcomings.
Nevertheless, a rough picture emerges: more people are dying in Lower Mainland supportive-housing buildings, and no one is watching or even trying to understand why.
Representatives for the four nonprofits analyzed spoke candidly with the Straight. No one was surprised by the numbers and everyone agreed they are higher than they should be.
“In the Downtown Eastside, you’re likely to die younger than everybody else,” Janice Abbott, the founder and CEO of Atira Women’s Resource Society, told the Straight. “Research demonstrates that if you’re poor, if you’re racialized, if you’re not cisnormative, then your lifespan is compromised.” (Indeed, a November 2018 report for Vancouver council states that on average, men living in the Downtown Eastside will die 15 years earlier than their counterparts who live on the city’s wealthier West Side.)
In a separate interview, PHS director Tanya Fader said that the need for low-barriers housing in Vancouver so far outstrips supply that by the time someone gets into supportive housing, they’ve usually been on the streets for so long that they’ve accumulated numerous health issues.
“Once we do get someone housed, we’re struggling with things that should have been prevented,” Fader told the Straight. “Nothing happens until someone is in a crisis. And even then, we struggle to get them an appropriate response and the health and care they need.”
Shayne Williams, executive director of Lookout Housing and Health Society, similarly said that turning a tenant's health around is often an uphill battle.
“The people that are going into supportive, minimal-barrier housing, in some cases, they should be in long-term care or even in a hospice,” he suggested. “The majority of deaths we’re seeing, at least within Lookout sites, are health-compromised people with very complex needs, usually with concurrent disorders, underlying primary-care needs…and struggling with addiction and mental health.”
Williams also questioned the Straight’s application of the term “supportive housing” and raised concerns about inadequate government funding. If there are only one or two staff members at a given building at a time, or if a building isn’t staffed 24 hours a day, how much “support” is there, he asked.
RainCity Housing co-executive director Catharine Hume spoke about what she described as opportunities B.C. is missing by failing to monitor deaths in social housing. Authorities could be unaware of trends in which too many people are dying, she conceded. But they also might be missing patterns that reveal life-saving programs that should expand across the province.
“We are mitigating deaths all the time, every single day, and that information is invisible,” Hume told the Straight.
She pointed to several on-the-ground innovations that Atira, PHS, Lookout, and RainCity all have implemented in response to the overdose crisis, for example. In late 2016, nonprofits integrated supervised-consumption rooms into many of their buildings and encouraged tenants to use drugs where an employee or another tenant is available to respond in the event of an overdose. Organizations have also flooded their buildings with the overdose-reversal drug naloxone and encouraged tenants to learn how to use it.
“Data around how many people have passed away at supportive-housing sites and data around how many lives have been saved—those stories are equally important,” Hume said.
All four nonprofit representatives repeatedly emphasized the extent to which B.C.’s overdose crisis has stretched resources thin, and told stories of the herculean efforts with which staff inside supportive-housing buildings have responded.
We can do better
There’s nothing shocking in the data obtained by the Straight, or at least not anything especially surprising. There are specific addresses where unusually large numbers of people have died in recent years. But for those buildings, operators specifically seek out high-needs tenants who otherwise wouldn’t have a home. People enter those buildings with serious physical health problems alongside both addiction issues and mental-health challenges. Other buildings are known for tolerating heavy injection-drug use, and B.C.’s overdose crisis has taken a brutal toll on Vancouver’s Downtown Eastside, where those sites are concentrated.
Dominic Flanagan, B.C. Housing’s executive director of strategic initiatives, told the Straight that without Vancouver’s low-barriers approach to supportive housing, many tenants who appear in these statistics would have died on the street. In a telephone interview, he added that the priority needs to be getting people into housing sooner.
“The longer you’ve been living on the street, the longer you’ve bounced in and out of shelters, the more complex and the more challenging your health becomes,” Flanagan said. He noted that B.C.’s last homeless count found 7,655 people lacked permanent shelter in 2018.
“We need to bring people inside far quicker than we are,” he continued. “And how can we better integrate and combine housing with primary health care? What does that look like?”
Flanagan acknowledged that authorities could monitor deaths inside B.C. supportive-housing sites closer than they do today.
“We are going to look at ways about how we track critical-incident reports—the reports we get from nonprofits—and do a deeper dive into them,” he said. “Could we be doing more? Absolutely.”
On the phone from the Woodward's building, Ward repeated a joke she’s heard several times over the years: “You only leave here in cuffs or a bag.”
Gagnon, who is also president of the Harm Reduction Nurses Association and an activist who works with homeless camps on Vancouver Island, suggested that if this were any other category of building than one that houses the poor and the marginalized, the numbers obtained by the Straight not only would be subject to close monitoring, but by now would likely have set off an alarm.
“If it were daycares or hospitals or prisons, and if there were one or two or three deaths, we would have reached a stage that triggered an investigation,” Gagnon argued. “People are dying in these spaces, no one is doing anything about it. No one is even looking into it.”