Supporting Tenants with Complex Needs: An example by the Toronto Community Housing Corporation

The following content was adapted from the Creating Tenant Service Models for Complex Needs session at the 2021 ONPHA Conference. Thanks to Richard Grotsch, Rebeca Escobar, Samantha Jani, and Ashley Fontaine for their contribution and information provided at the session. 

Imagine the following scenario: 

“You are a housing manager who receives frequent reports from staff and other tenants about a vulnerable senior whose unit condition is extremely poor. There is excessive clutter and unsanitary conditions, urine and feces throughout the floors and furniture. There are frequent plumbing concerns. Objects often clog the toilet. The unit is infested with bed bugs, flies, and roaches. The odor is so strong that you can detect it when you get off the elevator. The tenant is visually impaired due to untreated cataracts and cannot manage activities of daily living. Physical and mental health issues are going untreated. This tenant is frequently in and out of the hospital but with no improvement. She often loses her keys and bank card, and the loss of the bank card cuts her off to access for food delivery, which she was surviving on.” 

The solution may sound simple. You would refer the tenant to other services that would give her the support she needs. However, how do you find and connect the tenant to the appropriate supports? Once you have found the right support services, what happens when the tenant refuses the help? 

The Complex Tenancies working group, one of the initiatives led by the newly created Tenancy Resolution Office at Toronto Community Housing, is responsible for responding to precisely these kinds of crises. The team, led by Samantha Jani, consists of four specialized Community Service Coordinators (CSC) who are assigned to a case when individual tenants or households are in situations that require more intensive support than their local resources can provide. The team’s goal is to stabilize the tenancies to prevent evictions, and to monitor the status to ensure that the plan in place is sustainable.  

Supporting Acute Elevated Risk situations 

The team specializes in supporting Acute Elevated Risk (AER) situations. These are imminent situations where an individual is likely to experience serious damage, harm, injury, liability, or loss to their personal or family health and safety. These can typically include at least one or more of the following: 

• Abuse 
• Death 
• Eviction/Homelessness Exploitation 
• Financial loss  
• Fire 
• Hospitalization  
• Harm to self or others  

TCHC’s Approach

When an AER situation arises, the team responds by creating a working group of internal and external supports to help resolve the problem. The key to success here involves a lot of communication, coordination and collaboration.  

The Complex Tenancies team frequently taps into the City of Toronto’s Situation Tables (such as FOCUS & SPIDER), and uses them as a tool to support tenants. These tables work by bringing together a group of city divisions and community agencies. When a client is brought to these tables, a tailored team is created to expedite health and social services through a coordinated approach.  

A note for smaller housing providers: Organizations who do not have access to a similar coordinated response program at the local level can take a grassroots approach by building their own working group for complex tenant interventions. You can use 211 to look up local support services focusing on mental health, substance use, and crisis interventions. These may include your local CMHA office, emergency shelter and housing access services, community nursing and pharmacies, or organizations dealing with food security and seniors care services. 

Monitoring to ensure stabilized tenancies 

A key for TCHC’s success in stabilizing these kinds of complex tenancies is by monitoring the situation after a solution has been implemented. This is done through weekly team meetings with the Community Service Coordinators to discuss the cases, problem-solve, and support each other. Team members also have one-on-one meetings with the manager, to ensure that they are supported with what they need. The Complex Tenancies team also implements and leads integrated team meetings with internal and external partners, recognizing that this work can’t be done alone.  

After a complex tenancy is stabilized, the team is also responsible for monitoring the situation to ensure the supports are still in place and meeting the needs of the tenant. Once a situation is under control and no longer considered an Acute Elevated Risk, the case is then transitioned back into the main regional team, where they can continue monitoring the situation.  

How to support a vulnerable tenant 

Now back to our scenario. In order to help the tenant described above, the Community Service Coordinators conducted various joint visits with a community paramedic and case management services. They needed to build rapport and trust with the tenant, which required consistent and frequent visits. Since the situation was so severe as to be putting the tenant at risk to herself, and the tenant declined services to clean her unit and address her health, the team went to the Justice of the Peace to obtain a Form 2, which allowed them to take the tenant to the hospital. The team then created a package (which included photos of the unit) so that the hospital was ready for the tenant and aware of the situation.  

Note on the use of Form 2: Providers without mental health intervention training should use this tool carefully. Getting a tenant formed can seriously damage the relationship and can put marginalized communities at risk of police violence. This approach should only be used when there is demonstrable, serious risk to the individual and/or others.  

Once admitted to the hospital the team advocated for the tenant and requested various assessments. Over the course of the two months that the tenant was in the hospital, she was diagnosed, treated for health and mental health issues, and deemed incapable of managing finances and personal care. Meanwhile the team at TCHC cleaned and treated her unit, since the infestation was affecting the other units as well. 

When released from hospital care, the tenant was then transferred into a safe and healthy environment in long-term care.  

About the Tenancy Resolution Office 

The Tenancy Resolution Office (TRO) at Toronto Community Housing was created in 2019 as part of a corporate restructure. The office, led by Richard Grotsch, was developed to support local service delivery though centralized oversight and development.  

Their key areas of work include: 

• Complex Tenancies: Supporting complex tenancies and stabilizing communities.  
• Community Resolution: Proactively engaging tenants to better understand their needs and linking the right partnerships and supports into those communities so tenancies can thrive.  
• Environmental Health: Delivering annual unit inspections and pest management programs.  
• Operational Initiatives: Providing operational support to specialized programs and tenancy administration activities, up to and including the provision of their annual rent reviews.  

The TRO was set up to help support the 4% of tenancies that take up 90% of TCH’s tenant support resources and has proven successful through the two years it’s been in operation. Having had to pivot when the COVID-19 pandemic hit, they have since then conducted over 25,000 wellness check-ins on their tenants, which lead to 12,000 referrals to medication and food security services. They also hosted more than 225 vaccination clinics throughout their communities and are looking to increase that number as they begin to provide booster shots.  

If you are interested in learning more about how you can support tenants living with mental health and addiction challenges check out our online course Supportive Housing Core Competencies: Enhancing Your Skills, offered in partnership with the Toronto Mental Health and Addictions Supportive Housing Network (TMHASHN). Stay tuned! Our next course starts April 2022.  

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