A story on homeless seniors published in The Royal Gazette on August 9 prompted Health Minister Walter Roban to release a statement insisting that Government was working to help those without shelter.

He cited the National Office for Seniors and the Physically Challenged (NOSPC), Bermuda Housing Corporation, Bermuda Housing Trust and the Mid Atlantic Wellness Institute (MAWI) as agencies involved in doing so.

And he said Bermuda Hospital Board's recently released Mental Health Plan contained several initiatives that would impact the well-being of the homeless, as well as outlining the "assertive outreach" used to help the needy.

His comments raised numerous questions — and last week Government provided the answers, gathered from various ministries and departments.

"The Government has available resources and is providing a variety of services to assist those persons who require and/or are seeking assistance," it said in a statement.

"Although there may not be an overarching homeless strategy, the resources exist and are deployed to assist persons who require and want assistance. It must also be accepted that accurate data is required for any and all of us to make the right policy decisions.

"A key benchmark for the development of this data will be the 2010 Census. This will hopefully provide us with numbers and conditions so that we can plan the way forward."

Here are the rest of the responses:

Question: Salvation Army volunteer Lucy Willitts reported the case of "Marshall" — the homeless senior referred to in one of our articles — to the NOSPC last month.

Can you advise if it is now managing his case? Has the office arranged for him to have health assessments, any health care, mental health assessments or has it done any advocacy on his behalf in relation to housing/accommodation or management of his assets?

Answer: The broad answer to your question is: no, the office has not arranged any health care assessments for him. This is because his family is very much involved in his life and has assumed what responsibility they can for his care. [He] is not homeless. He can stay with family if he wishes and they accept responsibility for his care.

Q: Has an NOSPC officer been out to visit Marshall recently? How many times has he received such visits in the last year?

A: On July 22, 2010, an intake worker had a conversation with him, concerning his wishes for care, shelter and assistance. There has been no follow up since Cup Match.

Q: How many active cases involving homeless seniors is the NOSPC currently dealing with? How many homeless seniors have been helped to manage their situation to a successful conclusion in the last year?

A: No records are kept of homeless seniors by NOSPC. Persons with no accommodations are referred to the Bermuda Housing Corporation or 'placed' (appropriately according to their need) if there is a medical need to do so. The National Office often assists persons to find accommodations. Their cases are managed to conclusion. If they come to NOSPC, they work with them to address that need.

Q: Are there any plans for a dedicated facility for housing homeless seniors?

A: There are no plans for a dedicated facility for homeless seniors. However, it is well known that there is a need for a facility for the homeless. The Government has communicated its plans around the development of a shelter. More information on the details of this facility will be shared in the future.

Q: Mr. Roban mentioned the Seniors Abuse Register Act and said it applied to those on the streets. Has anyone reported neglect/abuse of a homeless senior since the Act came into force? Have any prosecutions been brought or convictions secured?

A: The Act applies to all seniors regardless of their circumstances. Persons on the street can be accused of self-neglect but that is by superficial standards as some persons have chosen to live on the street. The NOSPC has received reports on persons being homeless but, on investigating, these decisions have been by choice and when assistance has been offered it has been refused or the persons have returned to the streets. There have been no prosecutions.

Q: With regard to MAWI, how would a homeless senior get admitted? If it was determined that they needed to remain in MAWI, who would pay for their care?

A: As it relates to mental illness, there is no such illness classification as homelessness. Any person suffering from a mental illness can be admitted to MAWI, either through self admission; a family member who on their behalf makes representation and the individual is willing; through the courts; or through a member of the public in the event some behaviour is exhibited that causes concern and is reported. If a person is deemed indigent, that care is paid for through the Hospital Subsidy.

Q: How many free (i.e. available) beds do you currently have in rest/care homes for the elderly?

A: This question cannot be answered as a matter of available beds. The elder care system is set up according to levels of need. The elder care system represents a continuum of care. Persons move through the system based on the nature of the care they require. This might range from rehabilitation from hospitalisation to placement in a home that offers minimum levels of supervision due to the fact that a family can no longer provide supports in the home.

Regardless of the level of care, the elder care system is controlled by the Geriatric Assessment and Placement Team (GAP). Every person who enters rest or nursing care starts from an assessment of need and that assessment determines their placement. Therefore, you cannot just take a person and assume that the next available bed in the system will be theirs.

The system does have respite beds for use by caregivers to provide them with the opportunity for a 'breather' from care. It should also be noted that where someone comes into the system as homeless, their route to assistance might be to the Financial Assistance Department and/or the Bermuda Housing Corporation or Housing Trust. In this event, the relevant agencies coordinate to assess and determine need and then address that need.

Q: With regard to the recently released Mental Health Plan, can you point to any sections which specifically deal with the homeless?

A: There is no section in the Mental Health Plan that deals with homelessness. As previously stated, homelessness is not a mental illness. However, the triggers that may have caused homelessness could be related to mental illness.

Therefore, the Mental Health Plan speaks to drug addiction, dual diagnosis i.e. drug or alcohol addiction coupled with mental illness, and other stressors that might lead to mental illness. Therefore, as an overarching document, the Mental Health Plan is a vehicle to assist homeless individuals who may also have a mental illness.

Q: Is any 'assertive outreach' currently being done in relation to homeless seniors who may have drug/alcohol abuse problems and/or mental illness?

A: There are as yet no new resources for assertive outreach, but individual clinicians are working beyond their remit and outside normal hours to commence this initiative.

Now that the Bermuda Hospitals Board has a geriatrician on-board, time will be allocated for a team approach between the psychiatrists, psychologists and the NOSPC to develop services for seniors.

Q: The Minister mentioned the Bermuda Housing Corporation and the fact that it helps those who make themselves known to it. What about those who don't, perhaps due to an inability on their part (because of mental illness, drug/alcohol abuse or other) to do so? Does it seek out such individuals to provide temporary or emergency housing and to advise them of the financial assistance available to them?

A: The BHC does not seek out those who have mental or drug/alcohol dependency issues. They do not provide assisted living facilities. These services are provided through MAWI.

You must view the system as a continuum. There are several entry points to the system but once in the system, the needs of the client can be addressed. The entry point could be King Edward VII Memorial Hospital, MAWI, NOSPC, Bermuda Housing Corporation, Financial Assistance or one of the Department of Health clinics. None of these facilities can be viewed in isolation. They all play a role in assisting persons who have a need. They all collaborate to address those needs.

The main role of the NOSPC in any of these instances could be case management. Although not a direct service provider, the NOSPC plays a key role to coordinate the necessary services to ensure assistance is provided.

Q: The Minister says Government is "working to pull together the pieces". Has any kind of committee or working group been set up to tackle homelessness in general or specifically the homeless elderly?

A: There is no specific plan to address the homeless elderly. The concerns of a senior that is homeless will be similar to the concerns of any other person who faces homelessness in Bermuda. The 2010 census will provide us with more accurate information from which to base policy decisions.

In the 2000 census, 65 persons were enumerated to be living in shelters. Persons at camping sites, caves, the Railway Trail, 'car world', parks and places where non-sheltered people stayed were also enumerated. These locations were identified by persons who had a working relationship with the non-sheltered. Thirty nine persons were identified extending from St. George's to Sandys Parish and from North Shore to South Shore.

Recent estimates by the Salvation Army identify approximately 200 to 350 homeless people across the Island. The 2010 census, which is presently under way, will provide us with better estimates of the true numbers.

Q: Will former Health Minister Nelson Bascome's homeless report ever be made public? If not, can you say why?

A: That report was completed in 2002 and therefore relied on data collected during the 2000 census. This data is certainly now dated and unreliable. Secondly, the Government at that time did not approve its release. It certainly would not be of much use today as relates to providing accurate data from which to base policy decisions.

Q: Can you advise if the information on the NOSPC website — found via www.gov.bm — is current? It seems not to have been updated for at least a year.

A: The information is not current. The NOSPC was moved to the Ministry of Health in August of last year. The past year has been spent addressing the strategic direction and structure of the office. The website content will be addressed in the near future.