The Current - The Toronto housing project saving lives

Episode Date: December 9, 2025

A year ago, Toronto opened Dunn house, a first-of-its kind social medicine housing initiative for people who are unhoused and frequent users of emergency rooms. We're joined by Dr. Andrew Boozary, a primary care physician and executive director of social medicine at University Health Network, who initiated this program. He shares the program's first-year results and what it would

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Donate at lovescarbro.cairbo. This is a CBC podcast. Hello, I'm Matt Galloway, and this is the current podcast. Last year, the city of Toronto tried to tackle two problems in one go. The city was struggling with record levels of homelessness and overwhelmed emergency rooms. A solution came in the form of Dunhouse, built by the University Health Network. It is a home with 51 units and on-site medical care designed to house some of the most frequent visitors to emergency departments in that city. One year in, the results are striking.

Emergency visits are down. Hospitals are saving a lot of money. Dr. Andrew Bizarre is a primary care physician, executive director of social medicine at University Health Network. He initiated this program and joined us in studio when Dunhouse first opened its doors. We wanted to check back in with him. And so the doctor is back with us in studio. Good morning.

Good morning. Thanks so much for having me. Good to have you back here. This is a good news story. Are you surprised by that? Well, I mean, I think we need more good news and hope given, you know, the realities on the ground. And I think not surprised, but I think always trying to push in alignment with the evidence that we've seen the power of housing first and housing for individuals and the impacts that it can have. You knew this was going to work, though.

When you were here, you were very bullish on this idea, thinking that if you build it, they will come. But that health and housing are intimately connected, right? Yeah, there's this inextricable link, and I think we've known this for a very long time. I mean, some of this thinking goes back to 1974 with Minister Lalonde, you know, this idea that health care insurance alone is not going to be enough. And when you look at the realities of now homelessness doubling in less than four years in Toronto, back to your point of, you know, the good news, I think we need more of this momentum and traction of the fact that we know. that people who are unhoused live nearly half as long as a general public. So the idea that people are losing 20 to 30 life years on repeat, if you think about that as a listener of someone you love or yourself losing 20 to 30 birthdays, you would think that's unconscionable. And if there was a

treatment that we had in health care that could restore 10 or 20 years of life, you'd think every funder would be tripping over themselves to bring it to market. But we know what that treatment is. It's housing and it's housing for all. And that's where I think really we're trying to galvanize some of this hope and evidence around some different solutions. And that's what you wanted to do. You wanted to build housing, which is what Dunhouse was. You built, as I said, 51 apartments with on-site medical care. That's a really important element that you're getting at is that it's housing and the fundamental housing as a human right.

But it's also around the integrated supports that are there of caseworkers working alongside nurse. practitioners, psychiatry, and primary care. And that's really a crucial part of the model is to make sure that the supports are there and these wraparound supports for people, whether it's around accessing mental health and addictions or palliative care or wanting to start to try arts-based therapy. These are the kind of supports that we're really embedding at Dunhouse. The numbers, and again, we walked through the evidence the last time you're here, but the numbers are really worth focusing on.

In 2019, something like 234 patients in downtown Toronto made up over 15,000 emergency department visits. What is, I mean, we talked about the cost on people's well-being and their ability to live a full and rich life. But there's also the cost, a material cost, a cash money cost. I mean, what is the cost of that? When you look at, and this is the part, so I think there's a real, the human dignity piece is paramount. But when you look at the health economics, the way we've been doing things for the past few decades makes absolutely no sense. And I think there's always this idea or a conversation that even if you're a cold-blooded economist, which I don't know any cold-blooded economists, are usually pretty fair and sensible, when you look at the cost breakdown of it being over $50,000 a month to stay in a hospital ward, around $14,000 to $15,000 in a provincial jail system, which many of us call it de facto mental health. system as people can't access supports. It's around $6,000 for a shelter system per month to less

than $4,000 for supportive housing. Again, the element of housing plus the supports, it's pretty clear we can't afford the status quo. And I'm going to really dive into some of those numbers. And I think this is really what a year in being able to release to the world, I think, is the hope of trying to see the scale across our country, is that we saw a 79% reduction in how long people we're staying in hospital. So that's hundreds of hospital bed days, to your point around the cost savings and the cost metrics, it's usually on average at a hospital over $2,200 a day in hospital. When you look at the fact that at Dunhouse, it cut emergency department visits in half,

that's usually around $400 to $450 for an ED visit. So when you look at the tally of over $2 million in cost aversion, that's where we're really seeing that kind of investment be there for people. upstream, upstream from the emergency department and having both really important health and well-being ramifications, but also this really important element of health economics. I mean, the money matters, but these are people too, right? Who are the people who are living in Dunhouse? I wish we could just have that point on repeat, because I think this is where it's been so polarized in the public. There's this element of where there's almost this disgust

and this hatred towards people in house. And it is one of the most painful things I've seen in the discourse coming through the pandemic, this idea that people don't deserve housing or what and where people deserve to live. When you look at the stories and the human stories coming out of Dunhouse, I think that to me is actually even as compelling as the data we're seeing. And there are people who are in their 20s, who've had mental health and addictions, who are now in various ways of their own trajectory of defining health and well-being to people in their 60s and 70s.

Tell me one of those stories. Tell me briefly one of those stories of somebody whose life has been changed by this intervention. I think if you haven't had a chance to read it yet, the profile of Jason Miles by Victoria Gibson in the last month, to me, is just one of the most powerful stories of heroism of someone who spent years being unhoused, suffering from, mental health and addictions and substance use disorders and has been able to see now for the first time them working finishing high school going back at Dunhouse to finish their credits and is now part of the lived experience advisory council for the mayor's office and is employed in terms of how they're now leading recovery groups they are active neighbors and members in Parkdale and advocating for more housing and more opportunities for people and so I I, you know, every week continue to be so moved by Jason, but there are dozens of other

stories and people that live in Dunhouse that, again, when you see, to me, the trust that's being built and the care and community that's being built amongst 51 people, that part of the last year, you can't capture it in a metric. But to me, that is really this core principle of why we believe housing is so fundamental to health and this idea around connection. And so I'm there seeing the 30-year-old tenants looking out for the folks in their 70s saying, make sure you know you check on miss so-and-so. I've noticed that, you know, they're walking a little differently. And that element of care and care in and amongst that's community, I think, is one of the most beautiful things that's emerged in the last 12 months.

How do you convince people? Because this, again, it's to go back in so much to the money. This is an investment. Correct. How do you convince people to put that money in at a time when everybody wants money? And the system is stretched in a million different directions, and they're trying to figure out where the money for this is going to come from, where the money for that is going to come from.

How do you convince people that this is a worthwhile investment? I hope the things we've talked about, the data especially is important. The fact is, as a society, we're spending the money. But the money is not actually well spent. We're spending it in jail. The jail system, the hospital system, the emergency. emergency department, all of the spillover costs that emerge from that. And it is not driving better outcomes or efficiencies that we want as a society. And it is not keeping people healthy.

It is not ensuring that people can contribute in ways to their own families and neighbors and partners the way that they want to be doing. And so I think it's this fundamental shift. And again, 51 units is not going to end the homelessness crisis. But the hope around Dunhouse is that it can show that there is a more cost-effective model or more humane model to ensure that we, you know, as we are, the status quo is spending a lot of money. You know, it is multi-fold more for someone to be in the hospital emergency department than be housed. And I hope it helps flip this argument on its head around, you know, we can't afford housing for all instead of, you know, the reality that's being pushed now that we can't afford these more humane

options for people. Two quick things before I let you go. One is we wanted to talk to you again, we have a tendency to tell stories and then you forget them. And we wanted to come back to a good new story because it's fascinating, but also because people are paying attention. Have you had people from across the country calling you and saying, we'd like to steal this idea with credit? Let us know how we can do that. I mean, I think it's totally open from, you know, and, you know, and UHN and UHN leadership deserve so much credit to believe in this radical idea, you know, six years ago when we first spoke in 2019. And I think the idea that, uh, people from Vancouver to the East Coast are looking to see this replicate and scale. I mean,

that's really the goal. And hopefully with Build Canada homes and other moves in the federal landscape, we can see this as a playbook for other parts of the country to address the homeless crisis in this way. So very quickly, just give me, if you were to look ahead five years, what would you want to see when it comes to this thing, you know, getting legs and walking forward? We just need so many more social medicine, housing. options for people across the country. And whatever that number needs to be, I think we have hopefully the economic case, the human case, and the health case that this is really a crisis we need to see responses and solutions to. And it's possible. It's possible. This is good news. We like

solvable stories and people doing things to address things in a solvable way. Andrew, thank you. Thank you so much, Matt. Dr. Andrew Brizari is a primary care physician, executive director of social medicine at the University Health Network. That story he mentioned, you can find that in the Toronto Star. They've been doing some really good journalism on this as well, telling the stories of those people who are living in Dunn House. This has been the current podcast. You can hear our show Monday to Friday on CBC Radio 1 at 8.30 a.m. at all time zones. You can also listen online at cbc.ca.ca slash the current or on the CBC Listen app or wherever you get your podcasts. My My name is Matt Galloway. Thanks for listening. For more CBC podcasts, go to cBC.ca.ca slash podcasts.