The Toronto Housing Charter is a key component of the Housing Opportunities Toronto HOT Action Plan 2010-2020, adopted by City Council August 5, 2009.

The Charter is designed to guide Council and staff in their efforts to assist those who often face challenges finding affordable housing, from newcomers and single parents to seniors and those with disabilities.HOT contains 67 recommended actions to be undertaken by the City of Toronto and the federal and provincial governments. It calls for new investment of $484 million annually for the next 10 years to help 257,700 households struggling with high housing costs or inadequate accommodation.HOT will serve as a road map to guide federal and provincial investments, as well as public and private sector activity.

The Housing Stability Service Planning Framework for Shelter, Support and Housing Administration was unanimously approved by Toronto City Council in December 2013.

The Child and Family Services Act (CFSA) recognizes that each of us has a responsibility for the welfare of children and a duty to report.

1.0 Definition of Shelter Resident and Reportable Death

A death of a shelter resident is considered reportable to SSHA if it satisfies the following definition:

“Shelter resident” means:

    1. a client of a shelter program with an active admission who dies on shelter property
    2. a client of a shelter program with an active admission who dies off shelter property
    3. a client with an inactive admission because they had been discharged from a shelter program directly to a health care facility such as a hospital or palliative care facility AND who dies within sixty (60) days of being discharged to said facility.

If a shelter resident dies within a shelter facility or outside of the facility but on the property of the shelter, an Incident Report is required in addition to a completed Death of a Shelter Resident Reporting Form.

The Incident Report should be completed in SMIS and a copy submitted with a completed reporting form; the Incident Report does not replace the reporting form (see next section for details).

2.0 Reporting Process

All deaths of shelter residents must be properly documented using the Death of a Shelter Resident Reporting Form (see Appendix). The most up-to-date version of this form is posted on the SSHA website under the “Information for Shelter Providers” expandable menu.

Note: Some steps of the process differ for staff at directly-operated and purchase-of-service shelters. The acronyms DOS (i.e., directly-operated shelter) and POS (i.e., purchase-of-service) are used to highlight a differentiation in process; if it is not indicated, the same step of the process applies to both DOS and POS.

Step 1: Immediate Notification

When a death occurs, shelter staff should provide written notification via email as soon as possible.

For DOS staff, the email recipients are:

  • Director, Homelessness Initiatives and Prevention (HIPS) Unit.
  • Manager, Homelessness Initiatives and Prevention (HIPS) Unit
  • Research Analyst, Homelessness Initiatives and Prevention (HIPS) Unit
  • Coordinator, Programs, Homelessness Initiatives and Prevention (HIPS) Unit

For POS staff, the email recipients is:

  • The Agency Review Officer (ARO) assigned to your shelter.

Step 2. Submit Incident Report within 24 Hours, if applicable

If – and only if – the death occurred within the shelter facility or outside of the facility but on the shelter’s property, an Incident Report is required.
The details of the incident should be entered into the Shelter Management and Information System (SMIS) Incident Report module as per Section 12.5.2(f) of the 2016 Toronto Shelter Standards (TSS).

In addition to the requirements of Section 12.5.2, shelter staff should attempt to document the following:

  • the circumstances leading up to death
  • any available information on the manner and/or cause of and any contributing  factors leading up to death
  • the source(s) of the information, both medical and non-medical
  • if Next of Kin and/or an Emergency Contact is known and if information was relayed to the proper authorities for notification
  • whether wishes for cremation, burial, etc. are known
  • how personal belongings and effects will be disbursed or disposed, including any pieces of identification, and
  • whether a memorial service will be held.

A copy of the completed Incident Report should then be exported from SMIS and electronically forwarded to the above-noted email recipients – for DOS and POS, respectively – within twenty-four (24) hours of knowledge of death.

Step 3: Submit Reporting Form Within 14 Calendar Days

For all deaths that satisfy the definition of “shelter resident,” submission of a Death of a Shelter Resident Reporting Form is required. Instructions for completing the form are outlined in the next section.

The completed form should include a hand-written signature of the supervisory- or management-level staff responsible for reporting the death and should be forwarded to the above-noted email recipients – for DOS and POS, respectively – within 14 calendar days of knowledge of death.

A Death of a Shelter Resident Reporting Form will not be accepted if:

  • It is not the most recent version available
  • It is missing mandatory information
  • It contains significant error(s)
  • It is signed by someone who is not authorized to do so
  • It does not contain a hand-written signature of the authorized staff.

When a completed reporting form is found to be unacceptable, follow-up with DOS staff will be conducted by a representative of the Homelessness Initiatives and Prevention (HIPS) Unit (typically, the Research Analyst); follow-up with POS staff will be conducted by their respective ARO.

Re-submission of an acceptable reporting form should occur within forty-eight (48) hours of follow-up.

3.0 Completing a Death of a Shelter Resident Reporting Form

Part 1 – Resident Information

Information for completing this part of the reporting form is obtained from SMIS.
Enter the date of birth of the deceased resident in the same format as SMIS: YYYY/MM/DD.

Part 2 – Most Recent Admission/Discharge Status

Information for completing this part of the reporting form is obtained from SMIS.

If the resident died with an active admission, enter the date of their most recent admission in YYYY/MM/DD format and calculate the Length of Stay in Shelter from the admission date to the date of death.

If the resident died with an inactive admission (i.e., they were discharged to a health care facility and died within 60 days, as per c) of the definition of “shelter resident”), enter the date of their most recent admission and date of discharge in YYYY/MM/DD format and calculate the Length of Stay in Shelter from the admission date to the date of discharge.

In the “Discharged to” drop-down menu of the reporting form, indicate whether the resident was discharged to: Hospital, Detox or Rehab, Hospice or Other Institution. If “Other Institution” is indicated, provide the name of the institution in the available text box.

When a shelter resident dies after discharge at a medical or other institution, shelter staff are expected to collect the above information to the best of their ability with the understanding of the ability of health care providers to share such information.

Part 3 – Date, Time and Location of Death

Obtain the necessary information to complete Part 3 from shelter staff, witnesses, staff from medical or other institutions (if the resident was under their care) and/or the completed Incident Report(s) regarding the death of the resident, if applicable.

Part 4 – Manner and Cause of Death

Indicate that the manner and cause of death is “Verified” only if such information was obtained directly from an original or known true copy of the resident’s Medical Certificate of Death.

If access to a Medical Certificate of Death is not possible or reasonably foreseen to be not possible within the reporting time limit (i.e., 14 calendar days), select “Unverified.”

In the course of completing the form, please keep in mind the following:

  • SSHA expects that only factual information will be reported on the form (i.e., free from speculation, reliance on hearsay or undue confidence in non-medical sources)
  • SSHA has delegated authority to shelter providers to collect the required information on behalf of the City and acknowledges that there may be limits on the ability to collect the information (e.g., from health care providers), and
  • the deceased shelter resident’s privacy must be protected at all times, and that shelter staff responsible for collecting the required information ensure that they will do so with consideration of the sensitivities of the deceased’s next of kin.

Part 5 – Reporting Checklist

The checklist in this part is to ensure completeness of the reporting requirements of a death of a shelter resident. Check all of the boxes that apply.

Part 6 – Certification and Approval

Indicate the name and position of the supervisory- or management-level staff who are accountable for thoroughly reviewing the accuracy and completeness of the information provided in the reporting form.

Date the form at the time of signing in the format YYYY/MM/DD.

A hand-written signature is required to certify the document. Staff should make a hard copy of the reporting form for their record keeping purposes, sign it with dark ink and scan into pdf format in order to facilitate email submission to the appropriate recipients.

4.0 Contact Information

DOS staff with questions regarding this guide and the completion of the Death of a Shelter Resident Report should be forwarded the Research Analyst, HIPS Unit at ryan.nagelmakers@toronto.ca.

For POS staff with questions and/or seeking assistance with the reporting form should contact their respective ARO.

Eating Well with Canada’s Food Guide has been translated into 10 different languages in addition to English and French.

Learning more about Canada’s Food Guide will help you and your family know how much food you need, what types of foods are better for you, and the importance of physical activity in your day.

Each province has its own provincial health acts and regulations. In Ontario, the Health Protection and Promotion Act, 1990 (HPPA) lays out the mandate to make regulations, programs and protocols which govern food premises. All health units/departments are responsible for the conditions and safety under which food is held, prepared and served to the public. This is also the responsibility of the food premises owner/operator and employees.

Read more about the Food Safety: A Guide for Ontario’s Food Handlers.

Standards and Guidelines related to Tuberculosis.

The Housekeeping Manual for Municipally Operated Shelters provides guidelines regarding the provision of housekeeping services in MOS with the objective of ensuring a clean, safe and healthy environment for staff, clients and the public. It is also intended to help MOS meet requirements of the Occupational Health and Safety Act and the Toronto Shelter Standards.

Bed Bugs: A Handbook for Shelter Operators

Bed bugs are a pest and are common in transient populations. Bed bugs are found in hotels, motels, apartment buildings, rooming houses, dormitories and shelters.

No spray or chemical can stop bed bugs from entering your shelter. Checking out areas where bed bugs may live can help prevent them from getting a foothold if they arrive at your facility.

An Integrated Pest Management (IPM) plan is needed to prevent and manage bed bug problems.

The goals of IPM are to

  • use pesticides only when absolutely necessary
  • take measures to prevent, find and track the insect problem early
  • teach people how to deal with bed bugs
  • always be aware of that bed bugs can become a problem in your shelter

What are Bed Bugs?

Bed bugs are a pest, about ½ cm long. They are tan-coloured and flat-shaped before feeding, and drop-shaped and reddish-brown after feeding. They do not fly or jump, but travel from person to person by walking. Usually, they travel from place to place in clothing or luggage.

Bed bugs feed only in the dark, usually at night. They feed on humans and do not move more than a few metres from their food source. Bed bugs hide in dark places between feedings, such as in the folds of mattresses, pillows, behind baseboards, in cracks in the floor, behind posters or wallpaper, and in curtains.
They only need to feed once every few days for about five minutes, then return to their hiding place. They do not stay on a person between feedings. Bed bugs can live about half a year without feeding.

There are no reported cases of bed bugs passing on disease to humans. After a bed bug bite, a whitish bump may appear and can be itchy. Scratching the bump can cut or tear the skin leaving it open to infection. A bed bug bite is rarely felt and is often painless. In rare cases, a small number of people are
allergic to the saliva injected while the insect feeds; this may result in painful swelling.

Bed Bugs at Intake

To prevent bed bugs from coming into the shelter, a few steps can be taken.

1. Ask the client if they were staying anywhere that has bed bugs.

If they have, suggest they immediately wash and dry all of their clothing to prevent bed bugs from entering your shelter. If they carry their clothes in a knapsack or similar bag, have them to wash and dry the bag too. Washing, and especially drying, kills bed bugs. If drying is your only choice, tumble the person’s clothing for 30 minutes in a dryer at 35 degrees Celsius or hotter. This will generally kill bed bugs. Hotter is better.

2. Ask the client if they have bed bug bites.

If they do, laundering clothes is even more important. The bed bugs will be killed and clean clothes will reduce chances of infection in sores caused by scratching the bites.

3. If laundry isn’t an option, try separation.

If you cannot wash and dry the client’s clothing on-site or at intake, try to separate their sleeping area from the rest of your shelter clients. If you don’t, it is likely that bed bugs will spread and multiply in your shelter. This means that bed bugs can increase across the entire shelter system. If the person is in a
separate sleeping area, check their bedding for bed bugs daily. Ask if they have any new bed bugs bites. Vacuum the sleeping area often, making sure to use the hose attachment of the vacuum in all the nooks and crannies. The separation area should be carefully sealed to prevent the insects from getting
behind baseboards or travelling through wall separations into other areas.

4. If the client refuses to have their clothes and bag laundered, separate and build it into the case plan.

If the client refuses to have their items laundered, have them sleep in a separate area of the shelter, and build laundering into their case plan. It may take some time to get the client’s agreement to this goal, but reaching it should not put others in the shelter at risk of being bitten.

5. In extreme cases, consider a referral.

Extreme cases occur when a client has many bites, comes from a location with many bed bugs, refuses to have their belongings laundered, and you currently cannot separate them from other shelter residents. In this case, contact colleagues in other shelters to see if they can provide a bed in a separate area.

There are bed bugs in your shelter, now what? Dos and don’ts when the shelter has bed bugs:

Do Don’t
Using the facts and a reasonable manner, tell clients and staff that bed bugs are in the shelter Panic – bed bugs can be controlled
Record the occurrence(s) including who, where, when, how much Shut down the shelter immediately
Let your Agency Review Officer know if the problem continues Throw out all the bedding and belongings
Encourage the person who was bitten to continue to stay at your shelter Think the problem will go away on its own
Manage the storage of belongings differently and alter the intake process Delay in starting the actions needed to minimize the presence of bed bugs
Increase laundry access Move the bed to another area
Contact your pest control operator to make sure you have an effective IPM strategy in place– NOW – even before it happens!
Remove clutter from sleeping areas

 

Once bed bugs are found, a quick response is needed prevent bed bugs from getting a foothold in your shelter. Residents, staff or your pest control operator can tell you if there are bed bugs. Controlling bed bugs involves these three groups of people.

When clients tell you that they have been bitten, record and track the information. Note the date, the number of people affected and in which sleeping area and/or part of a sleeping area they were. This is valuable information for your pest control operator and staff.

Staff are critical in looking for bed bugs in the sleeping area. Checking for bed bugs is an important part of having a safe, livable environment. Schedule bed and bedding checks to ensure detection. Insect glue boards are valuable as an early warning of bed bugs. These can catch bed bugs when they are not easily found.

How to Minimize Bed Bugs

There are many ways to minimize bed bug activity in a shelter, but none will prevent bed bugs in the first place. Hostel Services does not recommend one method of minimizing bed bugs over another. A combination of methods can have a real impact.

1. Laundry

Washing and drying clothes can reduce the number of bed bugs in a facility. Drying is most important.

2. Storing belongings

Storing personal property prevents bed bugs from spreading. This is important for those individuals whowill not have their belongings laundered. Store belongings in a sealed plastic bag, such as a large-sized garbage bag. This may not kill the bed bugs, but it does prevent them from travelling in the shelter.
Next, choose a storage location away from the sleeping area. Bed bugs cannot survive if they are far away from their food source. Bed bugs cannot live if they are exposed to heat (35 degrees Celsius or hotter). They cannot live if exposed to cold (9 degrees Celsius) for a prolonged period of time, about a day. With the client’s permission, place the sealed bag of belongings in a freezer for a day.

3. Check the bed and bedding

Finding bed bugs early helps to reduce their spread in your shelter. Each female bed bug can lay 6–10 eggs at a time and between 200 and 500 eggs in her lifetime. They hatch in about 10 days.

Signs of bed bugs

  • check a sample of bedding in the morning
  • look for small blood stains on the bedding
  • look for live bed bugs inside pillowcases
  • check around the elastic area of a fitted sheet
  • check the folds of the mattress and where the bed touches the bed frame

Laundering bedding is a good step to reducing the spread of bed bugs. If the mattress is washable, wash all of it, especially the folds and seam areas. This can reduce bed bugs.

4. Bed position and bed frame

Bed bugs do not fly and it is very difficult for them to walk on polished surfaces. This is why the position of the bed and the treatment of the bed frame are important.

Move the bed 3 to 6 cm away from walls and other fixed furniture to remove one of the ways bed bugs get into the bed. Make sure blankets and sheets are not touching the floor.

Making changes to the bed frame applies to wood bed frames and can be done in many different ways

  • seal the all wood with a glossy wood sealer
  • apply a 3 cm band of petroleum jelly, such as Vaseline, around each leg
  • place each leg of the bed in a clean, polished metal can, such as old soup tins, or wrap each leg in metal tape
  • wrap double-sided tape around the bed legs, making sure the tape is tight or the bugs will crawl underneath it
  • place an insect glue trap under each bed leg

5. Replace the bed frame

Bed bugs have a hard time climbing up metal bed frames, especially if the legs are wiped with a cloth every couple of days to keep them shiny. Replace all existing wood bed frames to metal ones.

6. Seal the mattress

Sealing the mattress and box spring in a fitted vinyl cover, or covering the whole mattress in plastic works because

  • it takes away crevices where bed bugs can hide
  • a tightly fitted cover is another shiny surface that bed bugs have difficulty climbing
  • the cover traps existing bed bugs, seals them away from their food source and they die

7. Steam

Steam kills bed bugs. Rent or purchase a steamer and apply the steam to all of the mattresses, bed frames, carpets, rugs and curtains in your shelter. Steam is effective to a depth of 3 cm from the surface of the material that is being steamed. The steam must be 70 Celsius or hotter to be effective.

8. Vacuum often

Vacuuming does two things. In shelters where there are no signs of bed bugs, a quick look at the vacuum collection will show if there are bed bugs. In shelters where there are bed bugs, vacuuming can remove them from hidden spaces that are dark in the daytime. The wand attachments helps you vacuum the spaces where mattresses meet the bed frame, along baseboards, behind and in the folds of furniture, in cracks in the floor or wall, along the edges of windows, in the folds of curtains, and in carpets and rugs. Empty your vacuum cleaner immediately and seal the contents in a bag before disposing of it. If it will be disposed of at your site, freeze it for a day first.

9. Small mattress tears

Small mattress tears are a chance for bed bugs to go deeper into the mattress during the day. If you cannot replace a torn mattress immediately or you cannot completely cover it, stitch the torn area or apply a heavy-duty tape, such as duct tape, as a temporary solution.

10. Eliminate other daytime hiding places

When bed bugs are in and along cracks and crevices in baseboards, walls and the floor, it is important to caulk or fill these daytime hiding places. If bed bugs are present, remove all posters, wall art, or other things on the wall that can be hiding places. If bed bugs are behind wallpaper, this is a chance to remove or repair the wallpaper and make sure no other bed bugs hidden. If bed bugs are in curtains, try a different style that does not have as many folds or seams.

11. Inspect donations of furniture and clothing

Before accepting a furniture or clothing donation into the shelter, take a flashlight and look over the piece, paying special attention to the cracks, crevices and seams. Furniture requires very close visual inspection. Vacuum and/or steam upholstered furniture and mattresses before using. Put all donated clothing through the dryer treatment.

12. Never stop monitoring, cleaning and treating

This pest is tough. Never think that the problem is gone. Monitor, clean and treat the problem. This must be part of the every-day, standard operating practice at every facility.

Costs

Managing the costs of bed bug control requires rethinking the processes and investment in good preventive measures in a pest control program. It is better to use resources for a preventive approach, rather than to spend a lot of money trying to control an infestation. There is no common dollar figure for how much it will cost to control an infestation because of the many variables involved. Prevention is cheaper.

Conclusions

Bed bugs are an issue beyond the walls of your facility. To decrease transmission from one facility to anotheror within your facility requires dedication. There are several common sense, cost effective strategies that can
be implemented to prevent and minimize bed bugs from taking a foothold in your facility as outlined in this document. Following some or all of these, in the context of an IPM strategy, will help address the issue.

The Role of Professional Pest Control

Toronto Shelter Standards address this in section 11.3.2 (e): Shelter providers will have a pest control policy, have procedures that specifically address bed bugs and have an integrated pest control program to keep shelters free of rodents and pests that, at a minimum, includes
(i)
Regularly scheduled inspections and treatment conducted by a licensed pest
control company
(ii)
Documentation of all pest sightings and/or evidence of infestations
(iii)
A communication plan to inform clients and staff of treatment plans that, at a minimum, includes a treatment schedule and the precautions required.

 

Integrated Pest Management (IPM)

Integrated Pest Management prevents and controls bed bugs. A good IPM always evaluates all new information and makes treatment changes if the results are not as expected.

The goals of IPM are

  • use pesticides only when absolutely necessary and limit their use to the minimum required amount
    to solve the problem
  • limit the success of the insect pest through preventive measures – “an ounce of prevention is worth a pound of cure
  • monitor for early detection
  • educate staff and clients
  • always be on the look out for bed bugs

Records containing personal information may be disclosed to police officers or other law enforcement agents under Section 32 (g) of the Municipal Freedom of Information and Protection of Privacy Act (MFIPPA).

City staff must follow the steps outlined in this document when completing the Law Enforcement Request for Personal Information Form. The form is used to provide access to records containing personal information to law enforcement agencies, while still protecting the rights of our clients