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Homeless and Homeless Shelters

Persons experiencing homelessness may be at risk for infection during an outbreak of COVID-19. Homeless populations tend to be more vulnerable to infectious disease in general (e.g., influenza) due to their limited access to healthcare, their mobility, and poor health status. As with any other congregate setting, there are special considerations for providers of homeless shelters to help reduce the spread of infectious diseases. 

People experiencing homelessness typically have limited resources and likely have past exposure to traumatic events. Therefore, they may be at higher risk of adverse physical and psychological reactions following a public health emergency or disaster. Trauma-informed approaches can help disaster responders effectively serve homeless individuals and families.

A trauma-informed approach to disaster response acknowledges past trauma and the current impact it may have on the lives of anyone receiving services or support. Sensitivity to trauma can improve communication between responders and the homeless and facilitate compliance with public health directives. (Source: U.S. Department of Human Services Office of the Assistant Secretary for Preparedness and Response, Disaster Response for Homeless Individuals and Families: A Trauma-Informed Approach).

Homeless Individuals Have High Rates of Past Trauma
  • The National Center on Family Homelessness reports that 92% of homeless American mothers have experienced severe physical or sexual abuse in their lifetime.
  • 83% of homeless children have been exposed to at least one serious act of violence by age 12.
  • There were 1,148 reported hate crimes committed against homeless people between 1999 and 2010 in 47 states, Puerto Rico, and Washington, D.C.; 27% of the crimes were fatal.
Disaster Planning Checklist
  • Include people with expertise in providing services to the homeless in planning activities and exercises.
  • Understand that homeless individuals and families often have a significant trauma history prior to an emergency.
  • Educate service providers about trauma and how it impacts a person’s physical and behavioral health.
    • Train providers to be mindful of common triggers for traumatic symptoms which include loud noises, small spaces, lack of privacy, and chaotic or disorganized surroundings.
  • Help providers recognize that shock, denial, anger, grief, acceptance, and coping are common stages by which individuals come to terms with trauma; a homeless child or adult may be in any one or more of these stages when a disaster occurs. Provide information about where it is safe, as well as where it may be unsafe, to seek shelter during a disaster.
When Responding to Homeless Individuals and Families During Disaster
  • Ensure that homeless individuals and families are physically safe.
  • Provide basic emotional and tangible psychological support using interventions such as Psychological First Aid.
  • Make the National Domestic Violence Hotline (1-800-799-SAFE) and the Disaster Distress Helpline (1-800-985-5990) available to sheltered individuals with concerns (through signage, access to a phone, etc.).
  • Keep families together during a disaster to help children and their parents maintain unity and comfort.
  • Address a homeless individual or family’s immediate and unique needs.
    • Arrange for food, shelter, and transportation.
    • Offer age-appropriate emergency and disaster information to homeless children.
    • Provide gender-informed services to women and girls by making female case managers available.
    • Make trauma-specific assessment resources available to service providers, such as tools that screen for anxiety, depression, or substance abuse (e.g. SAMHSA’s Behavioral Health Screening Tools).
    • Build the capacity to connect homeless disaster survivors with experienced service providers for follow-up care after their physical and psychological wellbeing has been safeguarded.
    • Reconnect with prior service providers when available and appropriate.

Local Guidance

During your planning process, homeless service providers should collaborate, share information, and review plans with community leaders and local public health officials to help protect their staff, clients, and guests. We would like to highlight the wonderful resources below, shared by our partner, the Alliance to End Homelessness in Suburban Cook County, for residents experiencing homelessness during this time of immense need. 

View the Alliance’s Coronavirus and Homelessness Resource Guide for Providers of Homeless Shelters, Transitional Housing, and Daytime Support Centers, to help you prepare for cases of COVID-19 and help prevent the spread of infection. Additional resources can also be found on their website by clicking these links: emergency sheltermortgage, rent or utility assistancedomestic violence, or housing crisis.

Establish ongoing communication with Cook County Department of Public Health to facilitate access to relevant information before and during an outbreak.

Having an emergency plan in place can help reduce the impact of the outbreak. During your planning process, homeless service providers should collaborate, share information, and review plans with community leaders and local public health officials to help protect their staff, clients, and guests. Set a time to discuss what homeless service providers should do if cases of COVID-19 are suspected in their facility, if a confirmed case of COVID-19 is identified in a client, or if a confirmed case of COVID-19 in a person experiencing homelessness is discharged from a local hospital. Identify if alternate care sites are available for clients with confirmed COVID-19 or if service providers should plan to isolate cases within their facility. 

Connect to community-wide planning

Find out if your local government has a private-public emergency planning group that meets regularly. Building strong alliances before an outbreak may provide your organization with the support and resources needed to respond effectively. Also, in recognition of the “whole community”external icon approach to emergency planning and management, your input as community leaders and stakeholders helps ensure that your local government’s emergency operations plan is complete and represented.

Develop or update your emergency operations plan
  • Identify a list of key contacts at your local and state health departments.
  • Identify a list of healthcare facilities and alternative care sites where clients with respiratory illness can seek housing and receive appropriate care.
  • Include contingency plans for increased absenteeism caused by employee illness or by illness in employees’ family members that requires employees to stay home. These plans might include extending hours, cross-training current employees, or hiring temporary employees.
Address key prevention strategies in your emergency operations plan

Promote the practice of everyday preventive actions

Use health messages and materials developed by credible public health sources, such as your local and state public health departments or the Centers for Disease Control and Prevention (CDC). Read more about everyday preventive actions.

Provide COVID-19 prevention supplies at your organization. Have supplies on hand for staff, volunteers, and those you serve, such as soap, alcohol-based hand sanitizers that contain at least 60% alcohol, tissues, trash baskets, and disposable facemasks. Plan to have extra supplies on hand during a COVID-19 outbreak.

Note: Disposable facemasks should be kept on-site and used only when someone is sick at your organization. Those who are sick should be immediately isolated from those who are not sick and given a clean disposable facemask to wear while staying at the shelter.

Plan for staff and volunteer absences

Develop flexible attendance and sick-leave policies. Staff (and volunteers) may need to stay home when they are sick, caring for a sick household member, or caring for their children in the event of school dismissals. Identify critical job functions and positions, and plan for alternative coverage by cross-training staff members.

Note: Use a process similar to the one you use when you cover for staff workers during the holidays.

Be prepared to report cases of respiratory illness that might be COVID-19 to your local health department and to transport persons with severe illness to medical facilities.

Discuss reporting procedures ahead of time with a contact person at your local health department.

If possible, identify space that can be used to accommodate clients with mild respiratory symptoms and separate them from others.

Most persons with COVID-19 infections will likely have mild symptoms and not require hospital care. Furthermore, it might not be possible to determine if a person has COVID-19 or another respiratory illness. Designate a room and bathroom (if available) for clients with mild illness who remain at the shelter and develop a plan for cleaning the room daily.

Identify clients who could be at high risk for complications from COVID-19

Those who are older or have underlying health conditions are at high risk for complications. Ensure their needs are taken into consideration.

Prepare healthcare clinic staff to care for patients with COVID-19

If your facility provides healthcare services and ensure facility has supply of personal protective equipment.

Plan for higher shelter usage during the outbreak

Consult with community leaders, local public health departments, and faith-based organizations about places to refer clients if your shelter space is full. Identify short-term volunteers to staff shelter with more usage or alternate sites. Consider the need for extra supplies (e.g., food, toiletries, etc.) and surge staff, ensuring they have personal protective equipment.

CDC Interim Guidance for Homeless Providers

CDC has developed Interim Guidance for Homeless Providers (including overnight emergency shelters, day shelters, and meal service providers) with planning, preparedness and response recommendations to help homeless service providers protect staff, clients, and guests from COVID-19.

Communicate about COVID-19 and everyday preventive actions

Create a communication plan for distributing timely and accurate information during an outbreak

Identify everyone in your chain of communication (for example, staff, volunteers, key community partners and stakeholders, and clients) and establish systems for sharing information. Maintain up-to-date contact information for everyone in the chain of communication. Identify platforms, such as a hotline, automated text messaging, and a website to help disseminate information to those inside and outside your organization. You also can learn more about communicating to workers in a crisis.

Identify and address potential language, cultural, and disability barriers associated with communicating COVID-19 information to workers, volunteers, and those you serve.

Learn more about reaching people of diverse languages and cultures.

Help counter stigma and discrimination in your community

Speak out against negative behaviors and engage with stigmatized groups.

People experiencing homelessness may be at increased risk of adverse mental health outcomes, particularly during outbreaks of infectious diseases.

Learn more about mental health and coping during COVID-19.

Get input and support for your emergency operations and communication plans

Share your plans with staff, volunteers, and key community partners and stakeholders and solicit feedback on your plans.

Develop training and educational materials about the plans for staff and volunteers.

Put your emergency operations and communication plans into action

Stay informed about the local COVID-19 situation

Get up-to-date information about local COVID-19 activity from public health officials. Be aware of temporary school dismissals in your area because these may affect your staff, volunteers, and families you serve.

Note: Early in the outbreak, local public health officials may recommend schools be dismissed temporarily to allow time to gather information about how fast and severe COVID-19 is spreading in your community. Temporary school dismissals also can help slow the spread of COVID-19.

Implement everyday preventive actions and provide instructions to your workers about actions to prevent disease spread.

Meet with your staff to discuss plans to help clients implement personal preventive measures.

Communicate with your local health department if you are concerned that clients in your facility might have COVID-19

Learn more about COVID-19 symptoms.

Download COVID-19 posters and CDC Fact Sheets

Keep your clients and guests informed about public health recommendations to prevent disease spread and about changes to services that might be related to the outbreak by downloading COVID-19 Posters and CDC Fact Sheets. Messaging may include:

  • Posting signs at entrances and in strategic places providing instruction on hand hygiene, respiratory hygiene, and cough etiquette.
  • Providing educational materials about COVID-19 for non-English speakers, as needed.
  • Encouraging ill staff and volunteers to stay home (or be sent home if they develop symptoms while at the facility), to prevent transmitting the infection to others.

Minimize the number of staff members who have face-to-face interactions with clients with respiratory symptoms

Use physical barriers to protect staff who will have interactions with clients with unknown infection status (e.g. check-in staff). For example, install a sneeze guard at the check-in desk or place an additional table between staff and clients to increase the distance between them.

Note: Disposable facemasks should be reserved for use by clients who exhibit respiratory symptoms. Clients who become sick should be given a clean disposable facemask to wear while staying at the shelter.

Staff and volunteers at high risk of severe COVID-19

Those who are older or have underlying health conditions should not be designated as caregivers for sick clients who are staying in the shelter.

If staff are handling client belongings, they should use disposable gloves

Make sure to train any staff using gloves to ensure proper use.

Ensure that clients receive assistance in preventing disease spread and accessing care, as needed

In general sleeping areas (for those who are not experiencing respiratory symptoms), ensure that beds/mats are at least 3 feet apart, and request that all clients sleep head-to-toe.

Provide access to fluids, tissues, plastic bags for the proper disposal of used tissues.

Ensure bathrooms and other sinks are consistently stocked with soap and drying materials for handwashing. Provide alcohol-based hand sanitizers that contain at least 60% alcohol (if that is an option at your shelter) at key points within the facility, including registration desks, entrances/exits, and eating areas.

At check-in, provide any client with respiratory symptoms (cough, fever) with a surgical mask.

  • If there is person to person spread in your local community, clients may have COVID-19.

Monitor clients who could be at high risk for complications from COVID-19 (those who are older or have underlying health conditions) and reach out to them regularly.

Confine clients with mild respiratory symptoms consistent with COVID-19 infection to individual rooms, if possible, and have them avoid common areas.

  • Follow CDC recommendations for how to prevent further spread in your facility.
  • If individual rooms for sick clients are not available, consider using a large, well-ventilated room.
  • In areas where clients with respiratory illness are staying, keep beds at least 6 feet apart, use temporary barriers between beds (such as curtains), and request that all clients sleep head-to-toe.
  • If possible, designate a separate bathroom for sick clients with COVID-19 symptoms.
  • Consider reducing cleaning frequency in bedrooms and bathrooms dedicated to ill persons to as-needed cleaning (e.g., of soiled items and surfaces) to avoid unnecessary contact with the ill persons.

Decisions about whether clients with mild illness due to suspected or confirmed COVID-19 should remain in the shelter or be directed to alternative housing sites should be made in coordination with local health authorities. Similarly, identifying respite care locations for patients with confirmed COVID-19 who have been discharged from the hospital should be made in coordination with local healthcare facilities and your local health department.

If you identify any client with severe symptoms, notify your public health department and arrange for the client to receive immediate medical care. If this is a client with suspected COVID-19, notify the transfer team and medical facility before transfer. Severe symptoms include:

  • Extremely difficult breathing (not being able to speak without gasping for air)
  • Bluish lips or face
  • Persistent pain or pressure in the chest
  • Severe persistent dizziness or lightheadedness
  • New confusion, or inability to arouse
  • New seizure or seizures that won’t stop

Ensure that all common areas within the facility follow good practices for environmental cleaning. Cleaning should be conducted in accordance with CDC recommendations.

Resources

Cook County Resources

Cook County ShinyApp

IDPH

CDC