Communities Work to Manage COVID-19 and Homelessness

COVID-19 has populations at risk for all determinants, especially the “housing compromised.”

Homelessness was 2019’s top social determinant of health (SDoH). 2019’s Annual Point in Time Count showed almost 570,000 people living on the street nationwide. With 2020’s results pending, ongoing increases are expected.

COVID-19 has populations at risk for all determinants, especially the “housing compromised.” Homeless individuals are three times more likely than the average person to have underlying or chronic health conditions, and they are at increased risk of acquiring and carrying, if not dying, from COVID-19. The five cities with highest rates of homelessness are in states hardest hit by the virus: New York City, Los Angeles, Seattle, San Jose, and San Francisco.

Hospitals are reconciling discharge planning headaches courtesy of COVID-19, with planning for patients with no formal residence being challenging. Communities take care of their own, and here’s how they’re flattening the curve for the homeless. 

• New York, Illinois, and other states are providing portable toilets, hand-washing stations, and shower

• Shelters are developing screening tools to ensure social distancing and creating proactive care guidelines for occupants, including taking temperatures and monitoring vitals.

• “Tent medicine” is all the rage: tent cities are being built daily, so far, in Boston, Baltimore, Philadelphia, Los Angeles, and Tampa; it’s far safer than returning to shelters or being housed in emergency rooms.

• Philadelphia’s Holiday Inn Express is among an expanding list of hotels to house homeless individuals who test positive for the virus.

• Detroit restaurants and eating establishments in other cities that were forced to close courtesy of the virus now cook meals for and feed homeless persons.

• Closed university dormitories and convention centers are being converted to house persons without a place to stay.

• Cities are following Baltimore’s lead, with guidance for hospitals to ensure proactive assessments of housing upon discharge to prevent unsafe community re-entry and provide safe alternatives for isolation, including:

• Discharge protocols defined for hospitals to assess housing status and facilitate transfer to isolation sites or emergency shelter beds:

• Before discharge: for persons discharged pending COVID-19 test results or confirmed cases, hospitals should complete a housing environment screen to see if individuals can self-isolate at home.
• For those being discharged when COVID-19 is not suspected, the hospital can coordinate discharge to an emergency shelter by contacting the Mayor’s Office of Homeless Services.
• The National Coalition of the Homeless, Aunt Bertha, and org have updated resource listings.

Listen to the “State of the Social Determinants” on Monitor Mondays for evolving developments of this story.