Pandemic Planning and Services that Support People Who are Homeless

NOTE: This blog is intended to stimulate discussion in your local community regarding pandemic planning and the homelessness services sector. This blog is NOT medical advice. You should work with your local Public Health officials, or other local health officials to develop a community response to plan for a pandemic, should one occur. OrgCode Consulting, Inc. is not responsible for any misinterpretation or misuse of the contents of this blog.

During the SARS outbreak, I was working in homeless services sector in Toronto, and I recall how much work that went into planning for and responding to the possibility of a pandemic and its impact on homeless individuals and families in the community. I suspect that many of you reading this, have, are in the process of, or are just starting to think about pandemic planning in the event the coronavirus is declared a pandemic. The time is now to be planning and preparing.

People experiencing homelessness are presented with unique challenges in the event of a pandemic. Many who are homeless already have compromised health in some fashion. Many who are homeless have no choice but to be in congregate settings for sleeping, meals, and to get out of the elements, which can be perfect for the transmission of the disease from one person to another. People who are generally poor can also experience considerable stigma in the event of a pandemic. Here are some thoughts to help stimulate discussion in your community on pandemic planning and homelessness:

Expect the Work Force in the Homelessness Services Sector to be Impacted

Health experts have estimated that between 15-35% of the workforce will be unable to work because of illness, fear of contracting illness or because they are caring for their own families that become ill. Think about how, or if it is possible, to keep your homelessness services operating if there was that amount of loss to the workforce in the sector. Would you be able to deliver the same services in the same way? Would staff need to be, or expected to be, at the work site for longer periods of time, possibly including living on the premises for all or some of the pandemic to keep services going?

Consider the Density and Layout of Sleeping Spaces

Many homeless service providers try to maximize the use of whatever space they have to accommodate as many people as they can on a nightly basis. This may work against efforts to decrease spread of the illness. Furthermore, if you don’t already do so, you may want to consider reconfiguring sleeping space to maximize the distance between people and/or ensure sleeping arrangements are organized in a head-to-foot configuration.

Increase Attention About the Importance of Having Clean Hands

Now may be the time to put up posters reminding people about the importance of washing or sanitizing their hands on a regular basis. Even if you don’t normally make hand sanitizer available, you may want to start having it available near the entrance of your facility and reinforcing behavior to always sanitize at the time of building entry.

Early Detection and Screening Methods

At the time of intake, or re-claiming beds for existing guests, it may be advantageous to have a very simple screening about how people are feeling and to see if people have any of the symptoms that may be related to the illness.

Order Personal Protective Equipment for Staff

You may already have masks and gloves and even biohazard-type suits for rare situations. A pandemic would place considerable demand on whatever volume of personal protective equipment you already have on hand. It may already be difficult to get these resources in your community, so getting them ordered now – even if there is a backlog in having orders filled – may be better than waiting until the illness has taken root in your community.

Extra Supplies May be Needed

Now is the time to look at things like the volume of cleaning supplies your organization has on hand, things like hand soap and sanitizer, and food – to name a few. Not only may some items become scarce in the event of a pandemic, going out into the community to get these materials could present unnecessary risks. Preparedness experts often say that having an eight week supply of materials on hand is good planning.

A Seat at the Incident Command Center or a Separate Incident Command Center for Homelessness

While many Incident Command Centers do have members that focus specifically on vulnerable populations, depending on the size of the homeless population in your community it may be warranted to have a dedicated seat at the Command Center just for homelessness related issues. If that is not possible, consideration may be given to organizing and activating an Incident Command Center just for homelessness related incidents during a pandemic.

Map Out Locations of Encampments

Now is the time to start bringing together outreach workers, parks staff and law enforcement to ensure your community has a comprehensive map and understanding of where people are dwelling in unsheltered locations. This information may end up being critical for testing and tracking people impacted by the illness or impacting others with the illness. Even if you start with those encampments known to have two or more people it would be helpful. (As an aside, it is entirely possible that unsheltered homelessness will rise in the event of a pandemic as some homeless individuals and families may leave shelters and go outside if they perceive it to be safer than being in a congregate setting or a homelessness service provider needs to close during an outbreak.)

Expect Some Homelessness Services Protocols and Practices to Need to Change

There can be many changes that may need to be altered or suspended during a pandemic. Service restrictions may need to be relaxed to get more people access to services. Hours of operations may need to change. Queueing practices may need to be altered. If your community has a protocol for encampment abatement, that may need to be suspended during an outbreak.

Plan for Impacts of People Not Getting Access to Medications

Access to and supply chains of medication can be interrupted during a pandemic. Knowing that many people who are homeless live with chronic disease or mental illness where they rely upon medication, consider what is going to happen and how you can still effectively serve people who may lose access to their medications.

Some Homeless Individuals May Die

Death amongst those who are homeless can already have an emotional toll on others experiencing homelessness and the professionals and volunteers who engage with and support them. It is entirely possible there will be more deaths amongst those who are homeless during a pandemic. Your community will likely already be planning larger storage areas for people who die during an outbreak, but may not have thought about deaths amongst people experiencing homelessness.

Consolidating Services

It is possible that a pandemic will result in some homelessness services needing to close. If that were to occur, which services for people experiencing homelessness in your community are deemed critical operations? How could you redeploy staff to keep those critical operations going? Is there any part of the homeless services response that you would cease operating immediately if there was a pandemic?

Know How Privacy and Confidentiality May be Impacted

While this may vary from jurisdiction to jurisdiction, it is possible that consent and sharing of health information as we know it today would change in the event of a pandemic. A freer flow of health information may make all the difference for health professionals and the response to the pandemic.

Unique Challenges When Serving Families

Family service providers need to plan for the unique challenge of a parent(s) that become ill or pass away while their children remain healthy and need access to supports. Working with Child Welfare organizations now to plan ahead for this possibility is better than scrambling to figure out the response if/when this occurs.

Compassion Fatigue May Reach a New Level

Self-care and personal wellness may be difficult if there is large scale disease transmission within the homelessness services sector that frontline workers are responding to for a prolonged period of time. This can lead to impacts not during the pandemic, but may impact the workforce and long-term sustainability of the workforce after the illness is under control or has passed in the community.

Cross-train Now

Many people who work in the sector may be asked to do different jobs than they are accustomed to during an event such as this. Now is the time to make sure you have easy explanations of the tasks of essential jobs and to undertake cross-training. For example, you may want to ensure the Executive Management Team of your organization knows the ins and outs of specific frontline positions they may be asked to perform.