Response, Action and Wellness During a Pandemic

You may have seen my blog on Planning for a Pandemic from March 1. You can access that here. Now that we are in the midst of a pandemic, I offer the following thoughts to help you, your organization and community. To reiterate from my previous blog on this, this is NOT health advice. Use this information to have conversations with health professionals, funders, elected officials, and senior policy makers in your community.

Shelter Differently

Work with your local health professionals to develop a simple screening that can be applied at initial intake and every time a person returns to shelter if they leave. A similar screening may be applied at set intervals with guests of the shelter that have not left. Usually, the questions at this time pertain to whether or not the person has a dry cough and whether or not they feel feverish/ill.

How you configure your space matters more than ever right now, even if you are moving some sheltering to new spaces like conference rooms or convention centers. You want 37.7 square feet per person. Take the total square footage of the space and divide by 37.7 and that will tell you generally how many people you can shelter in that space. Within the shelter space, the sleeping areas should be configured to allow for separation between cots or bunks (distance of 2.5 feet is good when we are not in this situation, the more you can increase this, the better right now), and a head to toe configuration of arranging how people bunk down. 

If you are opening a new space for sheltering, aim for the following:

• A minimum of one (1) washroom that is barrier-free, fully accessible and designated gender-neutral

• A minimum of one (1) toilet for every fifteen (15) clients up to the first one-hundred (100) clients, and one (1) toilet for every thirty (30) clients thereafter. Urinals may replace up to half the number of required toilets in men’s bathrooms

• A minimum of one (1) washbasin for every fifteen (15) clients

• A minimum of one (1) soap dispenser within 0.6 m. (2 ft.) of each washbasin

• A minimum of one (1) shower for every twenty (20) clients.

How you staff and support people in shelter may also look different.  With staffing shortages as staff become sick or their loved ones do, you may be forced to look at skeleton crews and dedicated schedules for essential services, including janitorial work. Some shelters may find it better to adopt scheduling practices used by first responders such as “staffing in place” with longer shift rotations…like three days on, three days off. Naturally, the three days on will require staff to sleep in shifts in the place they are providing shelter in order to manage fatigue and maintain wellness.

Unless you set up your shelter intake process properly across your system, and you add shelter capacity, you can expect some people to start moving from one shelter location to another, especially if they think it offers the likes of a break in routine, better amenities, better food, or more relaxed rules. You actually want to put policies and procedures in place now that decreases the likelihood of people on the move in such a manner.

Also think of how people use your space when lines are involved. If you still have people that queue up for shelter access, bathroom use or meals, ensuring social distancing remains in place as best as possible when people are in line

If you are using a facility that was never designed to be a shelter, you should give some thought to air exchanges over the course of the hour and whether or not the number of air exchanges are sufficient for the volume of people in the facility. The more air exchanges per hour, the better.

Examine every single rule or policy that may, under other circumstances, result in the individual or family being asked to leave the shelter, if only for a brief period of time. Ask yourself at this point which of these are 100% essential at this period of time, in these unprecedented conditions. Removing or relaxing as many rules or policies as possible is not going to put already vulnerable people into, perhaps, a more vulnerable situation.

While we have no idea at this point when this will happen, if you expand capacity now you need to be putting some thought into how you will retract capacity later – if this is truly an interim measure. (In some communities this may permanently increase shelter capacity which may or may not be a good thing based upon a slew of variables.)

Quarantine Locations

Already in many communities there is a struggle to figure out where the best location will be to quarantine people who are homeless because of the virus. The best advice on this one is this: do not let the homeless services system become solely responsible for solving this potential need. Some within the health community have never been to a shelter or other homeless services facility and have zero idea that this is not a possibility or practice, unless there are fully health specialist-staffed, separate facilities just for homeless individuals and families to be quarantined. Only in rare circumstances with rare building configurations can I think of any shelter where establishing a quarantined wing may be possible. And even then, they will need people with greater health expertise to provide the human resources necessary.

Do Outreach Differently

If your community has expanded shelter accommodation or motel options, your outreach has likely moved from intensive supports to a desire to connect people that are unsheltered to the latest available emergency shelter options at this time.

If you do not have increased capacity, now is not the time to be spending precious time to try and thread the needle of having people compete for a single shelter space. Instead, focus on knowing where all encampments are. This will be critical for future contact tracking in some instances. Remember to maintain social distancing when engaging and use personal protective equipment to decrease health risks for you and your clients. With so many community services impacted, dropping off supplies so people can meet their basic needs is okay. If you are not gloved when doing so, consider leaving a plastic bag with disinfecting wipes for people to use when they receive the materials to they can wipe them clean.

Take the time to plan your outreach efforts. Prioritize who you want to reach based upon things like how vulnerable people are within different areas, as well as how mobile the people living within the encampment are. For example, a sequestered camp that has little to no interaction with the outside world may be served differently (less frequently) than a camp in a dense urban environment with lots of interaction with others.

There will be some people who were sheltered that choose to become unsheltered at this time if they deem it safer than the possibility of disease transmission within shelters. The outreach worker needs to use existing knowledge from HMIS when engaging these individuals and families rather than treating them as new individuals or families to be served. Continuity of service is better than repeating stuff that has already been done or is in the works to support the individuals or families.

Be very clear the purpose of your outreach at this time, and how the intention of the outreach may currently be different than if these were normal times. You don’t want to confuse people now or later.

Now May Be the Time When Some Sanctioned Encampments Make Sense

This is not the case for every community, but for some, centralizing outdoor camping opportunities (with appropriate spacing between tents) may make the most sense for ensuring there are hand-washing facilities, toilet facilities and food drop-off or preparation locations that are easier to serve and support. Unless your jurisdiction is special, remember that people cannot be forced to these locations, only encouraged to access them if required to take care of their needs.

Do Housing-Based Support Differently

There will be a natural tendency to move towards “checking in” with program participants as opposed to doing case management supports remotely.  We will have more on this in the not too distant future, but suffice to say we need to balance this. Yes, the immediate welfare of the people you are supporting in housing is paramount. But that does not mean we should abandon all previously constructed goals. There may be a need to examine goals, timelines and activities associated with them, but do not abandon them. Spend time figuring out if there are methods for staying in contact with program participants through phone calls or FaceTime or similar technologies. For those where technology is not an option, you may still need to provide them written information on how to contact you and how to be supported at this time. That can be mailed if necessary. Don’t think that because you have not heard from some individuals or families that all is okay in their world.  Professional responses to pandemics must recognize and respond to the impact of fear and anxiety on the mental wellness and housing stability of participants as well as the immediate needs for basic supplies and medical screening.

Harm Reduction and Supporting People Who Use Substances Can Look Differently and Presents Unique Challenges

Where, how and what people use when it comes to alcohol and other drugs can look quite differently during these times. If there is an appetite, now may be the time to institute a Managed Alcohol Program or Safer Consumption Site.

Here are some practical questions and thoughts to consider in your planning and actions at this time:

• How do people with dependency on alcohol or other drugs get access to their product of choice at this time? If we are practicing social distancing and decreasing community interaction, can we make alcohol or other drugs (or safe alternatives for detoxing or reduction) available to people where they are at rather than expecting people to go into the community?

• For people working on cessation or abstinence, how can they access supports at this time? There are online AA meetings, for example, but people may need access to technology to take advantage of this opportunity.

• As people’s product supply chain may change, they may not be as familiar with the product they are using or its potency. Encourage people to protect themselves by starting with smaller dosages first to reduce unintended overdoses.

• Alternate use methods may be the key to success for some to make what product is scarcely available last longer. Now may be the time for the conversation about alternative administration techniques such as booty bumping, for example.

• Using with a close friend may not be an option right now. Talking with people about how to plan the in-tox can become important so that people are safe, thinking about overdose prevention, and managing appropriate social distancing.

• Source of income like panhandling or sex work to afford substances will be on the decline. This will leave some in a state where a medical intervention may be required if they were dependent on a substance like alcohol that they cannot access right now. A number of others will be dope sick. Assisting staff on how to incorporate harm reduction conversations and resources in their interactions with participants will be essential.

Do Coordinated Entry Differently

Now is not the time to abandon coordinated entry, but it does require doing it differently. There will still be vacancies to be filled and many landlords have adapted their practices for lease signings and move-ins during this period of time. On the front end of coordinated entry, move to phone screening and diversion practices, as well as telephone-based triage and assessment whenever possible. Of all the horribleness of this current time, one silver lining is that you may be able to reach some very vulnerable people who otherwise are service adverse. You don’t want to miss this opportunity to get them included in your CES.

Compassion Fatigue Will Set in Quick Under Certain Conditions

You have likely felt the overwhelming need to ramp up service efforts differently in response to the identification of a global pandemic. It is important to recognize that this is the first wave. There are more waves to come. When you and others in your organization treat this event as a sprint rather than a marathon, you will feel the impacts much more acutely and staff become less effective. In terms of preparedness and endurance, remember that planning for a marathon – rather than a short, powerful sprint – is the best approach to maintain effectiveness and efficiency within the midst of a pandemic. Now is not the time to measure heroes by going above and beyond as fast as possible. Heroes now are those that can put a vision in place for how to manage each wave of impact (including wellness concerns, demands for service and compassion fatigue) and space out the impacts on staff across each wave with the use of evidence informed approaches.

Be Prepared for Stigma

The good news is that some people are talking favorably about intervening in the crisis of homelessness that previously had no interest in homelessness. However, should COVID-19 be found in the homeless population or if there is spread of COVID-19 within the homeless population, be prepared for considerable stigma against the homeless population. There is the possibility of wanting all homelessness driven out of town or have restrictions upon them that do not apply to the rest of the population. Being strategic regarding communication, policies and practices that impact neighbors experiencing homelessness must continue to be a priority in our work.

Collect and Respond to FAQs from Service Users and Staff

Provide sticky notes, a white board or a note pad for your service users and staff to ask their most pressing questions. Then prepare an evidence-informed response to those FAQs in an easily accessed location that promotes facts, not fears. If you don’t know the answers, ask experts who can answer them for you. There will continue to be different rumors and opinions, as well as updated and changing directives. Cut through the noise. Deliver the most up-to-date facts you can. You can probably safely assume that you and your organization have access to credible sources more than people without access to technology. 

Monitor and Reorder Supplies, Especially Food, Hand Sanitizer and PPE

Food security will potentially become an issue moving forward. If you provide meals on the site, starting figuring out your back-up plan if these meals or ingredients to prepare meals are sidelined in the not too distant future. You don’t want to be scrambling later to figure out how to feed people if this goes off the rails. The availability of more non-perishables will help tremendously in weathering the storm.

As for hand sanitizer and personal protective equipment (PPE), yes, health providers are sounding the alarm that these are already limited and in short supply. Better to get your order in the queue now for future supplies, rather than throwing your hands up. Also, you may want to begin researching alternate (and not as good or recommended) approaches to ensuring there is some protection in contact with program participants rather than no protective equipment.

Create an Electronic Wish List that Can Be Filled

Think of the stuff you NEED as an organization to keep running during this time. Create a wish list on Amazon, for example. Every outside person or organization that wants to help with homelessness during this time but cannot visit your organization to drop off supplies should be redirected to your wish list where delivery of the required items can be activated.  Many online retail sites are now offering free delivery on all orders so optimize this opportunity when possible.