USA: Emergency homeless services during the COVID-19 crisis

By Aaron Clark-Ginsberg, Sarah B. Hunter, and Benjamin Henwood

The recently passed $2 trillion stimulus package includes a suite of measures designed to support households being impacted by the COVID-19 outbreak. However, policymakers may want to consider what protections it offers to a particularly high-risk group: people experiencing homelessness. Will the $4 billion for emergency homeless services and the $1200 stimulus checks that the bill provides to support this population adequately address sheltering and service needs? Or perhaps more importantly, it might be worth examining whether, without additional support, both people experiencing homelessness and the broader general population would continue to face risks associated with COVID-19.

Examining the COVID-19 outbreak from a disaster research perspective helps illuminate why people experiencing homelessness may need more support than what the stimulus package offers. Disaster research has developed an understanding of risk as more than an intrinsic property of a hazard. Risk is also socially-constructed, the result of societal forces marginalizing certain segments of the population, and shaping exposure, vulnerability, and capacity. Exposure refers to the people or systems in a hazard zone. Vulnerability is the characteristics or circumstances that make people or systems susceptive to damage. And capacity is the strengths and resources that can be used to mitigate risk.

Although disaster impacts vary within different groups, people experiencing homelessness are often highly impacted by disasters due to their high levels of exposure and vulnerability and limited capacity.

People experiencing homelessness may have particularly high levels of exposure to COVID-19 due to issues related to sheltering and work. Being without a permanent home, “sheltering in place” is not an effective option for people experiencing homelessness. Living in places such as parks, shelters, homes of friends and family, and the streets can oftentimes be dense, high-contact areas, making it difficult to practice social distancing. Additionally, most people experiencing homelessness also do not have the luxury of being able to telecommute or work remotely. Instead, they work public-facing jobs that often require high levels of public engagement, such as day laboring, recycling, and panhandling.

People experiencing homelessness are also more likely to have greater vulnerability to the effects of COVID-19 mainly due to their higher than average levels of physical and behavioral health challenges. People experiencing homelessness are disproportionately likely to have chronic and acute physical health problems, including chronic lung disease, hypertension and diabetes, and nutrition-related health issues. They are also more likely to suffer from high rates of stress and other behavioral health problems. These preexisting behavioral and physical health conditions increase susceptibility to other health problems, such as those produced by the coronavirus (PDF).

Facing both greater exposure and vulnerability, people experiencing homelessness also have less capacity in the form of material and social resources to mitigate risks of COVID-19. Buying the recommended two weeks supply of food and 90 days of medication is all but impossible for these people, not to mention hand sanitizer, soap, and other resources that can help minimize exposure. Getting good information is also challenging. Not having a permanent address makes mailing information difficult. Maintaining mobile phone communication can also be a problem. While levels of cell phone ownership are relatively high among those experiencing homelessness, many rely on prepaid phones, have limited data, and can run out of credit. Internet access is similarly patchy. Many of those experiencing homelessness access the internet through local, public spaces, such as libraries and cafes—which are closing in response to the virus outbreak. Some people, such as LGBT youth with unsupportive families or women fleeing abuse, also may not have strong networks on which they can rely for information. In addition, because of previous mistreatment, many of those in marginalized circumstances can be distrusting of institutional sources of information.

Organizations that typically provide assistance for those experiencing homelessness appear to be struggling to meet the immediate needs of this group in light of the COVID-19 outbreak. Typical sources of food such as meal lines and some food banks, are no longer operating. Libraries, cafes, and restaurants where people can normally charge their phones are no longer open. Cities such as San Francisco are also cutting shelter services out of fear of the virus spreading. Frontline workers, such as outreach and supportive service providers, can no longer provide in-person support. Such changes can place additional strain on an already vulnerable group, further exacerbating the impacts of the coronavirus.

Failure to address COVID-19 outbreak among people experiencing homelessness can contribute to broader health challenges, too. Previous health crises such as the 2018 Hepatitis outbreak show how risks can spread from people experiencing homelessness to the general population and vice versa. Past experience indicates that managing something as virulent as the COVID-19 outbreak requires supporting all populations.

Immediate and Long-Term Actions to Address COVID-19 and Homelessness

While the stimulus package offers resources for people experiencing homelessness, according to colleagues at the University of Pennsylvania and Boston University, the $4 billion for emergency homeless services included in the package is far short of the estimated $11.5 billion in new costs (PDF) required to shelter people from the outbreak. They point out that this amount does not even include future costs that are sure to be borne. One of the largest benefits from the package, stimulus checks, may not help either. Many individuals who are currently experiencing homelessness may not receive the $1200 stimulus checks that the package provides because they do not have a mailing address, may not have their banking information on file with the IRS, and face more barriers accessing information.

What would a support package look like that might better address the needs of people experiencing homelessness? Policymakers could consider allocating funding to reduce exposure in shelters by screening individuals who are using shelters for symptoms of COVID-19; using convention centers and other large spaces where social distancing can be practiced as alternative shelters; and providing hand sanitizer, soap, and other resources to reduce contamination. Another option could be offering people their own rooms or apartments to facilitate social distancing. Policymakers could also consider strengthening healthcare programs to reduce vulnerability associated with preexisting physical and behavioral health issues. And, to improve capacity, serious efforts might need to be made to ensure stimulus checks reach everyone, including people experiencing homelessness. Of course, more funding for institutions focusing on homelessness would certainly be worth considering as well.

Implementing options like these could result in less risk–for people experiencing homelessness, the workers who provide homeless services, and for all of us.

Aaron Clark-Ginsberg is an associate social scientist at the nonprofit, nonpartisan RAND Corporation. His research focuses on disaster risk management, including issues related to disaster risk reduction, response, and recovery. Sarah Hunter is a senior behavioral scientist at the nonprofit, nonpartisan RAND Corporation. Her research interests include improving services for vulnerable populations, building community capacity for evidence-based program delivery, and implementation science. Benjamin Henwood is an associate professor and the director of the Center for Homelessness, Housing and Health Equity Research at the University of Southern California Suzanne Dworak-Peck School of Social Work.

Commentary gives RAND researchers a platform to convey insights based on their professional expertise and often on their peer-reviewed research and analysis.