By Dora Barilla & Rishi Manchanda
May 18, 2020 at 5:00 am ET
According to conservative estimates, more than 21,000 people experiencing homelessness could be hospitalized due to COVID-19. For those who recover, where will they go? Hundreds of thousands more could be infected — without homes, where will they stay? Without safe ways to care for people without homes, how will communities prevent the virus from spreading? What will happen to unsheltered people when the pandemic threat is diminished?
State and local leaders, public health departments and nonprofits have rallied to answer these questions with swift action. In California, the governor and mayors are now working to secure up to 15,000 hotel rooms to provide safe spaces for people experiencing homelessness. In Washington, Seattle and King County have created new 24/7 shelters and other places for homeless individuals to stay while recovering from COVID-19. Early lessons from these communities show us how political will and coordinated cross-sector action can save lives.
Hospitals can strengthen these heroic community-led efforts.
Provide emergency funds and long-term support for essential services
Nonprofits that provide essential services for basic social needs are now under tremendous strain. While Congress considers critical nonprofit relief measures, hospitals can use their treasury funds and extend direct loans, guarantees and lines of credit to nonprofits. Nonprofit hospitals also can ramp up “community benefit” funds — spending to meet community needs — to support local coalitions of homeless service providers and community clinics.
There are important opportunities for hospitals to work with partners to target resources using data on community-level social vulnerability. In Washington, for instance, Providence provided $25,000 in unrestricted emergency funds to keep local homeless shelters open. With their broad community footprints, hospitals can also help align local response funds with “Wellness Trusts” — local, long-term financial trusts used to spur cross-sector investments in affordable housing and other essential community health infrastructure.
Support public health response efforts
People experiencing homelessness are at extraordinarily high risk of getting infected, suffering severe symptoms and dying from COVID-19. In response, county public health leaders are expanding testing, safe isolation and treatment for this population.
Hospitals can enhance this critical public health capability by sharing testing data with public health departments and by repurposing available resources to support care strategies. In California, for example, Providence has sent rapid mobile health teams to homeless shelters, is helping to expand a local Medical Reserve Corps and loaned mobile clinics to county health departments to support testing and care for hundreds in temporary housing. At community testing sites, hospitals can also support screening for housing insecurity and other health-related social needs.
Fast-track steps to house and care for people without homes
The most fundamental way a community can save the lives of people experiencing homelessness is to provide them with homes. At this moment, hospital beds are filling up. Case managers are struggling to find a safe place to discharge unsheltered patients who’ve recovered from COVID-19. Community action to immediately house people experiencing homelessness, including those who need isolation and quarantine, is essential to preserving the capacity of health systems to care for the sick.
In Northern California, Providence funds are being used to support medical respite providers to care for homeless patients who no longer need hospital-level care. And in California and Seattle, hospital leaders are working with homeless service providers to deploy telemedicine to support thousands of homeless individuals now living in repurposed hotels and community isolation/quarantine sites.
Accelerate “Housing First” and other efforts to end homelessness
When this crisis begins to diminish, we must ensure that people experiencing homelessness are not forced back on the streets. Hospitals can come alongside community partners to help leverage private and public funds to accelerate and scale “Housing First” solutions, which provide chronically homeless individuals with immediate access to long-term housing and supportive services. Demonstrated benefits include up to 44 percent fewer emergency department visits and 39 percent fewer hospital visits.
In Seattle, for example, Providence, Swedish and Premera Blue Cross each invested $5 million for expansion of eight new housing locations operated by Plymouth Housing for people experiencing homelessness. In California, Providence is also supporting local nonprofit coalition-led advocacy efforts, from enforcing eviction moratoriums to economic relief for families at risk of losing their homes.
In this crisis, saving lives requires many heroes — in hospitals, public health departments and communities. Saving the lives of people experiencing homelessness and other vulnerable populations has propelled these heroes into bold new ways of working together. When the crisis is over, we should not let go of the solutions and innovations that housed and sheltered so many. Now more than ever, hospitals can and should be advocates and participants in homelessness prevention.
Dora Barilla, DrPH, is group vice president of Community Health Investment for Providence. Rishi Manchanda, MD MPH, is CEO of HealthBegins.
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