CDC: Homeless shelters can screen clients for symptoms of respiratory infections. Clients who have symptoms may or may not have COVID-19. Make sure they have a separate place they can safely stay within the shelter or at an alternate site in coordination with local health authorities. An on-site nurse or other clinical staff can help with clinical assessments.
- Provide anyone who presents with symptoms with a mask.
- Facilitate access to non-urgent medical care as needed.
- Use standard facility procedures to determine whether a client needs immediate medical attention. Emergency signs include:
- Trouble breathing
- Persistent pain or pressure in the chest
- New confusion or inability to arouse
- Pale, gray, or blue-colored skin, lips, or nail beds, depending on skin tone
Notify the designated medical facility and personnel to transfer clients that the client might have COVID-19.
VA: “Know if your community has an eviction moratorium and when it expires and if there might be an extension. Prepare for a potential influx of homeless prevention cases. Coordinate with key partners (legal aid, tenant rights groups, courts, etc.) and fellow SSVF grantees in your area, legal aid and other groups that work on homelessness prevention.
Do not wait until eviction moratoriums are lifted to identify and enroll at-risk Veterans. By enrolling Veterans who are severely debt burdened by their rent before an eviction moratorium lifts, SSVF is better positioned to intervene and coordinate a resolution to the housing crisis with the Veteran and landlord. While grantees should still do their best to document – via the landlord or problem solving conversations with the Veteran – that the household will become homeless once the moratorium is lifted, they do not need to wait until the eviction notice is formally offered to make that enrollment.
Understand your local tenant laws related to eviction. Eviction means different things in different communities. Make sure you understand the timelines associated with housing loss from eviction and how that impacts the SSVF intervention.”
CDC: “Health departments and administrators of homeless service sites, in partnership with healthcare providers, should decide whether and how to implement these testing considerations to identify cases among people who are asymptomatic, including both those with and without known exposure to COVID-19.
Those providing services for people experiencing homelessness should continue to follow guidance for basic COVID-19 prevention among people who are staying in homeless shelters or experiencing unsheltered homelessness.
Facility-wide (universal) testing involves offering viral testing for SARS-CoV-2 to all clients and staff who were affiliated with the site or encampment any time from 2 days before the individual began experiencing symptoms, or 2 days before a positive test in an asymptomatic individual, until they were isolated.
Any client who tests positive should be connected to a place where they can safely isolate and access necessary services until they meet criteria to discontinue isolation.
Staff who test positive should be advised to seek medical care as needed and to stay home until they meet criteria to discontinue isolation.
Repeat testing of all previously negative or untested clients, staff, and volunteers (e.g., once a week) is recommended until the testing identifies no new cases of COVID-19 for at least 14 days since the most recent positive result.
It will not always be possible to provide testing to every individual who would qualify, but the intent is to broadly offer testing to anyone who might have been exposed.
Community transmission categories: The transmission categories included in Table 1 are described in the CDC Community Mitigation Framework. Health departments should consider setting precise incidence indicators that reflect these categories and are suitable to the local context.”
FEMA: “Sheltering solutions should be determined by the Applicant requesting assistance, such as hotels, motels, dormitories, or other forms of non-congregate sheltering. The solutions should meet the criteria of non-congregate sheltering for the COVID-19 emergency, including what is necessary to protect public health and safety, be in accordance with guidance provided by appropriate health officials, and be reasonable and necessary to address the threat to public health and safety.”
FEMA: “Examples of target populations include those who test positive for COVID-19 who do not require hospitalization but need isolation (including those exiting from hospitals); those who have been exposed to COVID-19 who do not require hospitalization; and asymptomatic high-risk individuals needing social distancing as a precautionary measure, such as people over 65 or with certain underlying health conditions (respiratory, compromised immunities, chronic disease). Sheltering specific populations in non-congregate shelters should be determined by a public health official’s direction or in accordance with the direction or guidance of health officials by the appropriate state or local entities. The request should specify the populations to be sheltered. Non-congregate sheltering of healthcare workers and first responders who require isolation may be eligible when determined necessary by the appropriate state, local, tribal, or territorial public health officials and when assistance is not duplicated by another federal agency.”
FEMA: “The term “medical sheltering” is meant to address the specific needs directly resulting from this Public Health Emergency. For purposes of eligibility under the COVID-19 declarations, FEMA will consider non-congregate sheltering for health and medical-related needs, such as isolation and quarantine resulting from the public health emergency. Alternate care sites and temporary hospitals are not considered non-congregate sheltering and such requests should be routed through the proper channels.”
CDC:
- “If possible, consider individual room or housing options for older adults or those with serious underlying medical conditions to decrease exposure potential.
Avoid moving those at higher risk for severe illness into shared settings.”
CDC: Homeless service providers should:
- “Use physical barriers to protect staff who will have interactions with clients with unknown infection status (e.g., check-in staff). For example, install a sneeze guard at the check-in desk or place an additional table between staff and clients to increase the distance between them to at least 6 feet.
- In meal service areas, create at least 6 feet of space between seats, and/or allow either for food to be delivered to clients or for clients to take food away.
- In general sleeping areas (for those who are not experiencing respiratory symptoms), try to make sure client’s faces are at least 6 feet apart.
- Align mats/beds so clients sleep head-to-toe.
- For clients with mild respiratory symptoms consistent with COVID-19:
- Prioritize these clients for individual rooms.
- If individual rooms are not available, consider using a large, well-ventilated room.
- Keep mats/beds at least 6 feet apart.
- Use temporary barriers between mats/beds, such as curtains.
- Align mats/beds so clients sleep head-to-toe.
- If possible, designate a separate bathroom for these clients.
- If areas where these clients can stay are not available in the facility, facilitate transfer to a quarantine site.
- For clients with confirmed COVID-19, regardless of symptoms:
- Prioritize these clients for individual rooms.
- If more than one person has tested positive, these clients can stay in the same area.
- Designate a separate bathroom for these clients.
- Follow CDC recommendations for how to prevent further spread in your facility.
- If areas where these clients can stay are not available in the facility, assist with transfer to an isolation site.”
CDC: Homeless service providers should:
- “Plan to maintain regular operations to the extent possible.
- Limit visitors who are not clients, staff, or volunteers.
- Do not require a negative COVID-19 viral test for entry to a homeless services site unless otherwise directed by local or state health authorities.
- Identify clients who could be at high risk for complications from COVID-19, or from other chronic or acute illnesses, and encourage them to take extra precautions.
- Arrange for continuity of and surge support for mental health, substance use treatment services, and general medical care.
- Identify a designated medical facility to refer clients who might have COVID-19.
- Keep in mind that clients and staff might be infected without showing symptoms.
- Create a way to make physical distancing between clients and staff easier, such as staggering meal services or having maximum occupancy limits for common rooms and bathrooms.
- All clients should wear cloth face coverings any time they are not in their room or on their bed/mat (in shared sleeping areas). Cloth face coverings should not be placed on young children under age 2, anyone who has trouble breathing, or is unconscious, incapacitated or otherwise unable to remove the mask without assistance.
- Regularly assess clients and staff for symptoms.
- Clients who have symptoms may or may not have COVID-19. Make sure they have a place they can safely stay within the shelter or at an alternate site in coordination with local health authorities.
- An on-site nurse or other clinical staff can help with clinical assessments.
- Provide anyone who presents with symptoms with a cloth face covering.
- Facilitate access to non-urgent medical care as needed.
- Use standard facility procedures to determine whether a client needs immediate medical attention. Emergency signs include:
- Trouble breathing
- Persistent pain or pressure in the chest
- New confusion or inability to arouse
- Bluish lips or face
- Notify the designated medical facility and personnel to transfer clients that the client might have COVID-19.
- Prepare healthcare clinic staff to care for patients with COVID-19, if your facility provides healthcare services, and make sure your facility has a supply of personal protective equipment.
- Provide links to respite (temporary) care for clients who were hospitalized with COVID-19 but have been discharged.
- Some of these clients will still require isolation to prevent transmission.
- Some of these clients will no longer require isolation and can use normal facility resources.
- Make sure bathrooms and other sinks are consistently stocked with soap and drying materials for handwashing. Provide alcohol-based hand sanitizers that contain at least 60% alcohol at key points within the facility, including registration desks, entrances/exits, and eating areas.
- Cloth face coverings used by clients and staff should be laundered regularly. Staff involved in laundering client face coverings should do the following:
- Face coverings should be collected in a sealable container (like a trash bag).
- Staff should wear disposable gloves and a face mask. Use of a disposable gown is also recommended, if available.
- Gloves should be properly removed and disposed of after laundering face coverings; clean hands immediately after removal of gloves by washing hands with soap and water for at least 20 seconds or using an alcohol-based hand sanitizer with at least 60% alcohol if soap and water are not available.
- Clean and disinfect frequently touched surfaces at least daily and shared objects between use using an EPA- registered disinfectant external icon.”
CDC: Homeless service providers should:
- “Provide training and educational materials related to COVID-19 for staff and volunteers.
- Minimize the number of staff members who have face-to-face interactions with clients with respiratory symptoms.
- Develop and use contingency plans for increased absenteeism caused by employee illness or by illness in employees’ family members. These plans might include extending hours, cross-training current employees, or hiring temporary employees.
- Staff and volunteers who are at higher risk for severe illness from COVID-19 should not be designated as caregivers for sick clients who are staying in the shelter. Identify flexible job duties for these higher risk staff and volunteers so they can continue working while minimizing direct contact with clients.
- Put in place plans on how to maintain social distancing (remaining at least 6 feet apart) between all clients and staff while still providing necessary services.
- All staff should wear a cloth face covering for source control (when someone wears a covering over their mouth and nose to contain respiratory droplets), consistent with the guidance for the general public. See below for information on laundering cloth face coverings.
- Staff who do not interact closely (e.g., within 6 feet) with sick clients and do not clean client environments do not need to wear personal protective equipment (PPE).
- Staff should avoid handling client belongings. If staff are handling client belongings, they should use disposable gloves, if available. Make sure to train any staff using gloves to ensure proper use and ensure they perform hand hygiene before and after use. If gloves are unavailable, staff should perform hand hygiene immediately after handling client belongings.
- Staff who are checking client temperatures should use a system that creates a physical barrier between the client and the screener as described here.
- Screeners should stand behind a physical barrier, such as a glass or plastic window or partition that can protect the staff member’s face from respiratory droplets that may be produced if the client sneezes, coughs, or talks.
- If social distancing or barrier/partition controls cannot be put in place during screening, PPE (i.e., facemask, eye protection [goggles or disposable face shield that fully covers the front and sides of the face], and a single pair of disposable gloves) can be used when within 6 feet of a client.
- However, given PPE shortages, training requirements, and because PPE alone is less effective than a barrier, try to use a barrier whenever you can.
- For situations where staff are providing medical care to clients with suspected or confirmed COVID-19 and close contact (within 6 feet) cannot be avoided, staff should at a minimum, wear eye protection (goggles or face shield), an N95 or higher level respirator (or a facemask if respirators are not available or staff are not fit tested), disposable gown, and disposable gloves. Cloth face coverings are not PPE and should not be used when a respirator or facemask is indicated. If staff have direct contact with the client, they should also wear gloves. Infection control guidelines for healthcare providers are outlined here.
- Staff should launder work uniforms or clothes after use using the warmest appropriate water setting for the items and dry items completely.
- Provide resources for stress and coping to staff. Learn more about mental health and coping during COVID-19.”
CDC: “Planning and response to COVID-19 transmission among people experiencing homelessness requires a “whole community” approach, which means that you are involving partners in the development of your response planning, and that everyone’s roles and responsibilities are clear.”
A whole-community approach will connect key partners and build a community coalition that includes:
- “Local and state health departments
- Homeless service providers and Continuum of Care leadership
- Emergency management
- Law enforcement
- Healthcare providers
- Housing authorities
- Local government leadership
- Other support services like outreach, case management and behavioral health support”
CDC: “Across the United States, some states and local areas are preparing to reopen businesses and community centers after closing. Even if COVID-19 cases have decreased in your area, quick spread of this disease in homeless shelters or encampments is possible. Protection of clients and staff remains necessary. During this time, continue to refer to the guidance for homeless service providers and unsheltered homelessness.”
Refer to the CDC’s Homeless Service Providers Re-Opening Checklist
HHS: RHY grantees are encouraged to work closely with their state and local public health authorities on issues related to addressing COVID-19 within their organizations and communities.
If you identify any youth with severe symptoms, notify your public health authority and arrange for the youth to receive immediate medical care. If this is a youth with suspected COVID-19, notify the transfer team and medical facility before transfer.
RHY grantees are encouraged to review the “Interim Guidance for Homeless Service Providers to Plan and Respond to Coronavirus Disease 2019 (COVID-19)” available at the CDC website: https://www.cdc.gov/coronavirus/2019-ncov/community/homeless- shelters/plan-prepare-respond.html.
Additionally, pursuant to the RHY Rule (45 CFR §1351.22), RHY grantees may adopt criteria “to determine eligibility for the program, or any activity or service, [that] may include an assessment of the needs of each applicant, and the health and safety of other beneficiaries, among other factors.”
HHS: “RHY grantees are encouraged to work closely with their state and local public health authorities on issues related to addressing COVID-19 in their organizations and communities. A list of state and territorial health departments and links to their websites can be found at the Center for Disease Control and Prevention’s (CDC) Public Health Professionals Gateway: https://www.cdc.gov/publichealthgateway/healthdirectories/healthdepartments.html. Additional information is also available at the Runaway and Homeless Youth Training and Technical Assistance Center website: https://www.rhyttac.net/covid-19”
HHS: “For youth under the age of 18, pursuant to the RHY Act (34 USC §11212(b)(2)(A-B)), BCPs must have “a maximum capacity of not more than 20 youth, except where the applicant assures that the State where the center or locally controlled facility is located has a State or local law or regulation that requires a higher maximum to comply with licensure requirements for child and youth serving facilities; and (B) a ratio of staff to youth that is sufficient to ensure adequate supervision and treatment.” As such, RHY grantees should consult with the appropriate State authority or local regulatory/licensing agencies to determine if it has increased its required maximum capacity for child and youth serving facilities as a result of the COVID-19 emergency.
Specific to TLPs/MGHs, pursuant to the RHY Act (34 U.S.C §11222(a)(4)), the “shelter facility used to carry out such project shall have the capacity to accommodate not more than 20 individuals.” The RHY Rule provides further clarification, at 45 CFR §1351.18(c), by stating that the capacity to accommodate not more than 20 individuals must be “within a single floor of a structure in the case of apartment buildings, with a number of staff sufficient to assure adequate supervision and treatment for the number of clients to be served and the guidelines followed for determining the appropriate staff ratio.”
CDC: “Connecting people to stable housing should continue to be a priority. However, if individual housing options are not available, allow people who are living in encampments to remain where they are. Encourage people living in encampments to increase space between people and provide hygiene resources in accordance with the Interim Guidance for People Experiencing Unsheltered Homelessness.”
CDC: “Homeless service providers can accept donations during community spread of COVID-19, but general infection control precautions should be taken. Request that donors not donate if they are sick. Set up donation drop-off points to encourage social distancing between shelter workers and those donating. According to usual procedures, launder donated clothing, sheets, towels, or other fabrics on high heat settings, and disinfect items that are nonporous, such as items made of plastic. Food donations should be shelf-stable, and shelter staff should take usual food-related infection prevention precautions. For more information about COVID-19 and food, see the Food and Drug Administration’s website on Food Safety and COVID-19. For further information on cleaning and disinfection, see here.”
CDC: “Those with suspected or confirmed COVID-19 should stay in a place where they can best be isolated from other people to prevent spreading the infection. Local health departments, housing authorities, homeless service systems and healthcare facilities should plan to identify locations to isolate those with known or suspected COVID-19 until they meet the criteria to end isolation. Isolation housing could be units designated by local authorities or shelters determined to have capacity to sufficiently isolate these people. If no other options are available, homeless service providers should plan for how they can help people isolate themselves while efforts are underway to provide additional support. Please see the Interim Guidance for Homeless Service Providers and Interim Guidance for People Experiencing Unsheltered Homelessness for more information.”
CDC: “If they meet criteria for testing, people experiencing homelessness will access COVID-19 testing through a healthcare provider. Local public health and healthcare facilities need to determine the best location for this testing in coordination with homeless healthcare clinics and street medicine clinics.”
CDC: “Many of the recommendations to prevent COVID-19 may be difficult for a person experiencing homelessness to do. Although it may not be possible to avoid certain crowded locations (such as shelters), people who are homeless should try to avoid other crowded public settings and public transportation. If possible, they should use take-away options for food. As is true for everyone, they should maintain a distance of about 6 feet (two arms’ length) from other people. They also should wash their hands with soap and water for at least 20 seconds as often as possible, and cover their coughs and sneezes.”
CDC: “Any person experiencing homelessness with symptoms consistent with COVID-19 (fever, cough, or shortness of breath) should alert their service providers (such as case managers, shelter staff, and other care providers). These staff will help the individual understand how to isolate themselves and identify options for medical care as needed.”
CDC: “People who are homeless are at risk of COVID-19. Homeless services are often provided in congregate settings, which could facilitate the spread of infection. Because many people who are homeless are older adults or have underlying medical conditions, they may also be at higher risk for severe disease than the general population. Health departments and healthcare facilities should be aware that people who are homeless are a particularly vulnerable group. If possible, identifying non-congregate settings where those at highest risk can stay may help protect them from COVID-19.”
