How States Are Housing the Homeless During a Pandemic

May 20, 2020 | ASTHO Staff

On a single night in 2019, roughly 568,000 Americans experienced homelessness. Of those, two-thirds were staying in emergency locations or transitional housing and more than one-third were unsheltered according to the U.S. Department of Housing and Urban Development (HUD) in the 2019 Annual Homeless Assessment Report to Congress.

COVID-19 can spread easily and quickly in settings where many people live in close proximity, such as emergency homeless shelters and transitional housing—creating additional challenges around homelessness in this pandemic. The unsheltered homeless population is also at risk. While they may be able to maintain the physical distance necessary to prevent the spread of infection, sleeping outdoors does not provide protection from the environment, adequate access to hygiene and sanitation facilities, or connection to services. Recovery and healing are more difficult without housing, further complicating COVID-19 risks and symptoms.

It’s possible to see an increase of homelessness as a result of COVID-19, especially with the rise in unemployment. Poor health and the costs of treatment are also major causes of homelessness, and lack of safe shelter exacerbates existing health problems. In addition to the potential complicating factors of COVID-19, homeless individuals are at risk for experiencing high rates of health problems, such as HIV infection and drug abuse, mental illness, tuberculosis. They also tend to experience barriers to care, lack of access to adequate food and protection, and limited resources and social services.

In response to the pandemic, Congress passed the Coronavirus Aid, Relief, and Economic Security (CARES) Act, which provides states with $497,493,000 in Emergency Solutions Grants to address the impact of COVID-19 among individuals and families who are homeless or at risk of homelessness. It also authorizes $200 million for the Indian Housing Block Grant program, which will be used to prevent homelessness due to lost income from the coronavirus among tribal populations. HUD released a Disaster Recovery Homelessness Toolkit that promotes a "Housing First" strategy—including rapid placement and stabilization in permanent housing for homeless individuals—and a recovery guide addressing post-disaster homelessness. Similarly, CDC emphasized prioritizing linkages to permanent housing, while encouraging housing options that have individual rooms and separate bathrooms, such as hotels, be used for the overflow, quarantine, and protective housing sites.

At the state level, policymakers have sought to prevent the spread of COVID-19 by focusing on non-congregate sheltering and alternative housing for homeless populations, restricting the use of hotels and other lodging specifically for homeless individuals. States have also proposed legislation to provide economic assistance, funding, and grants to address homelessness in response to the COVID-19 pandemic. Below is an overview of the policies to address to provide support to the vulnerable populations experiencing homelessness during the COVID-19 pandemic.

Governors in several states—Alabama, Alaska, Connecticut (Executive Order 7P and subsequent Department of Public Health Order), Ohio, and Vermont— issued executive orders calling for non-congregant shelters to be identified and utilized for those experiencing homelessness or those unable to safely self-quarantine. New Hampshire’s governor issued Emergency Order No. 27 restricting hotels and other lodging to only be used vulnerable populations and essential workers, including children in emergency placements, victims or at-risk persons of domestic violence, and homeless individuals. The governor also issued Emergency Order No. 28, which directed state, local, and private sector partners to work together to identify isolation sites for COVID-19 positive individuals, those with symptoms, and individuals experiencing homelessness. The order also called for the cross-sector partners to create a plan and collaborate with communities to reduce the numbers of individuals in shelters.

Many states are considering bills to provide economic assistance and funds to help prevent the spread of COVID-19 among homeless populations. Arizona enacted legislation establishing the Crisis Contingency and Safety Net Fund. Money from the fund may be used to provide services for homeless persons, including shelter, food, clothing, and transportation. The Ohio legislature is considering a bill that would appropriate funds to support homeless shelters during the COVID-19 pandemic. Similarly, Alaska enacted a bill providing financial assistance to address or prevent homelessness caused by COVID-19.

Pennsylvania is considering a bill that would establish the Emergency COVID-19 Homelessness Grant Program, which would support non-profit organizations and local governments that provide community-based services and programs to secure shelter, housing, food, essential supplies, public assistance benefits, and sanitation measures to protect the health and well-being of individuals who are homeless. The Department of Human Services would be directed to award grants for the following purposes: shelter or securing part-time or full-time housing; food and essential supplies; sanitation and personal hygiene measures, including, but not limited to, outdoor latrines, hand-washing stations and personal protective equipment; and any other related services that support individuals who are homeless.

Recognizing that between 22 and 57 percent of all homeless women report that domestic violence was the immediate cause of the their homelessness—and that sheltering in place will slow the spread of COVID-19—California’s legislature proposed a bill requiring at least 12 percent of funds allocated for homelessness prevention or support be used domestic violence survivor services. Another California bill would require the Homeless Coordinating and Financing Council to collect data on the number of people experiencing homelessness who accessed interventions like shelters, recuperative care, and motel and hotel stays, in response to the COVID-19 pandemic. The District of Columbia enacted legislation authorizing the mayor to put families in interim eligibility placement for homeless services for 60 days during the public health emergency.

In Massachusetts, a proposed bill (S 2656) calls on the Department of Housing and Community Development to establish a grant program that’ll provide funding to operate temporary shelters for homeless individuals established in "Gateway Cities" during the COVID-19 state of emergency. Massachusetts is also considering a bill (H 4688) that would create a bill of rights for people experiencing homelessness. This would grant them enumerated rights, including: the right to rest in public spaces and seek protection from adverse weather or an imminent public health emergency, the right to access routine and emergency medical care free from discrimination on the basis of housing status, and the right to access testing and health care related to the coronavirus for the entirety of the COVID-19 pandemic.

Health agencies are in a unique position to educate policymakers on the links between homelessness and poor health outcomes and the increased risk of infection from COVID-19 and other infectious diseases. Curbing the spread of COVID-19—and addressing the social determinants of health generally—with require engaging partnerships with housing agencies and community organizations to secure adequate and safe housing, health care services, and other services that will improve financial stability. ASTHO will continue to track this important public health issue.