Vox: “Shelter in place” is impossible if you can’t afford a home

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Source:  Vox

By Roge Karma

Social distancing and self-isolation have quickly emerged as essential public health responses to the coronavirus. As of March 31, 270 million people in at least 33 states, 89 counties, and 29 cities across the US have been urged by their government officials to stay home. While these policies often come with seismic life disruptions, the vast majority of Americans are taking them seriously. Most of us don’t even think twice about it: We just stay home.

But “stay-at-home” orders are impossible to follow if you don’t have a home in the first place. The US Department of Housing and Urban Development (HUD) estimates that there are around 550,000 homeless individuals on any given night in America (others estimate that around 2 million people find themselves homeless in a given year).

The coronavirus has exposed the massive weaknesses in our already lacking social support infrastructure for the homeless. Shelters are too understaffed, under-resourced, and crowded to enforce proper social distancing and hygiene measures. Outdoor encampments lack basic sanitation. In some instances, the homeless are being shuttled into empty parking lots and told to sleep on asphalt.

These conditions are not only deeply inhumane, they are a major public health risk. The purpose of social distancing is to prevent putting additional pressure on our already at-capacity health care system. If coronavirus is allowed to rip through the homeless population, it will not only be a humanitarian disaster for the most vulnerable — it will overwhelm the health care system we all depend on.

I spoke with Diane Yentel, the president and CEO of the National Low Income Housing Coalition, to better understand why the homeless are particularly vulnerable to coronavirus, the circumstances homeless shelters are dealing with on the ground, the kinds of policy solutions that can prevent the virus from having devastating consequences for the homeless community, and more.

Roge Karma

In recent weeks restaurants and businesses have closed, public spaces like libraries and parks have been shut down, and, in some cases, entire cities have been told to shelter in place. Many of us don’t think twice about taking measures like self-isolation and social distancing, we just go home. But homeless people, by definition, have nowhere to go. So where does that leave them?

Diane Yentel

It leaves them with tremendous challenges. Many homeless shelters are only open at night. In the morning, they close their doors and the shelter residents are left to find other places for the day. And now, libraries, coffee shops, public parks — all the places where people who are homeless usually congregate during the day — are closed, which leaves them really with no place to go.

This is not only challenging for the people who are experiencing homelessness themselves — it’s also not conducive to social distancing. After spending a day moving about the city, the same people are returning to the shelter to sleep in close quarters. And those close quarters present a whole other set of challenges and risks for people who are homeless.

If a homeless person is particularly vulnerable to the coronavirus — if they are a senior or have underlying health conditions — there’s no place for them to isolate themselves, especially if shelters don’t have the resources that the shelters need to put safety measures in place.

Roge Karma

And if I understand correctly, the homeless generally are far more vulnerable to the serious health risks of coronavirus than the non-homeless population.

Diane Yentel

The population of people who are experiencing homelessness is, on average, much sicker than the general population. Many of them have the underlying health conditions that come often from living in poverty: diabetes, asthma, heart disease, and other chronic health conditions that put them at high risk of more severe cases of coronavirus. These kinds of underlying health conditions are experienced among the homeless population at rates that are three to six times higher than that of the general population.

Within the segment of the homeless population that tends to be unsheltered, individuals have an average age of 50 to 55, but they present with health issues that are more commonly seen among people who are housed who are more like 70 or 75.

All of this makes them highly vulnerable to getting very sick and potentially even dying if they were to contract the illness.

Roge Karma

Do we have any idea how the virus is already impacting the homeless community?

Diane Yentel

There’s no accurate or complete count of homeless people who’ve contracted the virus. We know of at least two people who were homeless who have died from coronavirus, one in Santa Clara and one in New York City.

New York City has the highest population of people who are homeless in the country and is also the epicenter of the outbreak currently. As of [last week] there were close to 60 cases of people who are homeless in New York City that are confirmed to have coronavirus [now that number is up to over 100]. And they stayed in at least 40 different homeless shelters and shelter providers. Those numbers have gone up rapidly in a matter of days and we can expect them to keep going up.

Roge Karma

Do you have any sense of what is happening on the ground right now in those homeless shelters and shelters around the country? If I’m a staff member at a homeless shelter right now, what am I dealing with?

Diane Yentel

Shelter providers and outreach workers are feeling scared and overwhelmed in a way that these folks typically don’t feel. That’s because, as people lose their jobs and their homes, these workers are seeing a tsunami of need in front of them — and they’re recognizing that they don’t have the resources to keep up.

Many homeless outreach workers or shelter providers don’t have hand sanitizer. They don’t have masks and gloves. They are starting to lose staff to illness and volunteers because of social distancing. As of [last Friday], about 20 shelters across the country have had to close because they don’t have the resources or staffing they need to be able to keep the doors open or keep doing the work that they do safely.

Shelters are also really struggling to implement social distancing. They need money to obtain more hotel rooms or build new wings of their shelters so they can separate out the most vulnerable people and allow those who have been exposed to self-quarantine. But generally, they don’t have the resources that they need.

Instead, they are essentially taking out half of the beds in their shelters so that they can spread the ones that remain further apart. But that means serving half as many people in the middle of a pandemic. Or it means shutting down intake altogether so that they’re not accepting any new clients when the need is probably greater than it’s ever been before.

Roge Karma

It strikes me that this isn’t just a humanitarian disaster for the homeless — it is a public health disaster that could impact us all. Can you speak to the connection between the humanitarian and public health dimensions of this?

Diane Yentel

A recent report by leading social scientists and homelessness experts analyzed exposure, hospitalization, and potential mortality rates from coronavirus among people who are homeless. They found that homeless people who contract the coronavirus are twice as likely to be hospitalized, two to four times as likely to require critical care, and two to three times as likely to die compared to the general population.

These findings have dire implications, not only for people experiencing homelessness themselves, but for our health care system’s ability to absorb this potential spike in need for urgent care. We can’t contain this pandemic if our health care system is overwhelmed, and what we are already seeing in New York City is that we don’t have the ability to absorb these kind of spikes in need.

It’s never been more obvious than right now that housing is health care. When our collective health depends on our ability to stay home, we all suffer when people are left unhoused — especially during a pandemic like this one. Absolutely ensuring that everyone has stable housing during this pandemic is not only a moral imperative, it’s a public health necessity.

Roge Karma

Something we’ve heard from doctors in cities like San Francisco, for example, is that the Bay Area housing crisis is making the hospital supply issue much worse. Unsheltered people are being brought in with possible coronavirus symptoms. They need to be quarantined until a test comes back, but they have nowhere to go. So they’re kept in a hospital bed which now can’t be used for other purposes. And if they just had a home, then this won’t be a problem.

Diane Yentel

That’s exactly right. And even more worrisome is some of the stories that we’re starting to hear from New York City. People who are homeless are going to the health care system because they’re confirmed to have coronavirus. But the hospital needs that bed for somebody who’s sicker. So they are releasing people who are homeless back to their tents on city sidewalks or back to congregate shelters. And obviously, that has tremendous health implications for everybody in New York City.

Roge Karma

Let’s talk about what’s been happening on the legislative level. The stimulus bill passed by Congress last week ended up including $12 billion in funding for HUD programs. Can you walk me through some of the ways that money will be used? And is it enough to address the issues we’ve been discussing?

Diane Yentel

This stimulus bill is definitely an important first step. It’s overdue and not enough to meet all the needs, but there are some substantial funding mechanisms in that bill. The biggest and most relevant funding for the homeless is the $4 billion in what are known as “emergency solutions grants” (ESG). That’s a lot of money that can be used by shelter providers and outreach workers to acquire basic safety measures, to obtain more space so that people can isolate or quarantine, to contract with hotels to use vacant hotel rooms to put people in, to provide rental assistance to get people into apartments, and more.

This is a significant amount of money. But that same report I mentioned above estimates that there is a need for $15.5 billion dollars in ESG funds to prevent and contain coronavirus among the homeless population. There are other funding pots within the bill that can also be used to supplement the ESG dollars, but there’s no guarantee they will be used that way. Our focus will be on ensuring that some of them are used to meet these needs among people who are experiencing homelessness.

Roge Karma

Something I’ve been thinking a lot about lately is what this crisis says about us, as a society and as a nation. From your perspective, what does this crisis say about us — and particularly, what does it say about how we treat our most vulnerable?

Diane Yentel

I think this crisis really lays bare how as a country, we have for decades consistently and purposefully failed to end homelessness. We have the solutions. We have the research. We have the delivery system. We can end homelessness in our country. We only lack the political will to fund the solutions at the scale necessary.

And now here we are. We’re scrambling to prevent or contain outbreaks of coronavirus among people who are homeless and among other highly vulnerable and marginalized communities: tribal communities, people with disabilities, seniors, low-income immigrants.

I think the crisis just really makes clear that we have failed for a long time to protect the most vulnerable and the most marginalized members of our communities. And it’s also making clear the implications of that failure, not only for the marginalized communities themselves but for everybody in the country.

Roge Karma

What can compassionate readers at home do to help with the terrible circumstances facing the homeless right now?

Diane Yentel

I think the most important thing that every individual who cares about this issue can do is call their member of Congress and urge them to provide the level of funding needed to end homelessness once and for all.

If people want to do something more immediate and closer to home, call your local homeless shelter and ask them what they need and then do your best to give it to them. Some might need cash. Some might need food. Some may say it again to call your member of Congress but they’ll know best what the local need is, and they could certainly use help right now.