Assessing Community-Level Responses to the COVID-19 Pandemic Among Homeless Serving Organizations

Background and Purpose

The coronavirus pandemic poses significant threats to people experiencing homelessness and those who who serve them. Congregate shelter settings increase the risk of infection among homeless individuals, and the older age and higher rates of comorbidities among the homeless population raises the risk of COVID-19 mortality. Adapting services to protect this highly vulnerable population required federal funding and an intergovernmental and interagency response that included infection surveillance, the creation of new shelter facilities, distribution of vaccines and PPE, and partnerships between health and social service providers. This crisis represents an opportunity to understand the adaptability and elasticity of these multifaceted social service systems that includes governments and nonprofits. Through a series of surveys with local governments and nonprofits, we studied how providers adapted their service provision, data collection, and housing strategies to meet the needs of the pandemic, with a focus on barriers and facilitators to successful adaptation.

Methods

We conducted a series of four surveys with the leads of Continuums of Care – local agencies that manage federal homelessness funding - between May 2020 and March 2021. Some domains and questions – like those concerning COVID-19 screening and data collection, the use of non-congregate shelters, and coordination with public health agencies – were consistent across iterations while others, like those concerning vaccinations and responses to federal legislation, evolved. Sample sizes ranging from 77 to 168; all survey iterations had a mix of urban, suburban, and rural CoCs from across the United States.

Results

Most communities developed new facilities and moved sheltered individuals into non-congregate settings, obtained critical PPE, and screened clients for COVID-19. However, we also observe significant shortfalls in infection management often stemming from barriers to intergovernmental and interagency relationships. Fewer than half of communities participated in FEMA’s program reimbursing non-congregate shelter activities, with reasons focused on interagency and intergovernmental concerns like a lack of interagency coordination, bureaucratic concerns about reimbursement speed and reporting requirements. In addition, one year after passage of the CARES Act that provided $4 billion to local homeless service providers, 41% of communities reported having unspent and unobligated funds, often due to difficulties accessing funds being held up by other local or state agencies. In addition, data related to COVID-19 rates among homeless populations has been difficult to collect and maintain due to largely systematic barriers like poor coordination with public health agencies and lack of internal infrastructure.

Conclusions and Implications

Our findings demonstrate an adaptability of local social service systems that was facilitated by significant federal funding and innovation as well as partnerships with relevant agencies. These resources facilitated the provision of critical services while providers faced severe staff and resource shortfalls. However, findings also indicate that a greater focus on intergovernmental and interagency relationships would facilitate more effective infection mitigation, data collection, and vaccine distribution. Such lessons are critical for planning for a potential future health crisis facing institutionalized vulnerable groups.