Guidance for providers of services for people experiencing homelessness (in the context of COVID-19)
June 29, 2020
On this page
- Homelessness in the context of COVID-19
- Planning for a COVID-19 outbreak in your community or facility
- Responding to a COVID-19 outbreak in your community or facility
- Recovery from a COVID-19 outbreak that has ended in your community or facility
- Public Health Authorities
Homelessness in the context of COVID-19
The following recommendations are for the providers of services for people experiencing homelessness (including overnight emergency shelters, day shelters, and meal service providers). This guidance is based on the Canadian context and public health assumptions that reflect the currently available scientific evidence and expert opinion. This guidance is subject to change as new information on transmissibility and epidemiology becomes available. It should be read in conjunction with relevant provincial/territorial and local legislation, regulations and policies.
Homelessness is often the result of the interaction between structural factors, insufficient services, and individual circumstances.Footnote 1 Many people experiencing, or at risk of experiencing homelessness rely on community-based organizations, non-profit and voluntary organizations for a range of essential services. Marginalized and vulnerable groups, including Indigenous community members, individuals identifying as LGBTQ2S+, and youth, are disproportionately represented among those experiencing homelessnessFootnote 2Footnote 3Footnote 4Footnote 5. While men comprise almost three quarters of the share of Canadians experiencing homelessness,Footnote 6 women's experience of homelessness tends to be "hidden", living temporarily with family, friends or in their car because they have nowhere else to live.Footnote 7 Evidence shows that women are most likely to be the head of the families staying in shelters.Footnote 8
Those who experience homelessness may be at higher risk of contracting COVID-19 or developing complications due to COVID-19 due to barriers to accessing traditional services and standard resources,Footnote 1 particularly Indigenous women and girls, and gender-diverse people, who report difficulty in accessing shelters.Footnote 9Footnote 10 These circumstances may affect their ability to follow public health advice, such as being able to effectively quarantine (self-isolate), isolate or practice physical distancing and perform proper hand hygiene. Those who are experiencing homelessness may have increased exposure to others as they move between locations, and due to crowding in shelter facilities. Those who experience homelessness may also be at higher risk of developing complications due to COVID-19, as they are more likely to report having an underlying chronic condition (particularly asthma, COPD, and heart conditions) compared to the general population.Footnote 11 In addition, those with chronic medical conditions (e.g. physical health, mental health, and substance use disorders) may be exacerbated by impacts of the pandemic and additional safety, harm reduction considerations and mental health supports may be required.
Organizations, community health workers and volunteers play an important role in helping prevent the spread of COVID-19 among those who experience homelessness. It is important that these service providers plan ahead and take precautions in their environments/workplaces, based on public health advice to reduce disruptions to their services. Consider reaching out to management, local governments, and the culturally and socially diverse population you serve, to understand the essential requirements of your organization during the COVID-19 outbreak.
Planning for a COVID-19 outbreak in your community or facility
Providers of services for people experiencing homelessness should collaborate, share information, and review emergency plans with community leaders and local Public Health Authorities (PHAs) to ensure measures are in place to help protect their staff, clients, and guests. Access your local PHA for information about COVID-19 activity in your community. Consult the local PHA and provincial guidance to determine if an outbreak should be declared at your facility.
- Collaborate with your local government on emergency planning. Your input helps ensure that your local government's emergency operations plan can provide your organization with the support and resources needed to respond effectively.
- Work with the PHA and local health care providers to plan for access to COVID-19 assessment centers, or to provide medical care (e.g. testing) on-site, as feasible.
- Consider specialist services that may be required (e.g. pharmacy services, mental health services, support/programming related to substance use and substance use disorder, harm reduction, social workers, and childcare).Footnote 12Footnote 13Footnote 14
- Consider safety planning around non-COVID-19 medical emergencies including substance withdrawal and drug overdose.
- Work with community networks (such as community leaders, PHA, and faith-based organizations) in advance to secure additional shelter spaces in order to accommodate the requirements of physical distancing (e.g. recreation facilities, community centres, hotels or modular units).
- Coordinate with affiliated shelters or congregate living facilities in the community to consider cohorting the following groups separately: a) those who are in quarantine (self-isolating) following potential COVID-19 exposure within the last 14 days, b) those who have symptoms consistent with COVID-19 (even if mild), and c) those who have been diagnosed with COVID-19. Those with severe symptoms (see below) should be transported via emergency medical services (EMS) to a health care facility.
- Anticipate an increase in emergency shelter usage. Consult with community leaders, local public health departments, and faith-based organizations about places to refer clients if your shelter space is full, taking into account cultural safety and the specific needs of different groups, including age and gender diversity. Identify short-term volunteers to staff a shelter with more usage or alternate sites. Consider the need for extra supplies (e.g., food, toiletries) and surge staff.
- Plan to have appropriate supplies on hand, such as personal protective equipment (PPE) for staff/volunteers who are providing direct care for clients (within 2 metres) or who cannot maintain a physical distance of 2 metres. The PHA can provide advice on the need for and use of PPE required for this setting. For those who are not providing direct care (within 2 metres) for clients, information on non-medical masks or cloth face coverings (i.e., constructed to completely cover the nose and mouth without gaping, and secured to the head by ties or ear loops) is available.
- When possible follow provincial/territorial guidance and consult with your local public health authority for site-specific recommendations.
- Plan for communication including technology and diversions to spend time while in shelter.
- Transportation of clients (e.g. for non-urgent medical appointments) should be temporarily suspended in the context of the outbreak.
- Ensure you have a plan in place to access and maintain supplies specific to the environment, including those to support environmental cleaning.
Set a time to discuss what providers of services for people experiencing homelessness should do if cases of COVID-19 are suspected or confirmed in their facility. Identify if alternate care sites are available for clients with suspected or confirmed COVID-19 or how service providers plan to isolate cases within their facility.
Anticipate an increase in absenteeism among staff. Develop flexible attendance and sick-leave policies. Support and encourage staff and volunteers to take care of their mental health. Staff and volunteers may need to stay home when they are ill, caring for a household member who is ill, or caring for their children in the context of school closures. Identify critical job functions and positions, and plan for alternative coverage by cross-training staff members.
Note: Use a process similar to the one you use when you cover for staff workers during the holidays.
Ensure that staff and/or clients are aware of financial and other support programs available through federal, provincial/territorial and local governments to those with financial instability related to COVID-19 (e.g. for those who are not able to work due to illness/exposure, isolation/self-isolation, or loss of job/income). Information on Government of Canada assistance is available at
Help counter stigma and discrimination in your community. Speak out against negative behaviors toward those who may experience stigma, recognizing that individuals may belong to multiple stigmatized groups.
Responding to a COVID-19 outbreak in your community or facility
If COVID-19 transmission is ongoing in the local community or COVID-19 has been identified among staff/volunteers or clients who attend your facility, work with your local PHA to establish plans to reduce the risk of transmission in your environment. If staff/volunteers or clients have exposures or develop symptoms, ensure alignment with local or jurisdictional protocols for diagnostic testing, quarantine (self-isolation), isolation, physical distancing and clinical management. Consider that clients may have COVID-19 even if they exhibit no symptoms at all. COVID-19 is spread through contact with the respiratory droplets produced by infected individuals when they cough, sneeze, or even when they laugh, speak or sing including by individuals who have not yet or who may never develop symptoms.
Decisions about whether clients who exhibit symptoms (even if mild), or those who have tested positive for COVID-19, should remain in the shelter or be directed to alternative housing sites should be made in coordination with the PHA. Identifying respite care locations for patients with confirmed COVID-19 who have been discharged from the hospital should be made in coordination with local healthcare facilities and your PHA.
Put your emergency operations and communication plans into action
- Stay informed about the local COVID-19 situation. Get up-to-date information from your PHA. Regularly provide accessible and actionable information to people who are currently living outdoors and in shelters in accessible ways relevant to the population.
- If COVID-19 is detected at your facility, or there is a cluster of individuals experiencing symptoms compatible with COVID-19 (even if mild), work with the local PHA to determine whether an outbreak should be declared, how to implement mitigation measures, and how the outbreak will be monitored by the PHA.
- Educate staff, volunteers and clients about ways to prevent the spread of COVID-19, including:
- Practicing frequent and thorough hand hygiene (washing hands often with soap and water for at least 20 seconds, or using an alcohol based hand sanitizer (at least 60% alcohol)Footnote 15.
- Avoiding touching the mouth, nose or eyes with unwashed hands.
- Physical distancing (e.g. maintaining a 2 metre distance from others).
- Increasing access to hand hygiene and cough etiquette supplies (e.g., alcohol-based hand sanitizer that contains at least 60% alcohol, soap, paper towels, tissues, waste containers).
- Increasing cleaning frequency of highly used spaces, surfaces and objects (kitchens, common areas, dining areas, desks, shared sleeping spaces, doorknobs, and faucets).
- Stay at home and away from others when ill, even if mild.
- Avoiding the use of shared personal items.
- Sharing information about what to do if staff or a client shows symptoms of becoming ill.
- Sharing information about how to care for and isolate people living in a crowded facility (including the use of separate washrooms, if available).
- For staff/volunteers who are providing direct care for clients (within 2 metres) or who cannot maintain a physical distance of 2 metres, the PHA can provide advice on the need for and use of PPE required for this setting.
- For clients, and staff/volunteers who are not providing direct care for clients (within 2 metres), non-medical masks or cloth face coverings (i.e., constructed to completely cover the nose and mouth without gaping, and secured to the head by ties or ear loops) are recommended for periods of time when it is not possible to maintain a 2 metre physical distance between individuals, particularly in crowded settings. Non-medical masks or cloth face coverings are not considered PPE.
- Monitor or connect with clients who could be at higher risk for complications from COVID-19 (those who are older or have underlying health conditions) and reach out to them regularly. Ensure they are informed about the symptoms of COVID-19 and how they may protect themselves through physical distancing and hand hygiene. When possible consider single rooms for shelter residents who are high risk related to medical complications.
- Download fact sheets and keep your clients and guests informed about public health recommendations to prevent disease spread and about changes to services that might be related to the outbreak. Messaging strategies to clients and guests may include:
- Posting signs at entrances and in strategic places providing instruction on hand hygiene, respiratory hygiene, and cough etiquette.
- Signs should be written in languages representative of the community, have a simple message with plain language, use a large font, include one or two graphics and focus on actions that should be taken rather than actions to avoid.
- Take a trauma and violence-informed approach when supporting clients, recognizing that increased stress and uncertainty can reactivate trauma.
- Implement everyday preventive actions and provide instructions to your clients, workers and volunteers about actions to prevent disease spread.
- Stock bathrooms with soap and drying materials for handwashing.
- Provide alcohol-based hand sanitizers that contain at least 60% alcohol (if that is an option at your shelter) at key points within the facility, including registration desks, entrances/exits, and eating areas. Do not use "home made" hand sanitizer.
- Provide clients with access to fluids, tissues and plastic bags for the proper disposal of used tissues.
- Non-medical masks or cloth face coverings (i.e., constructed to completely cover the nose and mouth without gaping, and secured to the head by ties or ear loops) are recommended for periods of time when it is not possible to consistently maintain a two-metre physical distance from others, particularly in crowded public settings. The wearing of non-medical masks or cloth face coverings is an additional personal practice that can help to prevent the infectious respiratory droplets of an unknowingly-infected person from coming into contact with other people.
- It is important that non-medical masks or cloth face coverings fit well and are worn safely. Non-medical masks or 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.
- When establishing policies regarding the use of non-medical masks, consider how to mitigate against any possible physical injuries that could inadvertently be caused by wearing a facial covering (e.g. interfering with the ability to see or speak clearly, or to identify individuals, or through increased conflict or stigmatization). The potential psychological impacts of the non-medical mask or cloth face covering on other staff, volunteers or clients should also be considered (e.g. design/construction of the mask, messaging, etc.).
- Follow environmental cleaning recommendations for how to prevent further spread within the facility.
- Encourage physical distancing:
- Staff should role model physical distancing and remind clients and guests of these precautions as appropriate (e.g. maintaining 2 metre distance, not shaking hands).
- Where applicable, use physical barriers such as plexiglass/ transparent barriers (e.g. for active screening by staff/volunteers).
- Use visual cues to encourage 2 metre spacing between individuals (e.g. accessible signage, floor markings).
- Clients who use substances should not use alone, but should be reminded to practice physical distancing by remaining at least 2 metres away from others.
- If staff and volunteers are not able to maintain a 2 metre distance between themselves and clients and guests, contact the PHA for advice in implementing measures within the shelter to minimize the opportunity for close unprotected contact.
- Information on non-medical masks and cloth face coverings can be found at the following: Use of non-medical cloth masks or face coverings in community settings
- Screen staff, volunteers and clients for symptoms consistent with COVID-19 (even if mild), at entrances, exits, and while within the setting.
- Active screening may include assessing staff, volunteers and clients for symptoms and exposure risks.
- Passive screening may include posting signage at the entry and throughout the shelter with a list of symptoms and exposure risks that encourages staff, volunteers and clients to self-monitor and self-report if feeling unwell.
- Staff and essential volunteers who are experiencing symptoms of COVID-19, even if mild, should stay home from work, inform supervisor, and use provincial assessment tools to determine next steps including testing.
- Staff and volunteers at high risk of severe COVID-19 should not be designated to provide direct care for clients (within 2 metres) who have been diagnosed with COVID-19 or who have symptoms consistent with COVID-19 (even if mild).
- Separate clients who a) are quarantining (self-isolating) following potential COVID-19 exposure within the last 14 days, b) have symptoms consistent with COVID-19 (even if mild), and c) have been diagnosed with COVID-19, and assign to individual rooms, if possible. This may necessitate transfer to an alternate (isolation) facility.
- Those with confirmed COVID-19 infections should not be in a shared space with others who have symptoms consistent with COVID-19 without laboratory confirmation of COVID-19.
- Additional advice on caring for a person with COVID-19 at home is available.
- If individual rooms for ill clients are not available, consider using large, well-ventilated rooms to separately cohort clients who a) are quarantining (self-isolating) following potential COVID-19 exposure within the last 14 days, b) have symptoms consistent with COVID-19 (even if mild), and c) have been diagnosed with COVID-19.
- If possible, designate a separate bathroom for cohorted clients.
- Ensure frequent environmental cleaning.
- Place possibly contaminated laundry into a container with a plastic liner and do not shake.
- Wash with regular laundry soap and hot water (60-90°C) and dry well.
- Clothing and linens belonging to the ill person can be washed with other laundry.
- In general, sleeping areas should have beds/mats placed at least 2 metres apart, temporary barriers between beds such as curtains, and request that all clients sleep head-to-toe.
- Limit visitors to the facility. Restrict physical access to essential staff and volunteers only, and encourage the provision of other services (e.g. group sessions) virtually (i.e. online or by telephone) whenever possible.
- If possible, provide storage for those who require relocation due to illness or self-isolation, to alleviate concerns about clients having to lose their belongings.
- Inform staff, volunteers and clients about how to respond to emergencies safely in the context of COVID-19.
- Consider training all staff and volunteers who may be involved in responding to medical emergencies in infection prevention and control and personal protective measures, in the context of COVID-19.
- Consult with your local PHA for advice about harm reduction and responding to medical emergencies in the context of COVID-19 in your setting.
- If you identify any client with severe symptoms, arrange for medical care immediately, and notify the PHA. If this is a client with suspected COVID-19, notify the transfer team and medical facility before transfer. Severe symptoms include:
- Extremely difficult breathing (not being able to speak without gasping for air)
- Bluish lips or face
- Persistent pain or pressure in the chest
- Severe persistent dizziness or light-headedness
- New confusion, or inability to arouse
- New seizure or seizures that won't stop
Recovery from a COVID-19 outbreak that has ended in your community or facility
A COVID-19 outbreak could last a long time, and the impact on your facility and the local community may be considerable. The PHA will work with your organization to determine when the outbreak has ended in your community or facility. Take time to talk over your experiences with your clients, staff and volunteers. As PHAs continue to plan for COVID-19 and other disease outbreaks, your organization has an important role to play in ongoing planning efforts.
Evaluate the effectiveness of your organization's plan of action
- Discuss and note lessons learned. How effective were your organization's COVID-19 preparedness actions?
- Talk about problems found in your plan and effective solutions. Identify additional resources needed for you and your organization.
- Participate in community discussions about emergency planning. Let others know about what readiness actions worked. Maintain communication lines with your community (e.g., social media, email lists and methods specific and unique to the population served).
Continue to practice everyday preventive actions. Stay home and away from others if you are ill; cover your coughs and sneezes with a tissue or your sleeve; wash your hands often with soap and water or an alcohol based hand sanitizer (at least 60% alcohol); practice physical distancing; clean and disinfect frequently touched surfaces and objects daily; and protect those most at risk from the virus.
Maintain and expand your emergency planning. Look for ways to expand community partnerships. Identify agencies or partners needed to help you prepare for an infectious disease outbreak in the future.
For more information, COVID-19 guidance for supporting people who use substances in shelter settings is available from the Canadian Research Initiative in Substance Misuse (CRISM).
For more information: 1-833-784-4397
Public Health Authorities
|Provinces and Territories||Telephone number||Website|
|Prince Edward Island||811||www.princeedwardisland.ca/covid19|
|Newfoundland and Labrador||811
- Footnote 1
Gaetz, S., Donaldson, J., Richter, T., & Gulliver, T. The State of Homelessness in Canada 2013. 2013. Toronto: Canadian Homelessness Research Network Press. [Accessed at: http://www.wellesleyinstitute.com/wp-content/uploads/2013/06/SOHC2103.pdf]
- Footnote 2
Casey, B. The Health of LGBTQIA2 Communities in Canada: Report of the Standing Committee on Health. Jun 2019. [Accessed at:https://www.ourcommons.ca/Content/Committee/421/HESA/Reports/RP10574595/hesarp28/hesarp28-e.pdf]
- Footnote 3
Gaetz, S., Dej, E., Richter, T., & Redman, M. The State of Homelessness in Canada 2016. 2016. Toronto: Canadian Observatory on Homelessness Press. [Accessed at: https://homelesshub.ca/sites/default/files/SOHC16_final_20Oct2016.pdf]
- Footnote 4
Employment and Social Development Canada. Advisory Committee on Homelessness - Final Report. 2018. [Accessed at: https://www.canada.ca/en/employment-social-development/programs/homelessness/publications-bulletins/advisory-committee-report.html]
- Footnote 5
Employment and Social Development Canada. Everyone Counts 2018: Highlights - Report. 2018.
[Accessed at: https://www.canada.ca/en/employment-social-development/programs/homelessness/reports/highlights-2018-point-in-time-count.html]
- Footnote 6
Gaetz, S,, Dej, E., Richter, T., & Redman, M. The State of Homelessness in Canada 2016. 2016.
Toronto: Canadian Observatory on Homelessness Press. [Accessed at: https://homelesshub.ca/sites/default/files/SOHC16_final_20Oct2016.pdf]
- Footnote 7
YWCA Canada. When There's No Place Like Home - A snapshot of women's homelessness in Canada. 2012. [Accessed at: https://www.homelesshub.ca/resource/when-theres-no-place-home-snapshot-womens-homelessness-canada]
- Footnote 8
Gubits. D., et al. Family Options Study: 3-Year Impacts of Housing and Services Interventions for Homeless Families. 2016. [Accessed at: https://www.huduser.gov/portal/publications/Family-Options-Study.html]
- Footnote 9
Abramovich, A. 1 in 3 transgender youth will be rejected by a shelter on account of their gender identity/expression. 13 Jun 2014. [Accessed at: https://www.rondpointdelitinerance.ca/blog/1-3-transgender-youth-will-be-rejected-shelter-account-their-gender-identityexpression]
- Footnote 10
Native Women's Association of Canada. Indigenous Housing: policy and engagement - Final report to Indigenous Services Canada. 30 Apr 2019. [Accessed at : https://www.nwac.ca/wp-content/uploads/2019/07/Housing-Report.pdf]
- Footnote 11
Lewer, D., et al. Health-related quality of life and prevalence of six chronic diseases in homeless and housed people: A cross-sectional study in London and Birmingham, England. 2019. [Accessed at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6501971/]
- Footnote 12
Pottie, K., et al. Clinical guideline for homeless and vulnerably housed people, and people with lived homelessness experience. 9 Mar 2020. [Accessed at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7062440/]
- Footnote 13
Constantino, R., Kim, Y., & Crane, P. A. Effects of a social support intervention on health outcomes in residents of a domestic violence shelter: a pilot study. 2005. Issues in Mental Health Nursing, 26(6), 575-590.
- Footnote 14
Rivas, C., Ramsay, J., Sadowski, L., Davidson, L. L., Dunne, D., Eldridge, S., et al. Advocacy interventions to reduce or eliminate violence and promote the physical and psychosocial well-being of women who experience intimate partner abuse. 2015. The Cochrane Database of Systematic Reviews, (12), CD005043.
- Footnote 15
If access to running water is not possible, other options may be considered. For example, wash hands in a large bowl and throw out the water from the bowl after each use. If water is not safe for use, use bottled water with soap or an alcohol based hand sanitizer (at least 60% alcohol) to wash your hands. If your community is on a boil water or do not consume advisory, the water can still be used to wash hands with soap and water.
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