Guidance for providers of services for people experiencing homelessness (in the context of COVID-19)

June 29, 2020

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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.

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

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

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

canada.ca/coronavirus

Public Health Authorities

Provinces and Territories Telephone number Website
British Columbia 811 www.bccdc.ca/covid19
Alberta 811 www.myhealth.alberta.ca
Saskatchewan 811 www.saskhealthauthority.ca
Manitoba 1-888-315-9257 www.manitoba.ca/covid19
Ontario 1-866-797-0000 www.publichealthontario.ca
Quebec 1-877-644-4545 www.quebec.ca/en/coronavirus
New Brunswick 811 www.gnb.ca/publichealth
Nova Scotia 811 www.nshealth.ca/public-health
Prince Edward Island 811 www.princeedwardisland.ca/covid19
Newfoundland and Labrador 811
or
1-888-709-2929
www.gov.nl.ca/covid-19
Nunavut 867-975-5772 www.gov.nu.ca/health
Northwest Territories 811 www.hss.gov.nt.ca
Yukon Territory 811 www.yukon.ca/covid-19

Canadian Network for the Health and Housing of People Experiencing Homelessness

Infection Prevention and Control Resources for Homelessness Service Settings (Toronto Public Health)

Footnotes

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]

Return to footnote 1 referrer

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]

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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]

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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]

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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]

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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]

Return to footnote 6 referrer

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]

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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]

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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]

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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]

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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/]

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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/]

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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.

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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.

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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.

Return to footnote 15 referrer

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