People Experiencing Homelessness

People who are homeless are at risk of COVID-19.

Homeless services are often provided in congregate settings, which could facilitate the spread of infection. Because many people who are homeless are older adults or have underlying medical conditions, they may also be at increased risk for severe illness.

Health departments and healthcare facilities should be aware that people who are homeless are a particularly vulnerable group. If possible, identifying non-congregate settings where those at increased risk can stay may help protect them from COVID-19.

How people experiencing homelessness can protect themselves

Many of the recommendations to prevent COVID-19 may be difficult for a person experiencing homelessness to do. Although it may not be possible to avoid certain crowded locations (such as shelters), people who are homeless should:

• Try to avoid other crowded public settings.

• If using public transportation, follow the CDC guidance on how to protect yourself when using transportation, try to travel during less busy times, and clean your hands as soon as possible after their trip.

• If possible, use take-away options for food.
• Maintain a distance of 6 feet (about two arms’ length) from other people.
• Wash their hands with soap and water for at least 20 seconds as often as possible, and cover their coughs and sneezes.

If people experiencing homelessness have symptoms

Any person experiencing homelessness with symptoms consistent with COVID-19  (fever, cough, or shortness of breath) should alert their service providers (such as case managers, shelter staff, and other care providers). These staff will help the individual understand how to isolate themselves and identify options for medical care as needed.

How to get tested for COVID-19

If they meet criteria for testing, people experiencing homelessness will access COVID-19 testing through a healthcare provider.

Local public health and healthcare facilities need to determine the best location for this testing in coordination with homeless healthcare clinics and street medicine clinics.

Anyone sick with COVID-19 should stay isolated

Those with suspected or confirmed COVID-19 should stay in a place where they can best be isolated from other people to prevent spreading the infection. Local health departments, housing authorities, homeless service systems, and healthcare facilities should plan to identify locations to isolate those with known or suspected COVID-19 until they meet the criteria to end isolation.

Isolation housing could be units designated by local authorities or shelters determined to have capacity to sufficiently isolate these people. If no other options are available, homeless service providers should plan for how they can help people isolate themselves while efforts are underway to provide additional support.

Donations of food and clothing to homeless service providers

Homeless service providers can accept donations of food and clothing during community spread of COVID-19, but general infection control precautions should be taken. Request that donors not donate if they are sick.

• Set up donation drop-off points to encourage social distancing between shelter workers and those donating.
• Launder donated clothing, sheets, towels, or other fabrics on high heat settings, and disinfect items that are nonporous, such as items made of plastic.
• Food donations should be shelf-stable, and shelter staff should take usual food-related infection prevention precautionsexternal icon.

Symptom screening of clients at homeless shelters

Homeless shelters can screen clients for symptoms of respiratory infections.

Clients who have symptoms may or may not have COVID-19. Make sure they have a separate place they can safely stay within the shelter or at an alternate site in coordination with local health authorities.  An on-site nurse or other clinical staff can help with clinical assessments.

• Provide anyone who presents with symptoms with a mask.
• Facilitate access to non-urgent medical care as needed.
• Use standard facility procedures to determine whether a client needs immediate medical attention. Emergency signs include:
  • Trouble breathing
  • Persistent pain or pressure in the chest
  • New confusion or inability to arouse
  • Bluish lips or face

Notify the designated medical facility and personnel to transfer clients that the client might have COVID-19.

Keeping open homeless shelters and encampments

Homeless shelters serve a critical function in our communities. Shelters should stay open unless homeless service providers, health departments, and housing authorities have determined together that a shelter needs to close.

Connecting people to stable housing should continue to be a priority.

• However, if individual housing options are not available, allow people who are living in encampments to remain where they are.
• Encourage people living in encampments to increase space between people and provide hygiene resources.