Homelessness during COVID-19: challenges, responses, and lessons learned from homeless service providers in Tippecanoe County, Indiana

Abstract

Background The COVID-19 pandemic laid bare some of the United States’ most devastating health and social inequities faced by people experiencing homelessness. Homeless populations experience disproportionate rates of underlying health conditions, stigma and marginalization that often disenfranchise them from health and social services, and living conditions that potentiate the risk of COVID-19 transmission and adverse outcomes. Methods Guided by the socio-ecological model, this community-based participatory research study examined the impacts of the COVID-19 public health crisis on people experiencing homelessness in Tippecanoe County, Indiana, and the ways in which homeless service providers prepared for, experienced, and responded to the pandemic. Eighteen (18) semi-structured interviews were conducted with representatives of 15 community-based organizations, including shelters and other homeless service providers. Results Qualitative content analysis revealed myriad challenges at the individual and interpersonal levels faced by people experiencing homelessness as a result of the pandemic, and multilevel responses for COVID-19 impact mitigation in this community. Many of the emergency measures put in place by homeless service providers in Tippecanoe County, Indiana created opportunities for innovative solutions to longstanding challenges faced by homeless populations that are informing better service delivery moving forward, even beyond the COVID-19 pandemic. Conclusions Community-based organizations, including homeless shelters, are uniquely qualified to inform pandemic response and disaster risk mitigation in order to respond appropriately to the specific needs of people experiencing homelessness. The lessons learned and shared by homeless service providers on the frontline during the COVID-19 pandemic have important implications to improve future disaster response for homeless and other vulnerable populations.

A Scoping Review of the Health Impact of the COVID-19 Pandemic on Persons Experiencing Homelessness in North America and Europe

“…Fear or perceived threat of COVID-19 among PEH was discussed by ten studies [ 12 , 13 , 82 , 83 , 84 , 85 , 86 , 87 , 88 , 89 ]. Fear varied across studies; in Los Angeles, 65% of tenants of permanent supportive housing surveyed by Henwood et al [ 85 ] in March 2020 regarded COVID-19 as a serious risk to their health, while 33% of those surveyed in Los Angeles by Kuhn et al [ 87 ] from December 2020 to February 2021 perceived it as a high threat.…”

“…A third study in Los Angeles carried out from April to June 2020 reported that 53% of young PEH (18–25 years old) were not at all worried about COVID-19, and 15% were very or extremely worried [ 88 ]. One study by Rodriguez et al [ 12 ] reported that PEH in Tippecanoe County, Indiana had an overall low risk perception of COVID-19, while authors of a study in France found that PEH felt that the virus was indeed a threat but was not a major concern compared to the other risks they regularly faced [ 13 ]. Using data from Hamburg, Hajek et al [ 89 ] found that increased fear of COVID-19 among PEH was associated with younger age, absence of chronic alcohol consumption, increased perceived own risk of contracting the virus one day, and a higher agreement that a diagnosis of COVID-19 would ruin their life.…”

“…Several studies described how the pandemic exacerbated insecure living conditions for PEH. Four studies reported shelters restricting new admissions [ 12 , 46 , 95 , 96 ], and three reported shelters closing during the pandemic [ 44 , 73 , 94 ]. One study reported that authorities in France dismantled a squat [ 39 ], and in Salamanca, Spain, PEH were not allowed to live on the street during the initial lockdown period [ 26 ].…”

“…While PEH have been disproportionately affected by the pandemic [ 5 , 8 ], the health consequences reach far beyond those of just infection and illness from COVID-19. For example, the large-scale closure of public buildings and facilities reduced access to toilets and basic hygiene and sanitation for those who were unsheltered [ 11 , 12 ]. Less financial support from the general public due to stay-at-home advisories and closure or reorganisation of food and social support services also contributed to difficulties accessing food assistance and hygiene products [ 12 , 13 ].…”

“…For example, the large-scale closure of public buildings and facilities reduced access to toilets and basic hygiene and sanitation for those who were unsheltered [ 11 , 12 ]. Less financial support from the general public due to stay-at-home advisories and closure or reorganisation of food and social support services also contributed to difficulties accessing food assistance and hygiene products [ 12 , 13 ]. Restrictions on international travel and freedom of movement interrupted alcohol and drug supply chains, increasing costs [ 14 ] and reducing access, leading some persons who use drugs to shift from using their preferred substance to potentially more dangerous substances [ 15 ].…”