While the COVID-19 pandemic has strained this country’s health care system in innumerable ways, a critical challenge to emerge for many communities is how to best support the health care needs of individuals experiencing homelessness. State and local governments as well as health care and community-based organizations (CBOs) needed to find ways to simultaneously address COVID-19-related health issues and the ongoing health needs of individuals who are homeless during shelter-in-place orders. California’s Santa Clara County, where many homeless individuals in the Bay Area reside, has been a leader on this issue fueled by its early surge of COVID-19 infections.

In April, CHCS spoke with Jennifer Loving, chief executive officer, and Ray Bramson, chief impact officer, of Destination: Home (DH), to learn about the county’s initial response and their organization’s unique challenges in providing services and health care for homeless individuals during the COVID-19 outbreak. DH, a public-private partnership based in Santa Clara County, works with local and state partners to promote strategies for homelessness reduction and outcomes-driven housing and services models and is closely connected with the county’s COVID-19 response efforts.

Supporting Individuals Experiencing Homelessness During COVID-19

This blog post is part of a series of resources, developed by the Center for Health Care Strategies in partnership with the California Health Care Foundation, aimed at sharing lessons on meeting the needs of people experiencing homelessness amid the pandemic.

Focus on Immediate Health Care Needs: Screening, Quarantine, and Isolation

To limit the spread of infection in Santa Clara County, the County Office of Supportive Housing (OSH) receives information from the local CBO partners and other County departments, including the Valley Homeless Healthcare Program, about positive or presumptive positive cases and is charged with coordinating safe sheltering options. To support these efforts, the response focused on several key areas:

  • Risk stratification: Recent data from homeless providers throughout the country underscore how quickly the disease can spread in close-quarter environments such as shelters. Recognizing this, partners throughout Santa Clara County quickly and proactively started identifying homeless individuals who had not yet tested positive and based on key risk criteria — e.g., those who are over 50 years old and those with underlying medical conditions — to move into protective housing.
  • Securing facilities and rooms for isolation and quarantine: OSH was able to secure hotel rooms for its clients through emergency governmental funding, which was critical for meeting the immediate isolation needs of these individuals. While this was an “early win,” it has logistical challenges – for example, coordinating meal deliveries and cleaning services within these settings — that can pose barriers to implementation.

Leverage Partnerships with Public and Private Entities

One of DH’s greatest needs as the crisis emerged was personal protective equipment (PPE) for frontline staff working with vulnerable homeless populations. In order to meet this and other resource needs, the organization creatively leveraged its relationships with a variety of public and private partners.

  • Partnerships with private companies: DH is unique in that Silicon Valley — home to the densest concentration of technology companies in the world — is in its backyard. Through new and existing partnerships with local companies, DH was able to help coordinate financial contributions and PPE donations. Dozens of corporations, private donors, and philanthropic institutions contributed over $25 million for a direct financial assistance effort, and the organizations also pitched in to provide additional supplies. For example, DH recently received a donation of 100,000 gloves from a technology company and received hundreds of gallons of hand sanitizer from local distilleries.
  • Collaboration with the local health system: DH was also able to leverage its close relationships with local health systems to trade and share resources. In one instance, a local hospital received a donation of latex gloves that did not meet their internal requirements. However, the hospital knew of DH’s important work and donated the gloves to the organization for use with its own frontline direct service partners.

Follow Local Governmental Pandemic Response Guidance

Counties across the country are currently relying on their emergency management structures to guide their COVID-19 response efforts. Due to the health care-related nature of the pandemic, Santa Clara County’s response is led by its local public health department and based out of its centralized emergency operations center (EOC). It is providing public health directives to local organizations by convening local stakeholders across sectors to share information, assess the current situation, and update guidance based on evolving public health recommendations. DH, which is working with the EOC to respond to the needs of homeless and vulnerable populations, highlighted two early lessons from this collaboration:

  • Open communication: In DH’s experience, active communication between the EOC and frontline organizations is essential for coordinating effective community-wide response, shaping directives, and advocating for health care resources and plans to support the homeless. The County has been able to leverage expertise from frontline organizations, coupled with state and federal guidance, in order to inform their decisions. Strong relationships between EOC leads and designated organizations like DH have been critical for allowing stakeholders to: (1) better understand the ground-level context; (2) effectively implement community response efforts; and (3) coordinate state and federal funding streams.
  • Financing implications: Another benefit of coordinating closely with the EOC is that it has helped direct service organizations ensure that they are aligned with state and federal reimbursement guidelines. Although federal funds from the stimulus packages and Federal Emergency Management Agency have been slow to reach Santa Clara County, EOC leadership is able to make funding decisions based on their anticipated allocation of federal emergency funds.

Looking Forward

In the weeks and months to come, Destination: Home will continue its focus on meeting the immediate health care prevention and treatment needs of its clients, as well as preparing for a future that may include a  wave of newly homeless individuals due to the economic fallout from COVID-19. As DH’s CEO Jennifer Loving stated, “COVID-19 is laying bare all of the challenges we already have — just at a much more rapid pace.”

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