Interim Guidance for Homeless Service Providers to Plan and Respond to Coronavirus Disease 2019 (COVID-19)

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People experiencing homelessness are at risk for infection during community spread of COVID-19. This interim guidance is intended to support response planning by emergency management officials, public health authorities, and homeless service providers, including overnight emergency shelters, day shelters, and meal service providers.

COVID-19 is caused by a new coronavirus. We are learning about how it spreads, how severe it is, and other features of the disease. Transmission of COVID-19 in your community could cause illness among people experiencing homelessness, contribute to an increase in emergency shelter usage, and/or lead to illness and absenteeism among homeless service provider staff.

Early and sustained action to slow the spread of COVID-19 will keep staff and volunteers healthy, and help your organization maintain normal operations.

Community coalition-based COVID-19 prevention and response

Planning and response to COVID-19 transmission among people experiencing homelessness requires a “whole community”external icon approach, which means that you are involving partners in the development of your response planning, and that everyone’s roles and responsibilities are clear. Table 1 outlines some of the activities and key partners to consider for a whole-community approach.

Table 1: Using a community-wide approach to prepare for COVID-19 among people experiencing homelessness

Communication

• Stay updated on the local level of transmission of COVID-19 through your local and state health departments.
• Communicate clearly with staff and clients.
  • Use health messages and materials developed by credible public health sources, such as your local and state public health departments or the Centers for Disease Control and Prevention (CDC).
  • Post signs at entrances and in strategic places providing instruction on hand washing and coughpdf icon[1 page] etiquette, use of masks, and social distancing.
  • Provide educational materials about COVID-19 for non-English speakers or hearing impaired, as needed.
  • Keep staff and clients up-to-date on changes in facility procedures.
  • Ensure communication with clients and key partners about changes in program policies and/or changes in physical location.
• Identify platforms for communications such as a hotline, automated text messaging, or a website to help disseminate information to those inside and outside your organization. Learn more about communicating to workers in a crisisexternal icon.
• Identify and address potential language, cultural, and disability barriers associated with communicating COVID-19 information to workers, volunteers, and those you serve. Learn more about reaching people of diverse languages and cultures.

Supplies

Have supplies on hand for staff, volunteers, and those you serve, such as:

• Soap
• Alcohol-based hand sanitizers that contain at least 60% alcohol
• Tissues
• Trash baskets
• Masks
• Cleaning supplies
• Personal protective equipment (PPE), as needed by staff (see below)

Staff considerations

• Provide training and educational materials related to COVID-19 for staff and volunteers.
• Minimize the number of staff members who have face-to-face interactions with clients with respiratory symptoms.
• Develop and use contingency plans for increased absenteeism caused by employee illness or by illness in employees’ family members. These plans might include extending hours, cross-training current employees, or hiring temporary employees.
• Staff and volunteers who are at increased risk for severe illness from COVID-19 should not be designated as caregivers for sick clients who are staying in the shelter. Identify flexible job duties for these increased risk staff and volunteers so they can continue working while minimizing direct contact with clients.
• Put in place plans on how to maintain social distancing (remaining at least 6 feet apart) between all clients and staff while still providing necessary services.
• All staff should wear a mask for source control (when someone wears a mask over their mouth and nose to contain respiratory droplets), consistent with the guidance for the general public. See below for information on laundering washable masks.
• Staff who do not interact closely (e.g., within 6 feet) with sick clients and do not clean client environments do not need to wear personal protective equipment (PPE).
• Staff should avoid handling client belongings. If staff are handling client belongings, they should use disposable gloves, if available. Make sure to train any staff using gloves to ensure proper use and ensure they perform hand hygiene before and after use. If gloves are unavailable, staff should perform hand hygiene immediately after handling client belongings.
• Staff who are checking client temperatures should use a system that creates a physical barrier between the client and the screener as described here.
  • Screeners should stand behind a physical barrier, such as a glass or plastic window or partition that can protect the staff member’s face from respiratory droplets that may be produced if the client sneezes, coughs, or talks.
  • If social distancing or barrier/partition controls cannot be put in place during screening, PPE (i.e., facemask, eye protection [goggles or disposable face shield that fully covers the front and sides of the face], and a single pair of disposable gloves)  can be used when within 6 feet of a client.
  • However, given PPE shortages, training requirements, and because PPE alone is less effective than a barrier, try to use a barrier whenever you can.
• For situations where staff are providing medical care to clients with suspected or confirmed COVID-19 and close contact (within 6 feet) cannot be avoided, staff should at a minimum, wear eye protection (goggles or face shield), an N95 or higher level respirator (or a facemask if respirators are not available or staff are not fit tested), disposable gown, and disposable gloves. Cloth face coverings are not PPE and should not be used when a respirator or facemask is indicated. If staff have direct contact with the client, they should also wear gloves. Infection control guidelines for healthcare providers are outlined here.
• Staff should launder work uniforms or clothes after use using the warmest appropriate water setting for the items and dry items completely.
• Provide resources for stress and coping to staff. Learn more about mental health and coping during COVID-19.

Facility layout considerations

• Use physical barriers to protect staff who will have interactions with clients with unknown infection status (e.g., check-in staff). For example, install a sneeze guard at the check-in desk or place an additional table between staff and clients to increase the distance between them to at least 6 feet.
• In meal service areas, create at least 6 feet of space between seats, and/or allow either for food to be delivered to clients or for clients to take food away.
• In general sleeping areas (for those who are not experiencing respiratory symptoms), try to make sure client’s faces are at least 6 feet apart.
  • Align mats/beds so clients sleep head-to-toe.
• For clients with mild respiratory symptoms consistent with COVID-19:
  • Prioritize these clients for individual rooms.
  • If individual rooms are not available, consider using a large, well-ventilated room.
  • Keep mats/beds at least 6 feet apart.
  • Use temporary barriers between mats/beds, such as curtains.
  • Align mats/beds so clients sleep head-to-toe.
  • If possible, designate a separate bathroom for these clients.
  • If areas where these clients can stay are not available in the facility, facilitate transfer to a quarantine site.
• For clients with confirmed COVID-19, regardless of symptoms:
  • Prioritize these clients for individual rooms.
  • If more than one person has tested positive, these clients can stay in the same area.
  • Designate a separate bathroom for these clients.
  • Follow CDC recommendations for how to prevent further spread in your facility.
  • If areas where these clients can stay are not available in the facility, assist with transfer to an isolation site.

Facility procedure considerations

• Plan to maintain regular operations to the extent possible.
• Limit visitors who are not clients, staff, or volunteers.
• Do not require a negative COVID-19 viral test for entry to a homeless services site unless otherwise directed by local or state health authorities.
• Identify clients who could be at increased risk for complications from COVID-19, or from other chronic or acute illnesses, and encourage them to take extra precautions.
• Arrange for continuity of and surge support for mental health, substance use treatment services, and general medical care.
• Identify a designated medical facility to refer clients who might have COVID-19.
• Keep in mind that clients and staff might be infected without showing symptoms.
  • Create a way to make physical distancing between clients and staff easier, such as staggering meal services or having maximum occupancy limits for common rooms and bathrooms.
  • All clients should wear masks any time they are not in their room or on their bed/mat (in shared sleeping areas). Masks 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.
• Regularly assess clients and staff for symptoms.
  • Clients who have symptoms may or may not have COVID-19. Make sure they have a 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.
• Prepare healthcare clinic staff to care for patients with COVID-19, if your facility provides healthcare services, and make sure your facility has supply of personal protective equipmentpdf icon[1 page].
• Provide links to respite (temporary) care for clients who were hospitalized with COVID-19 but have been discharged.
  • Some of these clients will still require isolation to prevent transmission.
  • Some of these clients will no longer require isolation and can use normal facility resources.
• Make sure bathrooms and other sinks are consistently stocked with soap and drying materials for handwashing. Provide alcohol-based hand sanitizers that contain at least 60% alcohol at key points within the facility, including registration desks, entrances/exits, and eating areas.
• Washable masks used by clients and staff should be laundered regularly. Disposable masks should not be laundered. Staff involved in laundering masks should do the following:
  • Masks should be collected in a sealable container (like a trash bag).
  • Staff should wear disposable gloves and a face mask. Use of a disposable gown is also recommended, if available.
  • Gloves should be properly removed and disposed of after laundering washable masks; clean hands immediately after removal of gloves by washing hands with soap and water for at least 20 seconds or using an alcohol-based hand sanitizer with at least 60% alcohol if soap and water are not available.
• Clean and disinfect frequently touched surfaces at least daily and shared objects between use using an EPA- registered disinfectantexternal icon.

COVID-19 Readiness Resources

• COVID-19 Infection Control Inventory and Planning (ICIP) Tool for Homeless Service Providers pdf icon[PDF – 426 KB]
• Checklist for Homeless Service Providers During Community Re-opening
• Visit cdc.gov/COVID19 for the latest information and resources
• Printable Resources for People Experiencing Homelessness
• Guidance Related to Unsheltered Homelessness
• Department of Housing and Urban Development (HUD) COVID-19 Resources external icon
• ASPR TRACIE Homeless Shelter Resources for COVID-19external icon