Examining Homelessness Through an Unprecedented Pandemic
By Crystal Pitt, LCSW-C
Social Work Today
Vol. 23 No. 3 P. 18

How COVID-19 Exacerbated the Homelessness Crisis

Imagine losing your employment status, having poor credit, losing your housing, and even worse, having to admit that you are in a place of need. There you are, facing one of the most traumatizing, life-changing events that’s happened to you, having to make a difficult decision to reach out for help. Where would you start? Who would help you?

This is where many individuals, families, and children begin. In a moment of fear, trauma, and lacking a sense of hope and motivation—our homeless population, in order to survive, has to communicate to community providers their stories while in a state of crisis as a signal of desperation. Coupled with the impact of the COVID-19 pandemic, homelessness has exacerbated national crises that existed historically. United Way emphasizes that this is more evident as you examine the pandemic’s influence on homelessness and affordable housing. Evidence-based research has shown that the consequences of the pandemic have led people to being at risk for homelessness, reexperiencing the cycle of homelessness, and/or experiencing homelessness for the first time.1

In 2020, The National Alliance to End Homelessness reported that 580,466 people experienced homelessness in the nation. Individuals made up 70% of that number, and the remaining statistical data represented families that are homeless. Although society has spent a decade focusing on ending homelessness and ensuring that the traumatizing experience is rare, brief, and nonrecurring, and the nation has seen a significant decrease in unsheltered homeless in the past 10 years, that trend has shifted within the last five years.2

The National Alliance of Homelessness reports that there are multiple factors inextricably linked with homelessness including poor physical and emotional/mental health that cause a person or family’s homelessness or exacerbates the experience; income and housing affordability; unemployment or underemployment—due to a number of factors such as limited education, criminal record, poor health/ disability, unreliable transportation, and a gap in work history; a gap between increasing housing costs and inability to increase income; domestic violence; and racial disparities (long-standing historical and structural racism).2

Homelessness continues to be an economic issue that affects everyone, even those who may not directly experience it but who know someone who has been or is on the verge of it.

COVID-19
On March 13, 2020, our lives changed forever as President Trump announced that there was a nationwide emergency; only two days earlier, the World Health Organization declared the coronavirus (COVID-19) a pandemic. In an instant, the nation was in a state of shock, with an enormous amount of fear and uncertainty. Days later, at a White House briefing, Anthony Fauci, MD, announced that approximately 250,000 deaths were expected in the United States even if all safety measures were in place.

By May, the United States unemployment rate was at its worst since the Great Depression (14.7%); the death toll surpassed 100,000; and 20.5 million people were out of work. Leisure, and health care industries were affected at an all-time high rate.3 The CDC3 reports that by October, food insecurity had reached 52 million people—a 17 million increase compared with the prepandemic statistics. Despite various efforts to minimize the risk and enforce safety measures, by the end of 2020, the death toll surpassed 300,000 in the United States.

The coronavirus continued to cause economic and social disruption, wreaking havoc globally and disrupting many individuals and families. Not only did it result in a global shutdown but it also ultimately created a demand shock, supply shock, and financial shock.4

More importantly, there were visible and invisible effects on the general public. The CDC outlined that the pandemic caused children, youth, and adults to face social, economic, and mental health challenges. According to the CDC,5 research has proven that the trauma resulting from the pandemic could cause a disruption in the developmental stages for children and youth and that collectively, the community dealt with unexpected challenges including the following:

• alteration in typical daily/weekly routines (eg, socially distancing from family and close friends, and disruption to social clubs/extracurricular activities, as well as their worship community);

• disruption to continuity of learning (eg, shift to virtual learning, issues pertaining to access to technology, and technological issues related to connectivity);

• disruption to access to mental/physical health care (eg, adjusting to telehealth, missing crucial appointments for immunizations, surgical procedures, general health care, and other health-related critical appointments;

• missed significant life events (eg, weddings, grief-related celebrations of life, graduation, vacations, and retirement and birthday celebrations); and

• loss of security and safety (eg, housing and food insecurity, increased criminal activity, unexpected death of close ones, and overall uncertainty about the future).

Eviction Moratorium
While homeless service providers pivoted to the trends and waves within the community regarding new COVID-19 cases, ensured the safety protocols were followed, assisted clients who lost employment, and diligently searched for housing placements, the eviction moratorium was enacted. It was put into effect to help prevent the spread of coronavirus, ensure that people abide by the CDC guidelines for social distancing and comply with stay-at-home orders, and prohibit a landlord from evicting a covered tenant from a residential property for the sole purpose of nonpayment of rent.6 As mentioned previously, if individuals and families were evicted during the pandemic, it more than likely would increase their risk of being exposed to or affected by COVID-19.7 Pattath and Landen report that historically, evictions and housing displacement are common factors in health inequity.

Based on the challenges faced during the pandemic, it could be hypothesized that many people would face eviction and/or face homelessness for the first time.7 Pattath and Landen found that 20.8 million renter households (47.5% of all renter households) faced the burden of not being able to pay their rent during the beginning of the pandemic.

Contrary to popular belief, the eviction moratorium did not cancel the payment of rent as it encouraged tenants to attempt to make partial payments. As long as the eviction moratorium was in effect, individuals could not be evicted from their homes; however, renters would still be obligated to pay arrearage in rent and/or utilities. In addition, it was strongly recommended that renters apply for rental/utility assistance through local/state entities. In simplest terms, tenants didn’t have to pay the full amount of rent if they had legitimate financial hardship and could provide proof they had a substantial loss of income, had been furloughed, lost compensable hours of work, had unexpected medical expenses, or experienced other related financial hardships.

Although the eviction moratorium was put in effect to prevent homelessness and overcrowded housing conditions as a result of an eviction, landlords experienced a financial burden as they were unable to secure rental payments for months at a time.8 de la Campa, Reina, and Herbert reported that there was significant impact on landlords as yearly rent collection decreased from 2019 to 2020; prior to the pandemic, 89% of landlords reported collecting 90% or more of their yearly rent, whereas in 2020, only 62% of landlords received at least 90% of the rent.

Impact on Homelessness
For homeless persons, often described as part of an at-risk community and residing in places not meant for habitation by persons with preexisting medical conditions, the pandemic complicated the work of many homeless service providers and made it difficult to locate affordable housing options for individuals and families experiencing homelessness. It was necessary for homeless service providers to pivot to modify the delivery of their services. They immediately had to implement a newly revised structure to ensure they could continue to meet the needs of their clients. The National Low Income Housing Coalition9 highlighted that not only was the general homeless population severely affected by the pandemic but there was also a substantially greater impact on subpopulations such as people with disabilities and people of color.

It’s well known that homeless individuals often have underlying medical conditions and are at greater risk of severe illness; therefore, homeless service providers’ primary focus was on ensuring the safety and well-being of the population. According to the National Low Income Housing Coalition,9 homeless persons have limited ability to engage in preventive measures that were recommended by the CDC, for example, due to lack of access to handwashing materials, the inability to isolate or quarantine safely, difficulty avoiding germ-infested areas, and the inability to receive health care rapidly. For the reasons mentioned previously, homeless persons who contracted COVID-19 were considered twice as likely to be hospitalized, up to four times as likely to need critical health care access, and two to three times as likely to die as compared with the general public population.9 In order to help prevent COVID-19, many state and local communities worked collaboratively with homeless service providers initially to decompress shelters. This means a transition of the most vulnerable populations (ie, those 60 and older and those with underlying medical conditions) to underutilized hotels and to use the underutilized hotels to allow households to quarantine or isolate after members received a positive test or to wait for test results. These methods resulted in a reduction in the number of positive cases, and many lives were saved.

People With Disabilities
Often overlooked, discriminated against, and seen as invisible, people with disabilities face more obstacles and challenges on a daily basis than do those in the general population. And in the pandemic, during which there were scarce resources within the community, people with disabilities were further disenfranchised. The CDC10 notes that 61 million adults in the United States (26%) have reported living with a disability. As it relates to homelessness, people with disabilities often have complex and multifactorial cases as they suffer from any combination of substance abuse, other mental health disorders, unmet medical needs, and physical challenges. Furthermore, people with disabilities who have a combination of disabling conditions and have been homeless for a year or experience multiple episodes of homelessness are defined as chronically homeless. According to the National Alliance to End Homelessness,11 in 2022, there were 127,768 individuals identified as chronically homeless—nearly 30% of the total population of homeless individuals.

The National Alliance to End Homelessness11 found that the rate of chronically homeless persons increased between 2019 and 2022; 62% of individuals lived in places not meant for habitation (eg, in a car, on the street, or in a park). Burdened by health disparities and typically living with underlying medical conditions, this population was far more susceptible to being exposed to COVID-19 or to dying as a result of having stayed within the most high-risk areas, such as congregate settings, metro stations, streets, and other places not meant for human habitation.

Racial Inequality and COVID-19
Evidence confirms not only that specific subpopulations of the homeless population were affected, such as people with disabilities, but also that it was evident COVID-19 was infecting and resulting in the death of people of color at a disproportionately higher rate compared with other ethnic groups.12 Historically, people of color, often identified as a marginalized population, are considered a high-risk group—more susceptible to contracting serious illnesses due to higher rates of certain underlying health conditions as compared with whites.13 According to Artiga et al,13 communities of color faced greater economic challenges and, therefore, experienced increased challenges in accessing testing and treatment.

The National Low Income Housing Coalition9 reports that people of color are more likely than others to experience adverse social determinants of health, at-risk comorbidities, and the inability to social distance given their environment and historically embedded structural racism and discrimination. People of color are more likely than others to reside in high-risk areas and work in service industry areas such as retail, food service, hospitality service, and warehouse distribution. Further, they’re more likely to reside temporarily or long term within nursing homes, jails, prisons, and shelters. 9 These areas were identified by the CDC as overcrowded and high-risk spaces, so it would be extremely difficult in such environments to adhere to social distancing protocols and use disinfecting/sanitizing procedures to keep the areas cleaned.

As reported by the National Low Income Housing Coalition,9 systemic racial inequities in housing are among the most impactful factors contributing to the suffering of people of color during the pandemic as they are a direct result of institutional racism and economic inequity. There have been decades of research demonstrating that housing is as vital as health care, and, therefore, during the pandemic, it became clear that housing instability and homelessness have to be addressed in order to return to normalcy.

Moving Forward
Through evidence-based research, data analysis, observation and assessment during the pandemic, we have learned many lessons during this shocking, unprecedented, tragic moment in history that will help shape a better future and lead us in responding to the postpandemic needs within the community.

According to Batko et al,14 numerous goals are shared by community stakeholders at the local, state, and federal level for designing a more robust, integrated, and coordinated system for homeless persons. These include expanding the range of shelter options to create a diverse choice of noncongregate shelter preferences, investing in permanent supportive housing and prevention initiatives, and increasing funding to maintain a comprehensive system that will improve efficiency. Ikura and Kolla observe additional considerations.15 One is that large-scale solutions to housing are not impossible—the pandemic has shown that persons experiencing homelessness can be placed in permanent housing or be prevented from becoming homeless very quickly. Secondly, support from multidisciplinary comprehensive team-based interventions can be useful to advance the postpandemic era. Both concepts prove that we can indeed end homelessness.

During the pandemic, people experienced increased levels of untreated mental and physical health care; grief related to losses from COVID-19, employment, housing, and more; scarcity of food/food insecurity; and impacts of shifting to a virtual learning environment for children during their critical developmental stages. Many postpandemic impacts remain uncertain and unpredictable, nevertheless we know COVID-19 has a direct impact on the social determinants of health.

Two questions remain. What will the new “normal” look like? And how will homeless service providers respond to the postpandemic era?

The solution will have to be multilayered, as the effects of the pandemic will be acute and long-lasting. There is no one-size-fits-all approach, as we will need to examine the lessons learned during the pandemic to inform policy and service delivery practices. Strategic planning and innovation will be key as we leverage the knowledge and experience that will lead us to evolutionary change. Increased collaboration with stakeholders; integrated behavioral health services offered within homeless settings; evaluating, tracking and monitoring data to inform best practice; increasing diversion services at front-door-entry; and, more importantly, addressing each social determinant of health are strategies not only for preventing homelessness but also for ending it.16

— Crystal Pitt, LCSW-C, is vice president of housing and homeless services at St. Vincent de Paul of Baltimore, working within the Baltimore City/County region. For the last eight years, her work has centered on policy and program development, data analysis, and researching evidence-based models in order to improve the overall well-being of individuals and families experiencing homelessness. She earned her master’s degree in social work with a concentration in Urban Children, Youth, and Families from Morgan State University and her bachelor’s degree in social work from Delaware State University. She holds a professional license from Maryland in clinical social work.

References
1. The impact of the COVID-19 pandemic on homelessness in the United States. United Way of the National Capital Area website. https://unitedwaynca.org/blog/the-impact-of-the-covid-19-pandemic-on-homelessness-in-the-united-states/. Published January 12, 2021. Accessed July 2022.

2. Solutions. National Alliance to End Homelessness website. https://endhomelessness.org/ending-homelessness/solutions/

3. CDC museum COVID-19 timeline. Centers for Disease Control and Prevention website. https://www.cdc.gov/museum/timeline/covid19.html. Updated March 15, 2023. Accessed July 2022.

4. Bauer L, Broady K, Edelberg W, O’Donnell J, Contreras A. Ten facts about COVID-19 and the U.S. economy. https://www.brookings.edu/research/ten-facts-about-covid-19-and-the-u-s-economy/. Published September 17, 2020. Accessed August 2022.

5. COVID-19 parental resources kit: ensuring children and young people’s social, emotional, and mental well-being. Center for Disease Control and Prevention website. https://www.cdc.gov/mentalhealth/stress-coping/parental-resources/index.html. Updated December 13, 2021. Accessed July 2022.

6. National Low Income Housing Coalition. Federal moratorium on evictions for nonpayment of rent. https://nlihc.org/sites/default/files/Overview-of-National-Eviction-Moratorium.pdf. Published August 2021. Accessed July 2022.

7. Pattath P, Landen M. Eviction moratoriums and COVID-19. Virginia Department of Health website. https://www.vdh.virginia.gov/coronavirus/category/social-determinants/. Published January 20, 2021. Accessed July 2022.

8. de la Campa E, Reina VJ, Herbert C. How are the landlords faring during the COVID-19 pandemic? JCHS website. https://www.jchs.harvard.edu/sites/default/files/research/files/
harvard_jchs_covid_impact_landlords_survey_de_la_campa_2021.pdf. Published August 2021. Accessed July 2022.

9. COVID-19 & housing/homelessness. National Low Income Housing Coalition website. https://nlihc.org/coronavirus-and-housing-homelessness. Updated May 23, 2022. Accessed July 2022.

10. CDC: 1 in 4 US adults live with a disability. Centers for Disease Control and Prevention website. https://www.cdc.gov/media/releases/2018/p0816-disability.html. Updated August 16, 2018. Accessed July 2022.

11. Chronically homeless. National Alliance to End Homelessness website. https://endhomelessness.org/homelessness-in-america/who-experiences-homelessness/chronically-homeless/. Updated April 2023. Accessed July 2022.

12. The National Low Income Housing Coalition. The gap: a shortage of affordable homes. https://nlihc.org/sites/default/files/gap/Gap-Report_2022.pdf. Published April 2022. Accessed August 2022.

13. Artiga S, Garfield R, Orgera K. Communities of color at higher risk for health and economic challenges due to COVID-19. KFF website. https://www.kff.org/coronavirus-covid-19/issue-brief/communities-of-color-at-higher-risk-for-health-and-economic-challenges-due-to-covid-19/. Published April 7, 2020. Accessed August 2022.

14. Batko S, Moraras P, Rogin A. Using COVID-19 relief resources to end homelessness. https://www.urban.org/sites/default/files/2022-08/Using%20COVID-19%20Relief%20Resources%20to%20End%20Homelessness.pdf. Published August 2022. Accessed October 2022.

15. Ikura S, Kolla G. Sheltering people experiencing homelessness in a pandemic: lessons learned. Healthy Debate website. https://healthydebate.ca/2020/07/topic/sheltering-homelessness-pandemic/. Published July 8, 2020. Accessed July 2022.

16. Rodriguez NM, Lahey AM, MacNeill JJ, et al. Homelessness during COVID-19: challenges, responses, and lessons learned from homeless service providers in Tippecanoe County, Indiana. BMC Public Health. 2021;21(1):1657.