Homelessness and the Critical Needs of Those Most At-Risk

April 23, 2020 - (7 min read)

As the COVID-19 pandemic wreaks havoc among communities across the globe, it is those already living at the margins who will see the deadliest consequences. For individuals who are housing insecure or experiencing homelessnessstay-at-home and shelter-in-place orders can be difficult, if not impossible, to comply withintroducing further uncertainty and fear into their lives.  

Among the housing insecure and those experiencing homelessness, some populations are particularly vulnerablenow more than ever. These include racial and ethnic minorities, youth and adolescents fleeing abusive situations, victims of domestic violencehomeless veterans, individuals recently released from incarceration or formerly incarcerated, and those struggling with mental health and substance use disorders 

Before the crisis, cities already grappled with increases in homelessness among these populations and worked to fill gaps in treatment, services (e.g. transportation, employment opportunities, etc.) and housing. Now, the crisis further deepens these gaps. The virus is disproportionately affecting racial and ethnic minorities, worsening decades of health and economic disparities in those communities and weakening their ability to recoverVulnerable populations experience increased stress and trauma, putting them at further risk.  

Will the response in this time of crisis change the trajectory and lead to long-term solutions to meet unmet needs?  

This is the call that city leaders can answerFrom early releases for low-level offenders to short-term rental assistance and freezes on evictions, a variety of unprecedented measures have been put in place to reduce the exposure of vulnerable individuals during the pandemic. The challenge and opportunity are to find ways to overcome long-standing barriers and ensure short-term measures can be sustained to equitably improve outcomes for individuals and reduce costs. 

In the near-term, cities can provide relief to these individuals through short-term measures. Such measures include expanding access to technology through public and private partnershipscoordinating regionally in under-resourced areas and connecting the vulnerable to services and supports through the engagement of community health workers, social workers and faith-based organizations 

As we move toward recovery and building long-term resilience in cities, we draw from city models and NLC’s existing work on homelessness and at-risk populations.  Mayors and local elected officials can advance and support long-term solutions, such as expanding permanent supportive housing, changing zoning laws to allow for multi-unit dwellings to build more housing capacity over timesetting up rapid re-housing, advocating for parity in reimbursement rates for behavioral healthcare comparable to physical healthcare, and expanding Medicaid benefits for non-emergency transportation and housing supports. These and other efforts will help to keep these individuals safely and stably housed and supported into the future 

Here are actions, examples, and resources for cities to use to support these populations: 

Facilitate access to ongoing services for those in recovery

Cities can play a critical role in supporting consistent access to drug treatment by coordinating with state efforts. Indiana, for example, is providing drug treatment providers with lockboxes so patients can continue to have access to care and life-saving drugs, such as Naloxone while adhering to social distancing guidelines. Cities can reduce restrictions for people in recovery and provide information on harm reduction. San Diego is going a step further by establishing a $25 million Behavioral Health Trust Fund for local service providers to treat, stabilize, and house individuals with mental health or substance use challenges. 

Ensure providers and the general public know about new regulations regarding telehealth

Federal agencies have expanded allowable telehealth services to respond to the ongoing crisis. Cities can make sure patients and providers alike know how the changes affect their services. In Boston, street outreach workers are handing out cell phones so that homeless individuals experiencing substance use disorder can have a virtual appointment with a clinician, to get a prescription for buprenorphine under the new SAMHSA regulations. In Kansas City, MO the Johnson County Mental Health Center is expanding phone and curbside services for mediation refills and using Zoom for psychosocial groups. 

Use vacant hotel rooms to safely house individuals experiencing homelessness

People experiencing unsheltered homelessness are at great risk of contracting COVID-19 and are likely to have health factors that increase their risk of hospitalization. With the need to reduce density in shelters to minimize transmission, state and local governments must be creative about how they provide shelter. Project RoomKey” is an initiative in California in which the state partnered with the Federal Emergency Management Agency (FEMA) to provide reimbursements to state and local governments to house people in hotels and motels over the next three months. They will access to healthcare and mental health services during that period.   

Connect residents with service providers

Cities can work with their police departments, social workers, and local jails to reach unstably housed or otherwise vulnerable individuals to the appropriate services. For example, in New Orleans, a reentry organization is still operating via phone to provide case management to returning citizens. Austin-Travis County has created a social services branch to coordinate services across agencies, with an interactive map to help people find the closest services. The Boston Housing Authority and Boston Public Schools are partnering to house students at risk of displacement and homelessness over the next year. Chicago has announced a partnership with Uber and Lyft to provide free rides for victims of domestic violence. 

  Additional Resources 

  • Community Solutions: What the CARES Act means for the COVID-19 homelessness response. This resource runs through three different funds and how they can be used by organizations and local governments.  
  • Pierce County, WA has created a 1.85 million response plan for the homeless. It uses state grants and county money to fund isolation and quarantine centers, increase sanitation for the homeless, and add shelter capacity. 
  • Greater Manchester mayor Andy Burnham announced an agreement for a new city region response on mental health, including digital services and online support.  
  • Hartford, CT has set aside a team of 4 police officers dedicated solely to responding to domestic violence calls, of which there has been a 20% increase in the past few weeks. This is being carried out in close communication with local domestic violence shelters.  

About the Authors

Headshot - Laura_McDaniel_smallLaura McDaniel is a program manager at the NLC Institute for Youth, Education, and Families. 





Sue Pechilio Polis is the Director of Health & Wellness in the National League of Cities Institute for Youth, Education, and Families.



Anne_Li_SmallAnne Li is the Program Specialist, Health & Wellness, for NLC’s Institute for Youth, Education, and Families.