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Across the U.S. nearly 1.4 million people rely on homeless shelters and transitional housing programs each year. During the early stages of the COVID-19 pandemic, health and social service agencies across the nation--some well, and others poorly--employed dozens of strategies to keep them safe.
Washtenaw County did the same, and the county did it well. Many agencies and organizations came together to support these efforts and combine their resources; Washtenaw County Community Mental Health, with resources from the county’s Public Safety and Mental Health Preservation Millage, was among them.
Why would a mental health millage support housing efforts, you ask? The reasons are plentiful, but perhaps first and foremost because housing provides the safety and stability residents need to get and stay healthy--both physically, and mentally.
In fact, Washtenaw County Community Mental Health (WCCMH), the county’s safety net behavioral health provider, has been a critical partner in the area’s homeless system of care for years by:
So perhaps it’s not surprising that in the early stages of the pandemic, WCCMH added to these longstanding contributions with a millage grant of $140,000 toward safe, temporary housing during the pandemic. And in the months to follow, WCCMH contributed another $20,000 in millage funds to cover emergency housing and rental assistance for more than five-dozen individuals and families in need.
One result of these efforts was that while two Washtenaw County shelter residents with COVID-19 were identified the week Michigan reported its first documented case, no new COVID-19 infections were identified among homeless populations in the county’s shelters over the next six months. In the winter months, when infections again began to rise, eight COVID-positive residents were identified among Washtenaw’s homeless. One of these individuals became sick enough to require hospitalization, but all have since recovered and are doing well.
Due to the fragile health of people experiencing homelessness, who often suffer from multiple chronic conditions that worsen the effects of COVID-19, hoteling individuals experiencing homelessness almost certainly saved lives. But there have been other benefits as well. Here’s the story.
Michigan’s first COVID case and Washtenaw’s response
On March 10, 2020, when the first COVID-19 case was confirmed in Michigan, more than 100 individuals were being served at the Delonis Center in downtown Ann Arbor. The Delonis Center, which operates 365 days a year, 24 hours a day, is Washtenaw County’s primary provider of safe, temporary housing for adults experiencing homelessness.
Dr. Ravi Vadlamudi, who oversees the shelter’s free medical clinic for Packard Health, had just begun to discuss infection prevention protocols with the Washtenaw County Health Department, and Delonis employees when Dr. Holly Murphy, his wife and an infectious disease specialist at the St. Joseph Mercy Health System, offered to help the group assemble a formal plan.
The next day, Murphy met Vadlamudi, as well as Delonis Center Director Daniel Kelly and Clinical Director John Schippers, to walk through the shelter and map out safety plans. That night, the evidence-based plans were implemented with residents sleeping head to toe to ensure adequate distance in the crowded shelter, with face masks required of all guests and staff, with hand sanitizer stations located across the building, and more. They also designed new screening protocols for visitors, which were implemented on March 13.
Four days later, the rigorous new screening protocols identified one individual with symptoms who later tested positive for COVID-19 and on March 25, they found another. Between those dates, the center moved many of its residents to individual rooms at a local hotel, the Red Roof Inn, to ensure adequate distance and safety.
The hotel rooms were basic, but they weren’t free. Each room cost $60 per resident, per day. But keeping Washtenaw County’s homeless residents out of the emergency room, out of the hospitals, and out of overcrowded congregate living facilities where infections can spread rapidly--as other communities across the U.S. learned all too well--would ensure the safety of Washtenaw’s homeless population while protecting the entire community from infectious disease spread.
The unanticipated benefits of a room and a phone
Additional gains and outcomes from hoteling Washtenaw’s homeless populations have come to light in the intervening months.
“In the beginning of the pandemic we said let’s get people safe--that was the intent in securing hotel rooms,” says Katie Hoener, a clinical social worker who leads homeless discovery for Washtenaw County Community Mental Health. “But there’s been all of these secondary gains and outcomes that we weren’t anticipating.”
When Washtenaw County Community Mental Health staff members need to locate a client who is overdue for medication--part of the county’s assertive community outreach program--it’s Hoener and her colleagues who locate them. But since the decision to shelter homeless individuals at a local hotel, this WCCMH team has spent much less time finding homeless individuals and much more time helping homeless individuals obtain housing, supportive services, and related social services.
Since March 2020, the WCCMH homeless outreach team has signed up 80 individuals for the housing choice voucher waitlist and 15 for the chronic homeless prioritization list, which gets people on the waitlist for rapid rehousing, supportive housing, and other services. To qualify, Washtenaw County residents need 12 months of documented homelessness over three years. Staying at a hotel paid for by the county counts toward that total.
Homeless populations are often medically fragile, says Hoener. The Delonis Center offers a rigorous recuperative care program for adult shelter residents and warming center visitors, but Hoener says the hotels have amplified that.
“We had one individual at the hotel who had just received a toe amputation,” says Hoener. “He’d had another diabetes-related amputation last year, but because he was living outside it got infected and needed further surgery. This year, because of the hotel stay, he was able to successfully recover.”
Another big thing Hoener and her team are grateful for is that hotels give Washtenaw’s homeless a consistent phone number, so they’re able to set up medical appointments, receive reminder calls, and get to their follow up appointments.
And residents at the hotel also receive three nutritious meals a day, have showers to clean and care for themselves, have a lock on the door so they feel safe, have climate-controlled rooms--a boon in the heat of summer and the cold of winter alike--and have a bed and blanket for proper rest.
Finally, the hotel has made it easy for WCCMH staff—and other service providers--to check in with residents on a daily basis. They now pop in to help with social security applications, court mandates, job applications, food stamps, and more.
A more active role in diversion
“The hotel, which is secured for Washtenaw’s homeless until March 31 at least, has been a real asset to our community work,” says Amanda Carlisle, director of the Washtenaw Housing Alliance, a coalition of local organizations committed to ending homelessness.
“No one wants to be in a loud congregate setting where there’s no personal space during a pandemic,” says Carlisle. And people with mental health and substance use disorders are particularly reticent (about 70 percent of those served by the Delonis Center have a chronic physical or mental health condition). “The hotel is a much more humane way to shelter and protect folks.”
Carlisle says that Washtenaw County Community Mental Health is now able to take a more active role in diverting individuals from shelters in the first place. With a $15,000 grant from the Public Safety and Mental Health Preservation Millage, WCCMH will provide flexible funding for diversion activities not currently covered by existing community resources, she says.
“Now, when Washtenaw County residents come to the shelter and say they’ve been staying with family members or friends but have to leave because there’s not enough food, the shelter can ask, “What if we give you a food card?” says Carlisle.
This diversion initiative, which was piloted for a year with state funding then launched in earnest in mid-January, shows great promise, says Carlisle. And there are other diversion activities in the works including discharge planning, which is about making sure hospitalized patients and incarcerated adults have adequate housing arrangements before they’re sent back to the community.
This could be particularly important in the months ahead.
“We’re seeing reports saying we could see a 40 percent increase in homelessness,” says Carlisle. While that hasn’t happened yet--largely because of the statewide eviction moratorium and rental assistance dollars--Carlisle says she and other local service providers are preparing for a large influx of people and families who need housing assistance.