2020 has been a very hard year. After months of uncertainty, no one wants to think about another public health crisis—especially one that could affect so many of us. An analysis of recent US census data estimates that 30-40 million people across America are facing possible eviction in the coming months as the prolonged COVID pandemic leads to high rates of unemployment and additional unemployment benefit ends.
The eviction crisis will have far reaching consequences—not only for homelessness but also for healthcare. Social determinants of health are key factors in inter-generational poverty and the pending eviction crisis in our country has surfaced fear in many Americans. Successfully addressing the crisis will require a truly collaborative community effort to ensure that temporal needs, such as housing and food security, are met along with physical and mental health needs.
The Current Situation
The Coronavirus Aid Relief, and Economic Security (CARES) Act passed earlier this year, offered financial assistance and protection in light of the COVID-19 pandemic and resulting economic downturn. With $600 a week in unemployment checks and a temporary moratorium on evictions, the act served to create a cash cushion for low-income Americans facing financial hardship following the furloughs, layoffs, and closed businesses caused by COVID-19.
Now, individuals and families across all levels of the community are facing eminent eviction as those temporary protections begin to expire. Following the July expiration date, over one-third of American renters failed to make their full August rent—and that number is expected to climb over time.
Furthermore, studies have shown that this eviction crisis will hit the Black and Latinx communities disproportionately—with people of color representing roughly 80 percent of households facing eviction.
The Connection Between Housing and Health
For those who are able to make rent, the Joint Center for Housing Studies of Harvard University suggests that those payments are a cost-burden for the families—or that the amount of rent represents more than one-third of the household income.
Before the pandemic, 25 percent of renters spent more than 50 percent of their household income on rent, and for those below the poverty line, one in four spent more than 70 percent of the household income on rent. Spending such a large percentage of income on housing limits the ability of these households to pay for other things—including healthy food, health insurance, preventative care, and even necessary medications. Additionally, living conditions that involve multiple families living in one household can raise further concerns for individual health.
For individuals and families where even the most basic housing is not affordable, health issues become even more complicated.
Homelessness is connected with a number of physical health conditions—including HIV infection, tuberculosis, inadequate food supply, and even “medieval diseases” such as typhus that stem from poor sanitation. Serious mental health conditions—including schizophrenia, bipolar disorder, and severe depression—are found in 25 percent of America’s homeless population, and 45 percent of the homeless population has at least one mental illness. Behavioral health conditions, such as substance use disorder, are prevalent among the homeless communities as well.
A great number of homeless patients are “dual diagnosed,” meaning they are struggling with both a mental health issue and substance use disorder (SUD) at the same time. Often the SUD stems from self-medication that happens as a result of unaddressed mental health issues. Understanding this, it’s imperative that our plans for addressing the eminent eviction and homelessness crises take into account not only the shelter, but the health, of these individuals and families.
Adopting a Community, and Charitable, Approach
Caring for our homeless neighbors requires an approach based on ideals of charity, collaboration, and community.
When we take a charitable approach to our care of others, we’re not just looking to cover bases by putting roofs over heads. We’re thinking about these individuals as just that—individuals. They have needs beyond shelter, including healthcare, case management, medication, food, and fellowship. If the eviction crisis leads to pop-up shelters offering little more than a bunk to sleep on, we’ll have made little progress in addressing the physical and mental illness and loneliness these individuals face, ultimately perpetuating the cycle of homelessness.
Adopting a collaborative approach gives us access to the tools necessary to address the multiple factors contributing to homelessness. For example, partnering with local emergency departments can help communities find appropriate placement for individuals with homelessness that need more than just a bed—they need access to electricity for heart monitors or rehabilitation for untreated substance use disorder.
In Spokane, we’ve seen a lot of success partnering with Providence Health Care in reducing ED visits for our homeless populations by having the hospital “sponsor” a set number of respite beds in our homeless shelters which are reserved and filled by homeless hospital patients being discharged. Because these patients are discharged to appropriate shelters with resources that will help alleviate, rather than exacerbate, existing health conditions, their health outcomes improve—breaking the cycle of discharge and readmission. In one case, a chronically homeless person—who visited the ER 60+ times per year— was able to enter the Providence respite program, receive case management, and become housed. Once in housing, this individual only came to the ER twice over the next year.
Finally, although an individual may be temporarily without a home, they should never be without a community. At many of our housing locations, we have designated volunteers and paid staff who make daily rounds to our residents to remind each tenant that we care and to simultaneously monitor for any potential issues—from drug use, to behavioral patterns like hoarding or signs of depression. These daily visits help us identify and address issues, and keep our tenants feeling cared for and like they’re not alone. Sometimes it’s a case manager knocking on a door, just checking in. Sometimes one of the nuns who volunteer with us make cookies in the community kitchen and go door to door visiting with residents.
Current predictions forecast that 29-43 percent of renter households could be at risk of eviction by the end of the year. We need to prepare for this crisis. Although there has been some CARES money designated to help people avoid evictions (and we are managing some of that money for the city), there will be a need for more resources once the eviction moratorium is lifted. Our rapid rehousing program is designed to keep residents from being evicted and has been successful for many years. But we typically work with a few hundred clients over the course of a month. This eviction crisis will bring a few thousand to our doors—likely all at once.
Working together to provide home and health, the responsibility is ours as communities and care teams to be open, kind, and friendly as we work with each other with empathy and understanding to address the new challenges brought on by this pandemic. Understanding the connections between homelessness, health, and poverty are essential if we want to create a sustainable, long-term solution to end the suffering of our community’s most vulnerable populations. We have a sacred obligation to care for all of our neighbors, especially the weakest among us. The COVID-19 crisis has made us all feel vulnerable…feel weak…feel afraid…feel alone in some way. But for the homeless, these feelings are amplified tenfold by the reality of their situation. We need to avoid adding thousands more to that number in our cities and towns as the eviction moratoriums begin to be lifted throughout our areas.
Robb McCann is President and CEO of Catholic Charities, Eastern Washington. He has been working on their ministry and implementing progressive strategies for supporting the health and progress of homeless populations in Washington for over twenty years.
This article is a collaborative effort with Collective Medical.