The Involvement of Business Elites in the Management of Homelessness: Towards a Privatization of Service Provision for Homeless People?

Although the influence of local urban elites on urban planning is well established in urban studies and geography, the ways in which business and property owners take part in the management of homelessness has received far less attention. This article focuses on Portland (OR) in the United States as a means of understanding the motivations that underlie the role of the private sector and its impact on public policies. To this end, I focus on the support by Portland's downtown Business Improvement District of homeless outreach programs, and on the funding of two homeless shelters by business elites / philanthropists. I argue that although public authorities have different views on the actions to be taken to end homelessness, business elites often manage to bring initially-reluctant public authorities to support their projects in what might be termed a forced-march cooperation. I also highlight the versatility of the private sector and business elites’ participation in homelessness management, given that the outreach programs they support and the homeless facilities they fund provide services for the homeless while simultaneously removing them from visible public space. In this sense, the involvement of business and property owners is also a way for them to protect their own interests.

Exploratory attitude survey of homeless persons regarding telecare services in shelters providing mid- and long-term accommodation: The importance of trust

Background With the expansion of digital health, it is imperative to consider intervention techniques in order not to be the cause of even more social health inequalities in underserved populations struggling with chronic diseases. Telemedicine solutions for homeless persons might compensate for shortcomings in access to valuable health services in different settings. The main aim of our research was to examine the attitudes and openness of homeless persons regarding telecare on a Hungarian sample. Methods Quantitative survey among homeless people (n = 98) was completed in 4 shelters providing mid- and long-term accommodation in Budapest, Hungary. Attitudes regarding healthcare service accessibility and telecare were measured by a self-developed questionnaire of the research team. Telecare attitude comparison was made with data of a Hungarian weighted reference group of non-homeless persons recruited from 2 primary care units (n = 110). Results A significant fraction of homeless people with mid- or long-term residency in homeless shelters did not oppose the use of telecare via live online video consultation and there was no difference compared to the national reference group (averages of 3.09 vs. 3.15, respectively). Results of the homeless group indicate that those more satisfied with healthcare services, in general, manifest more openness to telecare. It is clearly demonstrated by the multivariate analysis that those participants in the homeless group who had problems getting health care in the last year definitely preferred in-person doctor-patient consultations. Conclusion Digital health technologies offer a potentially important new pathway for the prevention and treatment of chronic conditions among homeless persons. Based on the attitudes towards telecare, initiating an on-site telecare program for mid- and long-term residents of homeless shelters might enable better care continuity. Our results draw attention to the key factors including building trust in the implementation of such programs among underserved and other vulnerable patient groups.

Homeless shelters and the blues

In this article, I analyze the emergence of New York City’s infrastructure of homeless shelters dialectically, relationally, and historically. The members of Boogie Down Productions met in an incipient New York City homeless shelter in the mid-1980s. Their relationship and music is a window into a critical political consciousness of men living in homeless shelters because the artists gave expression to an emergent structure of feeling of resistance taking hold during intense changes to New York’s political economy and its institutions. The paper first analyzes homeless policy and infrastructural change through a reading of archival sources and government reports and documents. The second section understands oral histories conducted with men living in a New York City homeless shelter as blues geographies—insurgent, critical explanations of these institutional spaces. Shelter residents actively challenge the material conditions, relations, and values that produce homeless shelters as essential instruments of the carceral state. I argue that they activate this resistance to the naturalization of shelters, and themselves as homeless, by narrating carceral spaces as abolitionist spaces.

COVID-19 prevalence and infection control measures at homeless shelters and hostels in high-income countries: a scoping review

Background: The COVID-19 pandemic has disproportionately impacted homeless populations and service workers, especially within homeless shelter/hostel settings. To date, there have been few evidence syntheses examining outbreaks of COVID-19 among both homeless shelters residents and service workers, nor has there been a critically engaged summary of relevant infection control and prevention (IPAC) measures. This scoping review offers a timely and much-needed synthesis of COVID-19 prevalence within homeless shelters and a review of current and pertinent IPAC measures. Methods: We conducted a scoping review in June 2021 that synthesized academic and grey literature published from March 2020 to July 2021 pertaining to 1) the prevalence of COVID-19 among both residents and staff in homeless shelters and hostels in high-income countries, and 2) COVID-19 IPAC strategies applied in these settings. Two reviewers independently screened the results of the literature search of several databases that included MEDLINE, PsycInfo, and the WHO’s COVID-19 Global Health Portal. All the extracted data was mapped, categorized, and thematically discussed. Results: Thematic analysis of included literature revealed five key themes: 1) the demographics of COVID-19 in homeless shelters, 2) asymptomatic spread, 3) pre-existing vulnerability of the homeless and shelters, 4) the limited application of IPAC, and 5) IPAC effectiveness. Conclusion: This review offers a useful glimpse into the landscape of COVID-19 outbreaks in homeless shelters/hostels and the major contributing factors to these events. The scoping review revealed that there is no clear indication of generally accepted IPAC standards for homeless populations and shelter care workers. This review also illustrated a great need for future research to establish IPAC best practices as well as additional resources for shelter systems to protect residents and staff at homeless shelters/hostels in high-income countries. Finally, the findings from this review reaffirm that homelessness prevention is a key to limiting disease outbreaks, and the associated negative health outcomes in shelter populations.

Monitoring for COVID-19 by universal testing in a homeless shelter in Germany: a prospective feasibility cohort study

Background Living conditions in homeless shelters facilitate the transmission of COVID-19. Social determinants and pre-existing health conditions place homeless people at increased risk of severe disease. Described outbreaks in homeless shelters resulted in high proportions of infected residents and staff members. In addition to other infection prevention strategies, regular shelter-wide (universal) testing for COVID-19 may be valuable, depending on the level of community transmission and when resources permit. Methods This was a prospective feasibility cohort study to evaluate universal testing for COVID-19 at a homeless shelter with 106 beds in Berlin, Germany. Co-researchers were recruited from the shelter staff. A PCR analysis of saliva or self-collected nasal/oral swab was performed weekly over a period of 3 weeks in July 2020. Acceptability and implementation barriers were analyzed by process evaluation using mixed methods including evaluation sheets, focus group discussion and a structured questionnaire. Results Ninety-three out of 124 (75%) residents were approached to participate in the study. Fifty-one out of the 93 residents (54.8%) gave written informed consent; thus 41.1% (51 out of 124) of all residents were included in the study. Among these, high retention rates (88.9–93.6%) of a weekly respiratory specimen were reached, but repeated collection attempts, as well as assistance were required. Around 48 person-hours were necessary for the sample collection including the preparation of materials. A self-collected nasal/oral swab was considered easier and more hygienic to collect than a saliva specimen. No resident was tested positive by RT-PCR. Language barriers were the main reason for non-participation. Flexibility of sample collection schedules, the use of video and audio materials, and concise written information were the main recommendations of the co-researchers for future implementation. Conclusions Voluntary universal testing for COVID-19 is feasible in homeless shelters. Universal testing of high-risk facilities will require flexible approaches, considering the level of the community transmission, the available resources, and the local recommendations. Lack of human resources and laboratory capacity may be a major barrier for implementation of universal testing, requiring adapted approaches compared to standard individual testing. Assisted self-collection of specimens and barrier free communication may facilitate implementation in homeless shelters. Program planning must consider homeless people’s needs and life situation, and guarantee confidentiality and autonomy.

Law's Ability to Further the "Menstrual Movement"

The current menstrual movement calls for overcoming the cultural stigma associated with menstruation, achieving “menstrual equity,” and ending “period poverty.” The stigma the movement seeks to address is that menstruation is seen as taboo, unclean, and impure. The movement’s aims are twofold: First, it wants to increase awareness of menstruation and remove discrimination against those who menstruate, thus achieving menstrual equity. Second, it intends to provide greater access to menstrual hygiene products (“MHPs”), particularly for homeless and lower income people, thus eliminating period poverty. To achieve these goals, the movement is advocating to legislatively eliminate the “tampon tax” and increase access to MHPs in prisons, homeless shelters, and schools. It also supports lawsuits challenging the constitutionality of the tampon tax. Advocates view these legal changes as instrumental in furthering the goals of equity and access to MHPs that underlie the movement. This Essay discusses whether the two major legislative changes the movement advocates—repeal of the tampon tax and providing MHPs in schools for free—will actually achieve the movement’s goals. The Essay begins by explaining how these legal changes, in theory, are meant to address menstrual equity and period poverty. It then explores the operational limits to, and expressive benefits of, these legal proposals. The Essay concludes that the expressive function of demanding these legal changes, and sometimes achieving them, plays a more significant role than the laws’ actual operation in reaching the movement’s goals.

344. Prevalence and Impact of Post-Acute Sequelae of COVID-19 Among People Experiencing Homelessness in King County, WA Between September 2020 - May 2021

Background Homeless shelters are high risk settings for SARS-CoV-2 transmission. People experiencing homelessness (PEH) have high rates of chronic illness, and have been disproportionately affected by COVID-19. The burden of post-acute sequelae of COVID-19 (PASC) in PEH has not been well-studied and PEH may be uniquely affected due to barriers to medical care and the potential exacerbation of existing threats to health, housing, employment, and self-care. Methods The Seattle Flu Study conducted community-based surveillance for SARS-CoV-2 in nine homeless shelters from September 1, 2020 and May 31, 2021. Individuals with and without respiratory symptoms were tested for SARS-CoV-2 infection using a PCR assay. We completed follow-up surveys with shelter residents age ≥18 years at days 5, 10, 30 and 60+ after positive or inconclusive diagnosis with SARS-CoV-2 infection. Individuals were asked about residual symptoms, impact on activities of daily living, access to medical care, and health-related quality of life. Results Of 51 eligible participants, 22 (43%) completed a follow-up survey, with six at day 5 or 10 survey, 11 at day 30, and 18 at day 60+. The median time from enrollment to last follow-up survey was 77 (range 49-138) days. Five (23%) participants reported at least one symptom at day 0, five (83%) at day 5 or 10, eight (73%) at day 30 and seven (39%) at day 60+ (Figure 1). Eight (36%) reported at least one symptom on a day 30 or 60+ follow up survey that interfered or prevented their daily activities. Nine (41%) received medical care at the quarantine facility. Of those with symptoms persisting beyond day 10, four (30%) received medical care outside of a medical provider at the quarantine facility. Prevalence of self-reported symptoms at Day 0 (enrollment), Day 5 or 10, Day 30, and Day 60+ in shelter residents who tested positive or inconclusive for SARS-CoV-2. Conclusion PEH reported a high prevalence of persistent COVID-19 symptoms 30+ days after their SARS-CoV-2 detection. Few participants accessed medical care for their persistent illness. The impact of COVID-19 extends beyond acute illness and PASC may exacerbate existing challenges PEH face in health and wellbeing. Disclosures Helen Y. Chu, MD MPH, Bill and Melinda Gates Foundation (Consultant)Cepheid (Research Grant or Support)Ellume (Consultant)Merck (Consultant)Pfizer (Consultant)Sanofi-Pasteur (Research Grant or Support)

Applications of geospatial analyses in health research among homeless people: A systematic scoping review of available evidence

BackgroundThe coronavirus pandemic visualized the inequality in the community living standards and how housing is a fundamental requirement to ensure a livable environment. However, even before the pandemic, unequal housing access resulted in more than 150 million homeless people worldwide, and more than 22 million new people were added to this inventory for climate-related issues. This homeless population has a counterproductive effect on the social, psychological integration efforts by the community and exposure to other severe health-related issues.MethodsWe systematically identified and reviewed 24 articles which met all three requirements we set forth-i. samples include homeless people, ii. focused on public health-related issues among the same group of people, and iii. used geospatial analysis tools and techniques in conducting the research.ResultOur review findings indicated a major disparity in the geographic distribution of the case study locations-all the articles are from six (6) countries-USA (n = 16), Canada (n = 3), UK (n = 2), and one study each from Brazil, Ireland, and South Africa. Majority of the studies used spatial analysis tools to identify the hotspots, clustering and spatial patterns of patient location and distribution. ArcGIS is the most frequently used GIS application, however, studies also used other statistical applications with spatial analysis capabilities. These studies reported relationship between the location of homeless shelters and substance use, discarded needles, different infectious and non-infectious disease clusters.ConclusionAlthough, most studies were restricted in analyzing and visualizing the trends, patterns, and disease clusters, geospatial analyses techniques can be used to assess health problems such as disease distributions and associated factors across communities. Moreover, health and services and accessibility concerns could be well addressed by integrating spatial analysis into homelessness-related research. This may facilitate policymaking for health-issues among the homeless people and address health inequities in this vulnerable population.