Globally, nationally and locally we are at a decisive point as the world makes its response to the COVID-19 pandemic. We are all required get involved in this enormous effort as we aim to keep the world safe.
Ironically, homeless people, the ‘undesirables,’ have often been isolated by society. Now the nation and all nations are being mandated to self-isolate and people are experiencing the challenges that this can bring with it. These are unprecedented times.
Social-distancing and self-isolation measures will be difficult to implement for rough sleepers and for those in hostel/temporary accommodation. Those who sleep rough are the most visible form of homelessness. However, people in a wide range of other situations are also described as homeless. All of them need to be identified and offered self-isolation support. Understanding each type of homelessness will lead to better support. Homeless people deserve to receive health care of a high standard and, in some instances, this care maybe lifesaving.
There are some social and clinical conditions that put homeless people at higher risk of severe illness from COVID-19. As a result of living on the street and sleeping rough, for example, many will have compromised immune systems, respiratory conditions and also a drug and/or alcohol addiction, the perfect storm for contracting the virus.
In 2018 in England and Wales, the mean age at death of a homeless person was 45 years for males and 43 years for females (compared with 76 and 81 years respectively in the general population). The total estimated number of rough sleeper deaths was 726, representing a 22% year-on-year rise (Office for National Statistics, 2019). The figures related to this vulnerable group may look very different in 2020. Soup kitchens, hostels and care provision are being stopped in the light of the virus, leaving homeless people even more vulnerable.
The Queen's Nursing Institute (2020) makes clear that, with the right support to tackle deep-rooted medical, personal and social problems, it can be possible for those people who are experiencing homelessness to enjoy positive health and rebuild more stable lives.
Throughout the UK, homelessness and COVID-19 taskforces should be established, including representation from the police, housing, health and social care, the homeless, people with lived experience, the wider voluntary sector and other relevant stakeholders. Contingency plans that include self-isolation protocols need to be developed.
The role of the nurse when caring for the homeless population is even more important today in fast-moving and changing situations. Nurses in the community are adept at developing and sustaining care interactions with homeless people.
There are provisions being made by local councils to purchase hotel rooms so the homeless can self-isolate, including in London (Mayor of London, 2020). These rooms will provide vital protection for rough sleepers. But it is acknowledged that the provision of hotel accommodation may not suit all homeless people. Some people may decline to go indoors and some may refuse to isolate because of the need to attend to their addictions.
We can all contribute to the health and wellbeing of the homeless by being kind, chatting to homeless people, asking if they need food or drink and, if desired, giving money. We must act responsibly and avoid taking any risks and, for the sake of the homeless, respect the requirements related to social distancing and wash hands. We can also make donations of useful things to individuals and to charities.