Promoting Emergency Response for Homeless Service Agencies: Field-Based Recommendations from Two Municipalities in Nova Scotia, Canada

Some of the core initiatives implemented by the two cities included: moving people into hotels; renovating shelter spaces to comply with public health ordinances; a managed alcohol initiative; a dedicated public health phone line for shelters; and comfort stations for IEHs to gain needed support (i.e., food, laundry, shelter from elements, and meet a worker. These essential initiatives came out of the multi-sectorial Tables. One critical study finding is the importance of partnerships. The two Tables signify the coming together of various organizations and players (formal/informal system - community, non-profit sector). Both systems held key expertise and deliverables. All SSs spoke of the importance of such collaborations and how COVID made for deeper and more trusted relationships. While these relations were seen as complicated at times with some tensions and critique, every participant noted that the sector had become “more collaborative,” “more collegial,” vast learning spaces to try out new ideas, knowledge sharing sites, and deeper trust built. Having discrepant lenses from diverse departments (i.e., government, community, and public health) created a deeper understanding and learning about homelessness- especially seeing homelessness from a social determinant of health perspective. Such collaboration enabled the sector to mobilize activities effectively based on trust and create more collaborations for efficient and effective teamwork. A vast majority of participants recommended that these multi-sectorial Tables continue post-pandemic and maintain the vibrant creative, and urgent focus on homelessness and housing.

In order to fulfill these essential service programs, SSs advocated that staff and volunteers working in these community-based service organizations supporting IHEs need to be considered essential workers, similar to those working in long-term care and hospitals. This acknowledgment has implications for bonus pay, vaccine rollout, and public recognition of the critical work these frontline staff contributed in a context of great duress, stress, and limited income.

All homeless participants indicated that more physical spaces are urgently needed for IEHs, including apartments, rooming houses, shelter beds, and also places to “[h]ave a coffee… Just to sit here and have a chat… makes you feel welcome, right?” (CBRM IEH). These participants highlighted how challenging it was to access shelters or independent accommodation during the pandemic because “there’s not always a bed available. And it sucks because there’s still a lot of people out there” (HRM IEH). Another CBRM IEH echoed that:

We should have more, like open up more shelters, more spaces that people can go and feel safe instead of living on the street freezing to death or having to live in rat-infested grossness.

Although shelters received upgrades, shelters are emergency spaces and are not permanent solutions to the systemic issues of homelessness. One HRM SS argued, “we can dump millions of dollars into homeless shelters but what we really need is sustained kind of long-term building of non-market housing.” Homeless service agencies should advocate for “a complete diversion program where everybody gets their own apartment or room, and you don’t have to be in a dorm-style environment at all” (HRM SS).

Almost all the homeless participants felt “left behind” and “exposed” when public health measures were enacted to curb the spread of COVID-19. A CBRM IEH noted:

Remember how quiet everything was and the whole town was suddenly like a morgue… All there would be people that were homeless or who just had nothing, and nowhere to be, kind of just roaming around.

IEHs are the core beneficiaries of homeless programs. Hence, their voices need to be engaged in the operational decision-making of homeless services. Although the Tables presented a COVID-19-driven, innovative, and collaborative approach, there was a large absence of IEHs’ voice representation at the Tables, who could have provided critical suggestions regarding what actions to take and how.

Due to the prevalence of substance use and mental health issues among IEHs (Gilroy et al. 2016), IEHS’ calls for full access to detox centers promptly, the establishment of rehabilitation programs, and the mental health services should be engaged.

There should’ve been a phone number that you can call if you were worried about your mental health during this COVID pandemic and just get more information about it, all right? Kind of vent a little bit. Just to talk to somebody (CBRM IEHs).

Numerous participants explained how income assistance rates needed to be increased, especially during the pandemic, as most people on income assistance were ineligible for the federal COVID-19 emergency response benefit (CERB): “I mean somebody who has worked and got the hours and got EI [employment insurance] or CERB. Why are they entitled to it when there are people on welfare that are struggling?” (CBRM IEHs). Participants also identified that the one-time payment of $50 from income assistance to help pay for COVID-19-related costs, such as masks and sanitizer, was inadequate. Other participants repeated the importance of implementing a universal basic income as the best support for people experiencing poverty and improving everyone’s quality of life. The pandemic has highlighted the importance of a universal, broad-based social protection floor and universal basic income as a viable federal solution to the systemic nature of homelessness. However, participants also noted that clarity and support are required when different levels of government offer income support for low-income people. As one Cape Breton SS explained:

“We [know of] 22 [people] evicted because they had received some source of federal pandemic benefits. What ended up happening was they got this money, they spent it on things that weren’t rent or food; expecting that they were going to get their income assistance cheque the next month, and then without warning, Income Assistance cut them off and they had spent the CERB … and had no money for rent. Had Federal and Provincial Government counterparts communicated better, I think that all that stuff was avoidable and, had the provincial government communicated better with clients in receipt of income assistance, I think a lot of that could have been avoided.”

Most participants noted having little information about the pandemic due to a severe lack of communication and knowledge transfer. One HRM IEH explained, “We were very ill-informed because they, the staff, were ill-informed themselves.” Public sectors that provide vital general information, make public health decisions, and design communication tools must focus on, and involve, the most vulnerable and marginalized at the forefront. These efforts fundamentally promote societal mandates of equity, diversity, and inclusion. SSs illustrated the importance of fostering essential information distribution among vulnerable and marginalized communities:

“They really felt forgotten,… they can’t even have access to information” (CBRM SS).

In addition, due to library and business closures, access to phones and the internet was severely hampered through COVID-19 among IEHs. Notably, the availability of a phone and the internet allowed only a few IEHs to access medical appointments and communicate with friends and family during the lockdown. Aiming to inform these vulnerable groups of up-to-date public health information (e.g., vaccine updates), an emergency communication infrastructure is urgently needed, including publicly accessible telephones and internet. One CBRM IEH underlined the importance and urgency of this critical infrastructure in the context of the swift evolution of the pandemic, frequently updated public health restrictions, and related service adjustments:

I feel like there wasn’t enough information about how to not contract the virus. I find people aren’t kept up to date on what to do. People need to be more up to date on what is going on with the virus because it is important. It is for everybody’s health honestly. A lot of people don’t realize how serious this virus is.

In addition to homelessness, other ongoing societal issues, including domestic violence and child protection, were intensified during the pandemic. The essential communication infrastructure is needed to critically support people living in precarious circumstances, report emergency issues, and provide quick responses and access to essential services and resources. As one CBRM SS noted, “[public Wi-Fi] would be a major thing that we identified and is something that we are going to have to address in future emergencies.”