Establishing spaces and staffing for isolation or quarantine in non-congregate settings

April 2, 2020
Bed graphic, created by Mister Pixel from the Noun Project

USER GUIDE

This information seeks to provide consolidated, vetted guidance on appropriate spaces to quarantine or isolate clients who are experiencing homelessness and may be asymptomatic, symptomatic, or high risk of contracting COVID-19.

This guide would be appropriate for Continuums of Care, Coordinated Access Networks, and Balance of States considering how to design non-congregate isolation settings for clients. 

The relevant sources have been listed in each section, and notes from Built for Zero’s internal quality control check can be found at the end of the document. It is further advised that beyond this guidance that you coordinate with public health partners in designing an approach and, if feasible, screen clients for COVID-19 at the first point of access.

Given that the clinical picture of COVID is ever changing, and that the information about response is changing in turn, Built for Zero anticipates there might be new information on this topic. Please keep an eye out for updated information.

Key Definitions

Isolation housing is a type of non-congregate housing, or units designated by local authorities or shelters determined to have capacity to sufficiently isolate individuals who are ill from those who are not sick.

  • Isolation housing can be a part of isolation sites where 1) individuals are housed who may not require medical care or 2) alternate care sites where individuals are housed who require a level of medical care.

Non-Congregate settings are private or public facilities providing contingency refuge to those who do not require hospitalization but need isolation and quarantine because of the current public health emergency.

Congregate settings are environments where a number of people reside, meet or gather in close proximity for either a limited or extended period of time. Examples include homeless shelters, group homes, prisons, etc.

Quarantine separates and restricts the movement of people who were exposed to a contagious disease to see if they become sick. 

Examples

Isolation Housing: hotels, motels, and dormitories

Facilities for Isolation Spaces: Recreation vehicles and utilization of recreation vehicles, large venues, safe parking sites for those unsheltered who live in vehicles

Sources

Isolation should be used for:

  • Clients who are confirmed to be positive
  • People awaiting test results
  • People currently experiencing homelessness and cannot be discharged to a congregate setting. 

Isolation should also be employed for individuals discharged from hospitalization. A  plan should be in place for how they will safely recover after discharge. Ideally these individuals will be housed for the duration necessary. 

Both unsheltered and sheltered individuals experiencing homelessness who are deemed at high risk of medical complications should also be prioritized for individual housing units. This population includes individuals who are 60 years of age or older and people of any age with pre existing lung disease, heart disease, cancer, diabetes, HIV, or other major medical conditions. (Source: the State of California) 

Sources


Considerations

Private individual rooms with a private bathroom equipped with personal cleaning supplies are most appropriate for individuals:

  • Who are symptomatic after screening
  • Have pending tests
  • Were in close contacts with confirmed cases
  • At high risk without symptoms
  • Confirmed to have COVID-19 but do not need hospitalization 

Individual bedrooms with walls on all sides and a door, or spaces with makeshift walls that are floor to ceiling  and separation of 6ft are appropriate for individuals:

  • who are symptomatic after screening, 
  • who are confirmed to be COVID-19 positive and who do not need to be hospitalized 

These individuals can have a limited shared bathroom with a cleaning regiment wherein the bathroom is cleaned and disinfected after each use by an ill person.  Ideally and where feasible individuals should have a dedicated entrance or passageway. For more information on cleaning bathrooms and isolation units, please click here. 

Sources

Separation 

Individuals, specifically if ill, should be able to stay in a specific room and away from other people.

Isolation housing or space should allow for clients to have separate eating and bathroom facilities and avoid common areas, if possible.

Ventilation

Isolation housing or space needs to be adequately ventilated, with a least one window. The space or housing in addition to adequate air ventilation should have air filtration and waste management. The space or single room ideally should have ensuite facilities. 

Basic Items

Additionally the space should be comfortable for the client with food, water, hygiene facilities, protection for baggage, access to medical treatment with a daily follow up of screening of body type and symptoms, and psychosocial support.

The room should be equipped with personal cleaning supplies for the ill person to be able to clean, unless this would be inappropriate

Sources

Space and Separation

These spaces should be set aside specifically for those that are ill.

If individual rooms with walls or makeshift walls is not feasible, isolation spaces should be arranged so that individuals are separated by 6 feet. If that is not possible, they should be separated by at least 1 meter or 3ft.

Barriers

Add temporary physical barriers between beds. These barriers can be created with sheets or curtains, with beds arranged so that individuals lie head to toe relative to each other.  

Ventilation

Ensure isolation spaces are in a large, well ventilated room.

Bathrooms

Spaces being shared by people in isolation should have a designated bathroom for individuals in the room.

If a separate bathroom is not possible, the bathroom should be cleaned and disinfected after each use of an ill person

Additionally, these areas should have designated bathroom for those individuals in the room, however if no separate bathroom is available, the bathroom should be cleaned and disinfected after each use of ill person, if not possible, staff should wait as long as practical after use by an ill person to clean and disinfect the high touch surfaces. 

Meals

Individuals should be fed or eat in their area. For more details on safe meal delivery and service, please click here.

Sources

Ideally, onsite support and services would include: 

  • Healthcare
  • A transportation plan for closest hospital with transport available
  • Janitorial staff
  • Non-congregate site management staff (i.e. hotel, motel staff)
  • Case management 
  • Security

If cost is prohibitive and staff capacity is limited, it is recommended to have: 

  • Identified staff to care for COVID-19 patients
  • Access to telehealth or telehealth options
  • PPE for available staff
  • Non-congregate site management
  • Security

Behavioral health teams should be involved in planning and present to facilitate continued access to support for people with behavioral health issues. 

Entities should identify emergency funds to expand medical respite programs so that health care and support services can be delivered to individuals who need ongoing care in these isolation spaces but do not require hospitalization. 

Sources

QUALITY CHECK

Learn more about our process for vetting information.

Scope

Graphic of eye in magnifying glass, created by Adrien Coquet from the Noun Project

What context was the data underlying this recommendation collected in?

  • Built for Zero compiled this information in response to Community/Partner need for information on appropriate spaces to quarantine/ isolate clients who may be asymptomatic, symptomatic, or high risk of contracting COVID-19. 
  • This resource looks at standing up appropriate spaces for shelter overflow that can ensure proper social distancing space to quell contamination of those who are healthy.
  • The data that informed this resource comes from congregate shelter settings in Connecticut, San Francisco, Seattle & Kings County WA in addition to articles from WHO, HUD, CDC, NAEH, APIC, and National Healthcare for the Homeless Council

What context or question do we recommend this resource for?

  • We recommend this resource for communities that are considering utilizing non-traditional and non-congregate settings to isolate  individuals.

What other contexts do we reasonably think this recommendation might apply to, and on what basis?

  • N/A

Authority

verified by Gregor Cresnar from the Noun Project

Who reviewed this data, and what are their credentials to assess it?

  • Built for Zero’s team reviewed this data to identify the most relevant and recent non-conflicting information.

Novelty

Graphic of clock by Adrien Coquet from the Noun Project

When was the data underlying this recommendation collected?

  • This information was compiled on 3/31/2020
    • WHO Interim Guidance was last updated on 3/19/2020
    • CDC guidance on Responding to COVID-19 among People Experiencing Unsheltered Homelessness was last reviewed 3/22/2020
    • HUD & CDC Non-Congregate Approaches to Sheltering for COVID-19 Homeless Response was last updated on 3/26/2020
    • Estimated ER and Observational/Quarantine Capacity Need for the US Homeless Population Related to COVID-19 from NAEH was last updated on 3/25/2020
    • Homelessness & COVID-19 Consideration and Action Steps from NAEH was last updated 3/23/2020
    • COVID-19 & the HCH Community: Needed Policy for a High-Risk Group from the National Healthcare for the Homeless Council was updated 3/2020
    • Seattle-King County Public Health’s Interim Guidance on COVID-19 for Homeless Providers was updated 3/16/2020 
    • COVID-19 and people experiencing homelessness SF from the recommendation of their Dept. of Public Health was last updated 3/26/2020
    • Coronavirus Disease (COVID-19) Guidance for Congregate Settings from the NYC Health Department was last updated on 3/19/2020
    • Fremont County Public Health Director issues public order for non-congregate shelter was last updated on 4/2/2020

Do we have reason to believe the situation has materially changed since that date, or is likely to change soon?

  • Given that the clinical picture of COVID is ever changing, and that the information about response is changing in turn, Built for Zero anticipates there might be new information on this topic. Please keep an eye out for follow up information as new resources emerge.

Qualifications

Error by Aleks from the Noun Project

What specific component of this resource do we recommend?

  • N/A

Are there any specific elements of this resource we do not recommend?

  • N/A

Open Questions

questions by Gregor Cresnar from the Noun Project

What elements of this resource were we unable to assess?

  • N/A

What elements of this resource do we want to know more about?

  • N/A
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