Abstract
Background: As COVID-19 surged in people experiencing homelessness, leaders at Boston Medical Center (BMC), New England's largest safety-net hospital, developed a program to care for them. Aim: Provide an opportunity for COVID-infected people experiencing homelessness to isolate and receive care until no longer contagious Setting: A decommissioned hospital building. Participants: COVID-infected people experiencing homelessness Program Description: Care was provided by physician volunteers and furloughed staff. Care focused on allowing isolation, managing COVID-19 symptoms, harm-reduction interventions, and addressing problems related to substance use and mental illness. Program evaluation: Among 226 patients who received care, 65% were referred from BMC. Five percent were transferred to the hospital for a complication that appeared COVID-related. There were no deaths, but 7 patients had non-fatal overdoses. Seventy-nine % had at least one diagnosis of mental illness, and 42% reported actively using at least one substance at the time of admission. Thirty % had at least one mental health diagnosis plus active substance use. Discussion: This hospital-based COVID Recuperation Unit was rapidly deployed, provided safe isolation for 226 patients over 8 weeks, treated frequent SUD and mental illness, and helped prevent the hospital's acute-care bed capacity from being overwhelmed during the peak of the COVID-19 epidemic.
Highlights
People experiencing homelessness (PEH) are at increased risk of infection from COVID-191–3 and recommended infection control measures are often not feasible.[4]
The COVID Recuperation Unit (CRU) was classified as a medicalized shelter by Department of Public Health (DPH), and as a “bedded outpatient” unit by the Drug Enforcement Administration (DEA), avoiding the need to qualify for inpatient level of care and permitting medications to be prescribed on an outpatient basis, which allowed the CRU to operate without an inpatient pharmacy
The development and implementation of the CRU were generally quite successful, the program faced a number of challenges
Summary
People experiencing homelessness (PEH) are at increased risk of infection from COVID-191–3 and recommended infection control measures are often not feasible.[4] Frequent handwashing is difficult, shelters are crowded, and physical distancing is not possible; beds often have no barriers between them and are located in large rooms. When COVID-19 infection occurs in PEH, they are often unable to isolate at home and may lack familial supports. These patients need help in order to recuperate, and it is essential that they isolate in order to reduce the risk of transmitting COVID-19 infection.[5]. BMC leaders prioritized addressing the unique needs of this vulnerable population
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