Hotel Rooms for the Homeless Change Health Outcomes Beyond COVID

Beyond the crucial goal of reducing the spread of COVID-19, providers say that the shift from congregate shelters to hotel rooms has made dramatic positive change for their clients. 

hotel rooms for the homeless are healthier than congregate housing. A nurse takes a homeless woman's blood pressure
Nurses for the Downtown Emergency Service Center (DESC) in Seattle provide accessible care for clients. DESC shifted more than 230 people out of congregate housing into hotel housing during the pandemic. Since the change, it has seen a drastic reduction in the number of emergency calls clients have made for medical attention and police. Photo courtesy of DESC

UPDATED Friday, Aug. 21, 2020—Dr. Nancy Connolly, a physician who works at UW Medicine’s Harborview Medical Center, which primarily serves the area’s homeless population, has worked for a while with a patient who experienced childhood trauma. “She has delusions that prevent her from moving on with her life,” says Connolly.

But something changed recently for the better. Somewhat ironically, that change was spurred by the pandemic.

As part of preventive measures against the spread of COVID-19, Connolly’s patient—along with many others—was temporarily moved from a congregate-style shelter to a hotel room. “When she moved into the hotel, I noticed such a dramatic improvement,” says Connolly. “She feels safe, she’s getting sleep. The ability to sleep without worrying is so essential for health. She has more mental and physical bandwidth. She can now name her trauma and can actively identify tools that will help her. The strides she’s making are remarkable.”

Congregate-style shelter is still the dominant approach to homeless services, but as the danger of COVID-19 became apparent and hotel and motel properties all over the country found themselves vacant while the tourism industry ground to a halt, many government officials were able to take advantage of CARES Act funding to negotiate lower nightly rates and effectively take over entire properties to house homeless individuals.

“This was the approach most shelters shifted to when it became clear that congregate housing would become a problem early on,” says Steve Berg, vice president for policy and programs at the National Alliance to End Homelessness. Through his organization’s work, Berg has spoken with countless homeless services providers across the country to get a deeper understanding of how the pandemic has shifted our approach to caring for this vulnerable population. It turns out that despite the stress of the pandemic, individual housing has had an enormous impact on unhoused people’s overall well-being—for the better.

 “The big change,” says Berg, “has been more privacy and the feeling like you have some control of your life when you aren’t sharing space.”

Organization leaders and service providers alike extolled the enormous benefits they’ve seen since shifting away from a congregate housing model, prompting a broader conversation about how we approach homelessness in America. By eliminating fundamental issues impeding more positive outcomes for their clients, providing clients a safer environment and alleviating emotional and mental health concerns, and strengthening their own ability to provide long-term treatment and care, shifting to a more individualized temporary housing model might be a key strategy for service providers in ending homelessness.

Overall, homeless services organizations that have shifted their congregate style housing to individualized care in motel settings are broadly reporting a significant quelling of emotional and behavioral health issues that they normally encounter frequently.

Dan Malone, the executive director of the Downtown Emergency Service Center in Seattle, was able to shift roughly 230 people out of congregate housing into hotel housing on a 90-day lease. With tight quarters and minimal security, the environment in the congregate shelter was one of rampant chaos, with squabbles frequently erupting into violence. Malone stressed that this issue has been all but eliminated since they made this crucial shift.

“What we’ve realized is that the physical environment contributed to the stress and difficulties that people were under, and we had a lot of crisis events,” he says. He notes that comparing a recent month in the individualized setting to the same time period last year in the congregate setting lays bare the stark contrast.

“For the period of June 1 through July 8 last year we had 128 emergency calls placed, 54 related to medical emergencies, and 74 for the police,” he says. “For the same period of time this year, at the hotel, there were less than [one-fifth] the number of calls—25 total, 15 for medical emergencies, and only 10 to police.”

Connolly of the Harborview Clinic says safety plays a major role in her patients’ emotional and behavioral health. “In a congregate setting, my patients hardly ever feel safe. They have to be concerned with their things being stolen, have no privacy, and that leads to trouble sleeping and feeling like they’re always on edge,” she says. “Once they moved, you just noticed how people could relax and have the bandwidth to start healing.”

In addition to increased safety, shifting to treating patients at a hotel versus a congregate shelter allows the ability to offer personalized services in a private setting. At the congregate shelter, Connolly saw patients in a large room with multiple other patients present. Now she can see them in their own hotel room. Having that private space allows them the psychological space to be calmer and better articulate what they are experiencing. This in turn allows service providers and caregivers like Connolly to care for their patients in a far more effective manner.

“At the beginning of the pandemic we recognized that there were significantly different health outcomes” depending how much privacy people receiving services had, says Dan Wise, the director of homeless services at Catholic Community Services (CCS) of King County in Washington.

While the organization has long offered both individual temporary housing and congregate sheltering, it shifted during the pandemic entirely away from the congregate model to move clients into five different hotels across the region. Each client received their own room with private bathroom and had meals professionally prepared and delivered three times a day.

The hotel residents engaged with services more deeply, in part because they stuck around longer. The increased safety, privacy, and comfort of their new lodgings encourages these lengthier stays, which allows care providers to observe clients over a longer period and better identify what it is that they need. “Oftentimes in congregate shelters, you might have people stay for four nights and then leave for the next three, so it’s hard to get them on a long-term solution,” says Wise. “In the hotels, we have folks staying every night, so we have daily contact with them that fosters connections with case managers and helps us get a better understanding of their service needs.”

Since CCS transitioned to individual housing in March, about 80 percent of its clients have successfully moved out and into permanent housing. A congregate shelter would have seen more like 20 to 40 percent of its clients transition to permanent housing over that time frame, says Wise.

With more consistent access to services and wraparound care because of the longer stays, “we had folks stay engaged with shelter services and on a path to housing,” says Wise.

In addition to being able to finally solve ongoing issues that generally plague the homeless community, like body lice, because clients have easier access to showers, Connolly has made marked strides in diagnosing underlying health conditions in her patients that were preventing their rehabilitation and ability to find permanent housing.

“I’m seeing more sobriety, less substance abuse, and more people reaching out for detox and rehab. Hip and shoulder mobility issues that would have once been hard to identify are now readily noticed and treated. I had one patient who I was finally able to diagnose as suffering from Parkinson’s disease, which I couldn’t do before because he was never around for long enough,” Connolly notes, adding that “this increases his priority for housing, and that’s something we wouldn’t have been able to do” had he not received such a diagnosis.

Health and homelessness cannot be divorced from one another, says Wise. “Housing is a component of health care. Elected leaders can vote against enhanced shelters and come out against people in poverty and at the same time they’ll tout the importance of health care. We also have to look at what plays into the overall health of our community.”

Can We Keep Individualized Housing Up?

The anecdotal and statistical evidence certainly proves that an individualized temporary housing approach has enormous benefits as compared to congregate shelter, for the unhoused population and ultimately for the elimination of homelessness in America. Should homeless services organizations across the country focus on implementing it, and if so, how can it be sustained over the long term?

Individualized housing is more costly, there’s no way around that. “Poverty is so high in King County that going the path of offering deeper services means that some people will get nothing,” acknowledges Wise. “We’re wrestling with that every day as an agency.” Still, she notes, by and large her organization’s staff members are advocating for a pivot to individualized, 24-hour service.

We must come to terms with the fact that congregate sheltering isn’t the most effective approach for dealing with homelessness, says Berg at the National Alliance to End Homelessness. “We now know that that model is not safe, not healthy, and not effective. If we’re going to have a short-term shelter, the model needs to be different,” he says.

But that’s also a big if. Berg suggests that organizations should be focused on how they can use operational dollars from closing congregate shelters to shift to rapid rehousing programs, which move people very quickly into permanent housing, providing initial subsidies to landlords rather than shelters or hotels.

“Communities that have honed the ‘housing-first’ approach have built ongoing relationships with landlords so they can move them immediately into housing,” Berg notes, adding that the rental market crash that is sure to occur once pandemic moratoriums run out will mean that homeless services providers will be in a position to negotiate for very reasonable rates.

“The real issue is whether this system of privately owned rental housing can work in the long run or if we need to shift to a publicly funded system. Our local and federal governments need to take responsibility for understanding how much housing is needed, how many people need it, and then build that housing and subsidize it so people with the lowest income can afford it.”

In the meantime, Malone believes, more use must be made of hotel and motel properties that remain largely vacant. “As a community we should make far more use of hotels that are consistently underoccupied,” he says. “We should refuse to go back to the status quo of cramming people into crowded congregate emergency shelters. They work against their purpose, which is to keep people safe and healthy.”

Editor’s Note: This article has been updated as comments made by Steve Berg, vice president for policy and programs at the National Alliance to End Homelessness (NAEH), were initially attributed to another NAEH representative. Shelterforce apologizes for the error.

Nicole Martinez is a writer and editor based in Miami, dissecting the intersection of culture and placemaking.

21 COMMENTS

  1. The benefits individualized housing provides are no surprise, and it’s good to finally have the data to demonstrate these realities so plainly. In order for people to heal and thrive, they need safety, privacy, and dignity. To go back to congregate housing would be a true disservice to our fellow humans, when we’ve seen how much better things can be. And as far as cost? The cost of providing inadequate service and perpetuating unhealthy cycles far outweighs the cost of truly supporting individuals, individuals who can then go on to strengthen our communities and multiply that good.

  2. Success requires more than housing.

    Psychologists such as Albert Bandura et al report that social behaviors are learned as they are modeled; and, in adults, self-efficacy (i.e. motivation) is central to self-actualization. Couple Bandura with Abraham Maslow’s pyramid of which the pinnacle is self-actualization and the foundation is basic physiological needs (shelter, food, safety). Therefore, it follows that housing and meeting basic needs are an essential first step (doing “for” others); however, attaining self actualization requires modeling of social norms coupled with motivation/determination by participants (tempered by boundary appropriate doing “with” others).

    In other words, for those housed in hotels to attain self-actualization (secure and afford their own housing), they must be motivated to climb Maslow’s mountain “with” the model/coaches as Bandura asserts.

    Successfully ending homelessness requires more than housing. Its a climb aided by the principles and practices of Maslow and Bandura.

  3. To whome it may concern, My family agrees with the subject of individualized housing. But the reason why is naturally since we are homeless no not in a homeless shelter..that would at least emply we were housed somewhere wouldn’t it? No,literally on a curb,homeless. It has been said there are no shelters in or near our area but we know that the gov.or other help agencies are said to supply hotel voucher assistance so have checked on Such claims with said agencies more than once only to be told no they don’t or aren’t. Then I find such reports and articals as these when seeking further help only to end up confused as to why it’s all over the web but not playing out for us when checking its validatey with local offices. Is the idea of sheltering homeless in hotels just a scam or is my family being lied to and discriminated against? If it is real then who is in charge of making sure families or individuals get helped properly? I informed our local offices of our whole situation and was given housing numbers instead of hotel sheltering or even any homeless sheltering information. 2-1-1 was helpful in informing housing wouldn’t be helpful to us when in need of emergency homeless assistance..though I was aware since my family lived in housing several yrs before becoming homeless. I asked for voucher assistance directly with stating homelessness and was turned away with claims they don’t do it. What now?

  4. Jennifer & Dylan could not have put it any clearer. My 71 year old mother and I are living out of a car. Every place we have called is either only helping women who have been abused, individuals with drug or alcohol abuse, or veterans. People who are homeless and have nothing else going on are basically left on the streets. The vouchers do not exist. I was given the number for our Congress woman Kathy Castor and told to call her because she always helps out the homeless and helps them get vouchers for hotels only to be told directly by her that unfortunately they are currently focused on the veterans right now. I have absolutely nothing against helping those in need because now I find myself in need as well, however singling certain people out is a type of discrimination. People in need are people in need no matter what you are going through. Whether you have an abuse problem or not, whether you are served are country or not. It is the sad truth and especially during this pandemic. One other point I would like to make, Is that other counties should help other counties at this time. I live in Hillsborough and have been refused help from Pinellas and Pasco for not being resident there for at least 6 months. These are tough times unity people. I have a 7 year old son that I waited for 6 years to hold in my arms and due to my circumstances he is not full time with my ex husband. I miss him to death. How do I explain to him that his momma is living in a car and he can’t come see her? We all need help.

    • Hello me and my wife came here form puerto rico visit family member I’m trying to get back to puerto rico and I lost everything and we re homeless me and my wife re marriage couple and need a emergency housing if any bed or room available we re in need and please help us I’m in medical issues asthma and mental retardation that can’t be outside my wife have medical need and ran out of medical please help us out we re deaf we re trying to get back to puerto rico to my home land my phone number for all call me at 541 223 9363

  5. I am also in a similar situation to Ana, Jennifer and Dylan above. I was doing everything right, had no substance abuse problems, even had a sizeable bank account at the beginning of the pandemic… and then the “circumstances” set in.
    We need to find each other, accept each other, be good to each other, and form our own support structure.
    No one is going to help, because the only people who have the heart and will to help, are those who have faced (or really, ARE facing) homelessness despite not making very poor choices. Indeed, many of those who have made poor choices didn’t have any way of knowing that those choices were wrong when they made them.

    Many of these organizations are absolutely scams- people who spend almost all of their time talking about the issues, in ways that never shine light on the realities of that we live through. I have worked for the USA’s largest non-profit housing corporation (yes, that is an oxymoron in words and in practice) and almost every employee out of hundreds was a staunch “republican”, regardless of how they registered or what they claimed publicly. Every resident was constantly at risk of eviction, all it takes is needing something fixed, or (rightfully) expecting some type of effort from property management to make their residence safe and liveable. I was a maintenance worker, and the first thing I was asked when transferred to my second property was whether I supported (then newly elected) Trump. This was heralded as an organization with a heart, and they never tired of promoting themselves… seriously, at orientation we heard the origin story and mission statement (both bogus propaganda) dozens of times each day. These people are literally getting rich, filthy rich, off of the misery and needs of our most vulnerable, while oftentimes doing nothing at all to help them, even in blatant violation of multiple laws. My last property manager, I suspect he was demanding sexual favors from single mother residents who were new to the USA, whom he knew were especially vulnerable due to obvious factors such as language barriers, lack of direct advocacy (he pretended to be that advocate) and the victims’ lack of knowledge of their rights. He never lost an opportunity to angrily, proudly rant about his own “immigrant story”, either. This is a common dynamic, predators pretending to help.

    There is effectively no help for any of us. We are expected to be used up, cast aside, and murdered without complaint. Two or three “success stories” out of millions of people waiting for help, is a statistically worse outcome than those who rob banks, flee the country, and are never found, free to live happily ever after… let that sink in. Waiting for anyone to do their jobs (yes, there are millions of people paid quite well to assist us) is far less likely to result in our survival than if we actually give up on them and become criminals in order to survive. This is what our nation (and sadly most of the planet) has decided is acceptable. I do not advocate for violence or illegal acts… but I also cannot condemn those who do turn to crime in order to survive, given the alternative slow deaths that many thousands would absolutely face if they didn’t.

    I will check back here to see if anyone else would like to join forces, so that we might share ideas of how to safely, non-violently organize and share ideas that can help us. I am all for starting or joining a community that is not governed by those who only pretend to help. We should do this soon if possible, and we need a means of communicating with each other ASAP so we can at least give each other a heads up to potential dangers, pitfalls, or (hopefully) viable assistance for homeless citizens who have been ignored and are not yet at absolute rock bottom. We need and deserve this, and we frankly have a duty to make this happen somehow. The alternative will almost certainly lead to a revolution the likes of which no red-hatter could even fathom, and that would be tragic for all life on the planet, if you knew how many formerly “respectable” people with dangerous knowledge are now desperate… and their mental health is failing fast.

    I hope each of you is well, or at least well enough to survive towards a day when life is worth living. Stay safe, and stay strong.

    • Your comment really got me. After a year and a half of being (somewhat) ignored by the services that are supposed to be assisting us, also. All of a sudden, a free months ago..I filled out a DSHS form (the main form for housing assistance) on a Wednesday, late morning, and was put into a motel on Friday afternoon. I’m sure I’m running out of time here, which is a constant great now because I don’t think I can make the horrible move back to the streets. I’m am older woman and neither my physical or mental health can handle it again. Of that in sure.
      Unfortunately, your comment brought my fear straight to the surface. I’m trying to find a place. The people at housing have told me they will help me with first, last and security but *I* need to find that housing in my own. I get a total of 350.00 a month, what apartment complex is going to give me the time of day? I’m worried, angry, nervous and frustrated.. I’m *sure* you understand. I think you have a great idea with having us communicate with one another but I’m not sure how to go about that.. I’ll check back here.
      I’m very sorry that anyone would have to go through any of this… Human beings should never treat one another on the way that I’ve been treated the past couple of years. It’s truly disgusting.

      Stay safe and stay well~

      • Karen,
        I am so sorry for your situation and for the fears my comment brings out. I still cannot lie, things look bleak. However, I intend to keep true to my word as long as I am able- so let me see if there is anything I can do to help.
        I am currently in my mother’s apartment in WV, where I have maybe another week or two before I will need to leave. After multiple attempts to find any sort of assistance, I have discovered mostly bad news for anyone in my particular situation… but you may qualify for assistance and advocacy based on what you have shared.
        If you are on disability, you should absolutely reach out to Adult Protective Services. The quality of care depends heavily on the individuals that you speak with, and of course the area you are in. For my own current area, I have discovered that every single “charity” is pretty much a scam, designed to steal taxpayer money through “addict rehabilitation”. The federal government made it too easy for sleazy opportunists to qualify as “licensed rehabilitation”, thanks to the “opioid crisis”, which is why every single person and agency I have sought help (or even simple information) from in the Midwest has referred me back to another “junkie mill”. The employees that answer the phones, even the HHS “helpline” are rude, uncaring, and disgusting… in THIS AREA.
        On a whim I called a city official in California, after reading about “safe parking” for non-addicted homeless on the West coast. The difference was night and day! Despite all of the bad press and propaganda, there are people out West that actually WANT to help. Even if they have no assistance for me, I was urged to get to California ASAP- because they seem to be aware of how bad things are East of Vegas. The humans that care are out West, and though I sincerely doubt there is enough “free money” to help the vast majority of us in need, people coming together to help themselves is not discouraged the way it is everywhere else I’ve lived.

        I think your next step should be to contact APS, and see about getting yourself relocated to the West coast states- California in particular. If you tell the APS worker that you are interested in relocating to a place with “wrap-around” services, they may be more willing to help connect you with the agencies that can make it happen. There will always be hoops to jump through, but out West they seem to be much more realistic. I know that here in WV, it’s all an absolute scam, no question. Washington state seems barely better than Ohio as far as focusing solely on opiate addicts, Oregon is apparently making strides but isn’t quite there yet, but California seems to at least understand that we need places for the new wave of homeless Americans to exist without constant threat. I plan on going as soon as I am able, so that I can set up a camp for others like us… a CLEAN camp, without addicts or predatory criminals. Mental and physical disabilities are just a part of life in the USA, so as long as everyone gets along without much drama, I can’t logically or morally exclude people who live with those. We’ve all got problems, right?
        There are “bussing” programs available in some cities, which have been used to shuffle homeless around in an attempt ignore the problems created in our society… disgusting, but for many in need this can be a good way to get themselves to a better area.
        My name I am using is my actual name- I don’t have a social media account (aside from one vehicle-related forum) but I will gladly reactivate my old facebook in order to post links and coordinate with others in need.
        If you have difficulty finding assistance where you are after speaking to APS, answer back here and let me know what area you are in. I will try to research and perhaps contact someone that can help, and then post the pertinent contact information back here again. As a young-ish non-addicted, straight white male with neither a criminal record nor former military service, I don’t expect much assistance for myself (I spent almost a month looking so far)… but if I can help you and others, I will gladly do so as long as I am able.

        Stay safe Karen, and keep faith in yourself- you matter, and deserve good chances.

        Ben

  6. Hello my name is Jamie Simpson.I am living with family but I have to leave here and am in need of a place to go until the apartment I am waiting for calls me. I can pay thirty percent of my disability for a room to stay in temporarily.
    Can you help me?

  7. To everyone that is in need of information- by either calling 211, or visiting 211.org you may be able to find assistance- those are *directory* services, and some people are having luck using them to connect with the proper agencies.

    If you can, join a major online forum such as reddit. They do have what are called “subreddits” for people that are homeless, or nearly homeless. These are discussion boards (“forums”) that can be very helpful with information.

    Once you get the hang of using them, there are even ways to request help from other members directly – though sending or receiving money is usually not a good idea due to scams.

    I hope this helps. Good luck.

  8. Hi my name is Marco I’m on 39-year-old Hispanic gay male I am currently residing in Denver Colorado that’s where I’m from I have my ID here and everything thinking about moving to Tennessee Nashville Tennessee or Louisville Kentucky only problem with that is is that I’ve been homeless and I got a little gig at a motel unfortunately they didn’t work out and now my home basically is being taken from under my feet and I have eight more days and well if anybody in Tennessee Nashville for Louisville Kentucky is reading this I would greatly appreciate your help whether it be for work shelter or whatever I would greatly appreciate it thank you so very much.

  9. It’s sad to see the number in homelessness
    I’m actually part of the homeless community I am
    This happened with and because of the covid situation
    I not only lost my job but my car my home and all the material items inside
    I didn’t sit and dwell on who was to b l and and I didn’t give up
    I continued to live
    I’m on the streets but none the less I’m with my one and only and were making the best of it
    The saddest part of it is I’m a member of the fascia taquitos tribe and in 28 years they have done nothing for me
    They let me be a victim to molestation abuse and a long long list of other more horrible forms of abuse but they assure housing for sex defenders drug dealers and those with violent sex crimes
    I went to the military graduated college and high school worked at the casino and a second job running g audit systems for hotels but have never been called even so after filing all the paper work each year
    It came up missing each year the taquitos tribe of as is so corrupt and so crooked they have a house to the same guy that was caught robbing the casino but me and my family are sleeping in the desert eating from trash cans and trying to make it to another day with no one to blame but I don’t think it’s right or fair the tribe does this I gotta be a junkie that touch’s kids while selling door and beating my wife all drunk and steal from my job to fit in and get help cause that’s what it’s made up of
    And don’t think I haven’t fought for my way with them it just have more reason for the oasis taquitos tribe to ignore me and my family 18 to 43 and I know people my age who got housing at 18 19 and live the life I just expressed .

  10. i’m from Houma, Louisiana and my kids are 4 hours away we have nowhere to go and where told that we could get a hotel for free. If this is not the correct program can you all please point to the right program , please and thank i

  11. I am single mom 3 boys and we are homeless. Yes and not only that but been placed on blackball list. Makes even worse. So even though. We have dhs in our life. And letter recommendation to hud office 3 months ago. We still sit homeless barely enough to eat and usually sleep whereever we can .i reach out shelters hud crdc 211. Nothing. If anyone can help us .we would like go to yakima washington. Home .and maybe have clean motel room to shower at or even just food to eat . homeless no one cates would love for angel fall from sky help us .

  12. I’ve been homeless since October of 2020 with my dog..travel on foot to find help been placed on different areas by so called friends but put back on the street cause of no money I recently started getting food stamps but that doesn’t put a roof over our heads .I have major health issues and unable to walk to find work in a length of distance where I’ve been staying want help me get anywhere I’ve missed lots of Dr.appointed tments and my family want get involved to help with housing our riding help.if there’s anyone that can help me towards real human help I’d appreciate it.

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