HomeMy WebLinkAbout05-2022 May Homeless minimum care standard finalMinimum Care Advisory for Homeless
April 28, 2022
Deschutes County
Public Health Advisory Board (PHAB)
Introduction
This PHAB document recommends a minimum care standard for homeless citizens of Deschutes
County to minimize reduced health resulting from being homeless.
This advisory document does not identify how the care will be delivered or funded. It can be used to
inform the Deschutes County Homeless Outreach Coordinator in helping community organizations
meet a Deschutes County minimum standard for the homeless. Furthermore this document can be
used in conjunction with the annual Point In Time (PIT) to inform the community about the size of the
need, logistical planning and locations for services.
This advisory is based upon The Sphere Project, an international standard developed for humanitarian
responses of displaced populations and modified for our community.
Executive Summary
There are a number of local groups are working to shelter to homeless people.
There were 824 persons identified during the 2021 PIT as unsheltered.
There have been year on year increases of homeless from 2015 to 2021
It is generally accepted that the PIT is an under-count. Some estimate 40% low.
Lack of sewage and trash services impacts neighbors and the homeless
Lack of adequate safe water negatively affects the health of homeless.
Mobile clinics report that frequent clearance of homeless people negatively affects their
healthcare: Clients can't be found for follow up chronic health care and often lose prescription
medications in the moving process
Recommendations:
Deschutes County should work with homeless communities, NGOs, and local governments to supply:
Safe water,
Toilets,
Trash collection
Coordinate medical care working with area providers.
Background
The international NGO community assembled minimum standards in humanitarian response and
published them in The Sphere Handbook in 1998. The 2018 edition is the fourth edition which has the
technical chapters updated to reflect current practices.
Current Need
Deschutes County has had a homeless census for the past 7 years. The number have approximately
doubled.(Table 1) There are many situations that contribute to a person losing their home, such as loss
of job, an unaffordable increase in rent, medial and other unexpected bills. During the January 2021
PIT count we found 824 people were homeless, (Table 2)
The Homelessness Leadership Coalition and other community groups, have worked to re-house our
homeless citizens. However, our community has not been able to keep up with the increase number of
homeless. County level plans and guidelines to keep homeless citizens from deteriorating health until
they can be successfully housed are in development
Table1: Point In Time (PIT) counts by year 2015 to 2021. https://cohomeless.org/agency-tools/point-
in-time-count/
Table 2: Point In Time (PIT) count of Un-Housed for 2021 https://cohomeless.org/agency-tools/point-
in-time-count/
Definition of Homeless for PIT Count:
HUD Literally Homeless Definition (§ 578.3)
Individual or family who lacks a fixed, regular, and adequate nighttime residence, meaning:
Has a primary nighttime residence that is a public or private place not meant for human
habitation; or
Is living in a publicly or privately operated shelter designated to provide temporary living
arrangements (including congregate shelters, transitional housing, and hotels and motels paid
for by charitable organizations or by federal, state and local government programs); or
Is exiting an institution where (s) he has resided for 90 days or less and who resided in an
emergency shelter or place not meant for human habitation immediately before entering that
institution.
PIT POPULATION 2015 2017 2018 2019 2020 2021 2022
TOTAL (Adults + Children)594 778 787 880 969 1099
All Households 409 510 572 616 586 836
Individuals in Families (1AD +1CH)211 284 199 243 360 165
Adults (18+ years old)465 615 663 773 604 989
All Children (<18 years old)129 163 124 147 203 110
Unaccompanied Children (<18)12 7 15 20 6 18
All Youth (18-24 years old)55 78 94 76 71 175
Unaccompanied Youth (18-24)43 61 83 52 48 154
Veterans >59 83 60 62 59 89
Chronically Homeless Veterans 30 49 22 22 27 8
Chronically Homeless Individuals 161 187 139 160 286 74
2021
Children (<18)75
Young Adult (18-24 years old)151
Adults (18+ years old)598
Total 824
PIT Unsheltered
Deschutes County Public Health Advisory Board 2022 Priorities
Each year the PHAB establishes a set of priorities based upon the needs of the community. One of the
priorities for 2022 was to address the public health aspects of homelessness. We established a
committee to review current programs operated by NGOs, health programs operated by care providers
under Medicaid /Medicare system and the county's public health department. We found the largest gap
in services that negatively affects the health of the homeless as well as negatively affecting community
public health were those around Water, Sanitation and Hygiene (WASH).
The issue of providing health maintaining WASH services for displaced homeless and refugees has
long been recognized as vital by World Health Organization, Red Cross Red Crescent, and Doctors
without Borders to name a few. These international NGOs assembled a set of minimum standards in
humanitarian response and published them in The Sphere Handbook for 1998. The 2018 edition is the
fourth edition and has been updated to reflect current practices. We used the Sphere WASH standard to
inform our analysis of need for the homeless in our community.
continues on next page:
Sphere 2018 Water Sanitation and Hygiene (WASH ) Diagram
The figure below is from the 2018 Sphere document showing the components of their WASH
programs. We use this as a guide for informing what is needed within our community.
Core Minimum Care Needs
1- Water Supply (Sphere 2018 WASH pg 89ff)
Lack of access to reliable and adequate water source has a significant detrimental effect on the
health of the homeless. Inadequate drinking water can cause dehydration leading to heat
related diseases (heat exhaustion or heat stroke), Dehydration can also occur in colder weather.
Lack of an adequate water source limits bathing and personal hygiene, including such crucial
health care as cleaning of wounds and chronic diabetes foot ulcers. (Tips for Healthy Feet
Summary https://www.cdc.gov/diabetes/library/features/healthy-feet.html)
The following are recommendations for water quantity used for drinking, cooking, and
personal hygiene:
Water, 2- 4 Gallons (7.5 -15 liters) per person per day (Sphere 2018 WASH Pg 107
Distance to water source: less than 1/3 mile (500 m)
At least one water source per 250 people.
Flow rate at source 2 gallon/ min (0.125 l per second)
Provide storage containers suitable for transporting water from source.
2- Excreta Management (Sphere 2018 pg113 ff)
Where a lack of facilities exists, many homeless people will self-dehydrate to limit the
frequency of urination. Dehydration leads to heat and cold related medical emergencies.
People need to have a safe and sanitary place to urinate and defecate. By providing excreta
management it also protects the community around homeless community as well as homeless
citizens of our county. The following recommendations are:
Maximum of 20 people per toilet (Sphere 2018 pg118
Toilet ratio 3:1 women to men (Sphere 2018 pg118)
Arranged by household (Sphere 2018 pg118)
Segregated by sex
Safety – Locking door.
Distance from dwellings 50 yards (50 m) (Sphere 2018 pg117)
Hand washing stations with soap (Sphere 2018 pg118)
3- Vector Control (Sphere 2018 pg121 ff)
It is important to control flies, mosquitoes, mice and rats. Flies, rats and mice contribute
contaminating food supplies and spreading disease. Our community is home to deer mice
which can be a reservoir of the Hanta virus.
Provide:
Trash and garbage containers with pick up services (pg 126 ff standard 5.1)
Provide adequate food storage containers. (pg 209 )
4 Drainage (Sphere 2018 pg237 ff)
Homeless communities should be evaluated for drainage and to minimize standing water.
(urban pg 241, drainage of rainfall pg 252)
5- Hygiene Promotion (Sphere 2018 pg96 ff)
The following hygiene supplies are usually difficult for homeless to obtain.
These items should be made available:
Soap and Laundry detergent (pg 99 -hand washing with soap also, pg 100)
Toilet paper (pg 99 -promoting the use of toilets)
Menstrual supplies (pg 102 standard 1.3)
Incontinence supplies (pg 102 standard 1.3)
Safe storage for prescriptions and medical supplies. These should be locked to prevent
theft and should be water tight and insulated to maintain prescription medicine efficacy.
6- Health Care Services (Sphere 2018 pg289ff)
Recommend that community providers such as the Mosaic Van, urgent care, ER and county
health department plan for best practices (Standard 1.1 pg 298)
Appendix
Reference Documents
Point In Time (PIT) count central Oregon:
https://cohomeless.org/
HUD Continuum of Care (CoC) Program
https://www.hudexchange.info/programs/coc/
The Sphere Project
https://spherestandards.org/
The Sphere Handbook 2018
https://spherestandards.org/wp-content/uploads/Sphere-Handbook-2018-EN.pdf
The Sphere COVID-19 guidance
https://spherestandards.org/coronavirus/
Related articles and videos:
UNHCR WASH Manual 2014
http://wash.unhcr.org/Cover_and_Prelims.pdf
Housing instability and food insecurity as barriers to health care among low -income
Americans, Margot B Kushel 2006
https://pubmed.ncbi.nlm.nih.gov/16423128/
The Right to WASH: Is San Francisco Willing to Ensure this Foundational Human Right?
https://www.streetsheet.org/the-right-to-wash-is-san-francisco-willing-to-ensure-this-foundational-
human-right/
Homeless Leadership Coalition Annual Central Oregon PIT
https://ktvz.com/top-stories/2022/01/19/homeless-leadership-coalitions-annual-c-o-point-in-time-
count-begins-monday/?fbclid=IwAR0oc-
_tuok87QGeg0nAG7ugqfwZrD_zL5NfU5qQQCADxTGTN5gSYv37gzc
Bend Bulletin: Worth your time: Bend Bulletin’s ‘Faces of Homelessness’
https://www.kgw.com/video/news/local/the-story/worth-your-time-bend-bulletins-faces-of-
homelessness/283-a1f6a6e8-9eed-4d71-97ce-48189262a8f7