Guidance on COVID-19: provision of night shelters
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The Ministry of Housing, Communities & Local Government has
published operating principles for commissioners and providers of
night shelters for people experiencing rough sleeping. Contents 1.
Who is this advice for? 2. General advice 3. Keeping people
safe...Request free trial
The Ministry of Housing, Communities & Local Government
has published operating principles for commissioners and
providers of night shelters for people experiencing rough
sleeping.
ContentsThis document sets out operating principles to support commissioners, staff and volunteers of rough sleeping accommodation (night shelters) as well as rough sleepers themselves during the COVID-19 pandemic, should the decision be taken to open a shelter. Please note that is a risk of COVID-19 in night shelters. Therefore, decisions to reopen shelters must be balanced on a detailed COVID-19 risk assessment. These settings should only be used as a last resort to protect against the risk to health and life of individuals remaining on the streets when other alternative options are unavailable, for example in very cold weather. This set of operating principles aims to support local authorities and providers to mitigate the risks of COVID-19 in these circumstances, but it is not endorsing the opening of shelters where local partners have agreed that they are not necessary. The principles have been drafted with advice and input from Public Health England and in consultation with the Department of Health and Social Care, Housing Justice, and Homeless Link. The situation will be regularly monitored. Restrictions on the number of people in gatherings under Regulations do not apply where reasonably necessary for work purposes or for the provision of charitable or voluntary services. Night shelters fall within this exemption. However due to the vulnerability of the group affected and the higher risks of transmission contact between guests and between staff should be minimised wherever possible and you should ensure that they do not gather in groups once inside the shelter. 1. Who is this advice for?The public health advice and regulations on social distancing and self-isolation during the COVID-19 pandemic may be challenging for people experiencing homelessness and rough sleeping. These operating principles are to support local authorities and commissioners, staff and volunteers of rough sleeping accommodation (night shelters) during the COVID-19 pandemic. For the purposes of this document, “rough sleeping accommodation,” or night shelters, is assumed to be temporary or semi-permanent sleeping accommodation with multiple people sleeping in a shared room, with shared facilities (toilets and/or bathroom, and kitchen facilities). These principles apply to:
This advice does not cover hostels. Separate guidance is available for hostel accommodation with individual self-contained rooms. Local providers will need to make an assessment on which areas of this guidance are most relevant for their particular circumstances and setting, such as their staffing arrangements and the extent to which their facilities are shared between guests. This advice may be updated in line with the changing situation. These principles are applicable to England only. 2. General adviceThe purpose of these principles is to reduce the risk of COVID-19 transmission if self-contained sleeping spaces are not an option. Night shelter projects should consider whether they can provide self-contained accommodation options. For clear safety reasons individual rooms and individual washing facilities should be the default to appropriately protect individuals from communicable diseases such as COVID-19. Rotating night shelter models – where a different venue is used each night and people/belongings move each day – carry a higher risk of infection and should not be used. Providers and commissioners of night shelters should work closely with their local authority, including local housing and rough sleeping teams, and local public health teams, to follow these principles. Providers may need to take additional measures if there are special measures in place for the local area where the shelter is located. See affected areas where special measures may be in place. 2.1 Deciding if a night shelter should or can re-openLocal housing and rough sleeping teams within local authorities must consider whether the risk people sleeping rough in their area is so great that it requires a night shelter to open or whether there is a more COVID safe option such as self-contained accommodation. This should be informed by an assessment of current numbers of people sleeping rough and/or availability of self-contained accommodation units. When looking across England, we expect that many local areas will not require a night shelter because either the number of people sleeping rough in that area is very low and/or because they have (or can quickly acquire) self-contained emergency accommodation for those who need it. Any accommodation option must include access to local authority self-contained accommodation if guests need to self-isolate (see section 3.3) These assessments should be regular in order to respond to changing circumstances, and should also involve planning for possible future changes in circumstances, for example if the incidence of COVID-19 changes in future months. All local housing and rough sleeping teams should engage with their local Public Health teams, as well as delivery partners and shelter providers, to make these assessments as soon as possible. Local authorities should ensure that they are communicating proactively with the faith and community groups who usually provide shelter accommodation. If a local authority deems that a shelter provision is not required in an area, voluntary and faith groups who usually provide shelter provision should not open their shelter in this area. If a provider or delivery partner has concerns about the assessment made by a local authority, they should raise these concerns at their local homelessness multi-agency meeting. This should be a forum to discuss what alternatives could be provided within local resources, and to share any emerging intelligence about rough sleeping. 2.2 General principles for communal night sheltersCommissioners and providers should make an assessment on how they are able to meet current guidelines on social distancing, shielding and self-isolation and plan their response. They should carry out a COVID-19 risk assessment in line with Health and Safety Executive guidance, and consult with the local Director of Public Health, who will work with the local PHE Health Protection Team, about reopening and establishing appropriate protocols, pathways and measures to reduce transmission risk. See contacts for your local public health team. Commissioners and providers should ensure that they have understood how they can apply guidance on COVID-19 case management and isolation to the shelter setting; particularly how the definitions of household and non-household contacts will apply to shelter guests. This includes a means to identify and contact individuals who have stayed in the shelter who have been in contact with a suspected or confirmed case, and a pathway to access self-contained accommodation for suspected or confirmed cases, and their contacts and ‘households’ at short notice, to enable self-isolation. Providers should limit the transitions between households where possible to minimise contact. For example, keeping guests who stay in the shelter for several nights in the same household groups, and keeping staff and volunteers in the same teams. There is no legal maximum number of individuals that could be within the same household, but providers should try to limit household groups to no more than six. It is important that if guests share these facilities they should be considered a household. If people are already in a “grouping” outside of the shelter (for example, a couple), then it is acceptable to consider them a household in shelter environments too. Providers should limit the number of guests using the same bathrooms and kitchens as much as possible, as well as reducing the number of staff and volunteers in direct contact with guests. To manage risk, it is important to highlight that there is no number of people under which risk is suddenly reduced; the higher the number of people, the higher the risk for everyone. As a minimum, providers should ensure that guests do not gather inside the shelter, particularly in groups of more than six. This will also have implications for contact tracing (“test and trace”), as a larger number of people in a group will require more effort from everyone to contact the relevant people who were exposed to a case. Please see section 3.3 for more detail on how to identify household groups. Providers should ensure that staff, volunteers, and guests are supported to adhere to this advice, and other legislation and guidance on social distancing, shielding, self-isolation, and working safely during COVID-19. Everyone in the venue should follow these general principles to help prevent the spread of infections caused by COVID-19 and other respiratory viruses, including:
3. Keeping people safe3.1 Access, referrals and triageProviders should work with local housing and/or rough sleeping and local public health teams to ensure there is a clear pathway to refer individuals into the COVID safe night shelter, including a triaging health assessment of guests before they enter. Providers should also agree a contingency plan with local housing and rough sleeping teams if a guest tries to access emergency accommodation by presenting directly during the night-time when a health assessment cannot take place. This may involve the local authority ensuring that alternative self-contained emergency accommodation can be made available at short notice until a health assessment has taken place.. Providers must ensure that everyone who would like to enter a shelter is first assessed for:
Anyone who falls into the above categories must not enter a night shelter. This applies to staff and volunteers working in the night shelters. Any potential guests who are assessed as having signs and symptoms of COVID-19, contact with a confirmed case in the previous 14 days, or at increased risk of severe illness from COVID-19 should be placed in alternative accommodation with individual rooms and individual washing facilities for self-isolation. Please see section 3.2 on what to do if a guest has COVID-19 symptoms or a positive test. Symptoms of COVID-19 and contacts with a confirmed case can be self-reported by guests, but shelter staff may wish to prompt guests to provide this information when entering the shelter each night. Providers should note that health assessments do not eliminate all risk that individuals may be COVID-19 positive without experiencing symptoms. This is why it is still important to follow the general principles to reduce the risk of COVID-19 transmission (see section 2), such as observing social distancing guidelines. Assessment of whether an individual has an existing condition or conditions which increase the risk of severe illness from COVID-19 must be overseen by a clinician. We strongly recommend that local authorities and shelter providers agree pathways with local Clinical Commissioning Groups (CCG) and NHS primary care commissioners to facilitate clinician support. Providers should also work with these partners to consider how they can support guests with health conditions which might present a barrier to adhering to the COVID-19 guidance (e.g. mental ill health, substance misuse, or a learning disability). Night shelters must have in place Standard Operating Procedures for what to do if an individual develops symptoms whilst on site. Pathways to ensure all assessments and referrals must be in place before a shelter opens. These should include, as a minimum:
Destitute arrivals requiring government accommodation to self-isolate Anyone who has recently arrived into the UK (within the last 14 days) from a country excluded from the ‘travel corridor’ list will need to self-isolate for 14 days, unless they are otherwise exempt. Similarly, anyone that exhibits COVID-19 symptoms upon arrival into the UK should self-isolate, even if they are otherwise exempt. In exceptional circumstances, shelter staff may become aware that a guest has entered the country and failed to make arrangements at the border. In this instance the shelter provider should either:
In all cases, guests must not be allowed to remain in the shelter if they are not able to self-isolate. Please note:
3.2 If a guest has symptoms of COVID-19 or has a positive test result for COVID-19If a guest has symptoms of COVID-19, however mild, OR they have received a positive COVID-19 test result, the clear medical advice is to immediately self-isolate for at least 10 days from when their symptoms started, or the day the test was taken if the individual does not have symptoms. Any guests with symptoms or a positive COVID-19 test result should not go to a GP surgery, pharmacy or hospital except in an emergency. Staff should support a guest with symptoms to arrange a test to see if they have COVID-19 if the guest is able to be self-isolated safely on site. Visit NHS.UK to arrange or contact NHS 119 via telephone if internet access is not available. Arrangements for urgent testing should be in place if a guest develops symptoms while in the shelter, and arrangements for alternative pathways to testing should be considered to meet guests’ needs. Providers should therefore work with their local Public Health teams to put these in place before the shelter opens. Staff should inform their local PHE Health Protection Team as soon as possible and conduct a risk assessment to determine whether the guest should be safely moved to an off-site self-contained facility. Providers should work with local housing and rough sleeping teams to ensure that self-contained accommodation can be available at short notice if required. If guests who are symptomatic require transfer, public transport should not be used:
Further information on safe transport options is contained in the hostel guidance listed at the end of this document. Staff should follow guidance for cleaning, which includes guidance on dealing with laundry and waste of someone with symptoms of COVID-19. If a guest’s symptoms do not get better after 10 days, or their condition gets worse, staff should use the NHS 111 online coronavirus service, or call NHS 111 if internet access is not available. For a medical emergency call 999. Local authorities and shelter providers should agree who will be responsible for making these welfare check ins as part of planning before re-opening. 3.3 Identifying contacts of guests that develop signs and symptoms of COVID-19Providers and commissioners must also have clear Standard Operating Procedures (SOPs) to identify contacts if a guest who has stayed in the shelter develops COVID-19 signs and symptoms and/or tests positive for COVID-19 on site, or within 48 hours of leaving the shelter. This should include, as a minimum:
Wider guidance and the legislative requirements is available. This guidance distinguishes between household and non-household contacts. In identifying contacts, providers will need to interpret the meaning of ‘household’ based on the set-up of their venue. This will depend on the layout of the accommodation and how it is organised. It is important to determine the household structure of the venue as part of prevention planning. In deciding what constitutes a household, the key factor is whether residents share living spaces, in particular: bathrooms, toilets, kitchens and sleeping space. Residents who share any of these should be considered as a ‘household’ and should be considered as a close contact if an individual who shares a household displays COVID-19 symptoms and/or tests positive for COVID-19. Therefore, there must be pathways in place to enable everyone in a household to access self-contained accommodation to self-isolate. 3.4 Responsibility for providing accommodation for self-isolationShelter providers should work with the local housing and rough sleeping teams within the local authority to assess options for suitable self-contained accommodation to prevent night shelter use wherever possible, to guests who are symptomatic, test positive for COVID-19, or are identified as a contact of someone who has tested positive for COVID-19. Providers should work closely with local authorities – both housing and public health teams – to develop established pathways to provide guests with self-contained accommodation where necessary prior to re-opening. If isolation is not immediately possible, ‘cohorting’ based on COVID-19 status may be considered to seek to mitigate some of the health risks. Cohorting is a strategy which can contribute to limiting the spread of disease by gathering people into different areas depending on their status. For example, contacts can be in a separate area of the shelter and non-contacts in another. The Clinical Homeless Sector Plan published by Pathway provides more details on cohorting in the context of emergency accommodation for people experiencing rough sleeping. 3.5 Managing an outbreakAn outbreak is defined as 2 or more confirmed cases in a single facility within 14 days of one another. In this event, commissioners and/or providers should seek advice from their local Health Protection Team. All shelter providers should look to their local authority and local health services for support. This is true whether the shelter provider has a contract with the local authority or not. Local authorities need to have a clear picture of all alternative local provision that could be used in the case of an outbreak. 4. Managing Health and WellbeingAs well as having their own room and bathroom facilities, guests who have stayed in the shelter who are now required to self-isolate as above should have personalised plans in place which include:
There is specific guidance for services that support people who use drugs and alcohol that hostels should be familiar with. Homeless Link has guidance on trauma and psychologically informed approaches, and the Public Health England (PHE) guidance for the public on mental health and wellbeing will be useful. 5. SafeguardingDuring the COVID-19 crisis, it is particularly important to safeguard adults with care and support needs. They may be more vulnerable to abuse and neglect as others may seek to exploit them due to age, disability, mental or physical impairment or illness. Services and existing safeguards may have been affected. Commissioners, providers and their staff should refer to COVID-19 and safeguarding resources and positive practice in adult safeguarding and homelessness. 6. Staff, volunteers and Personal Protective Equipment (PPE)Staff and volunteers who can work from home, should be supported to do so, particularly if they are clinically extremely vulnerable. Staff and volunteers with COVID-19 symptoms should follow COVID-19: stay at home guidance. They should not visit the night shelter or care for guests until it is safe for them to do so. They are classed as essential workers and can apply for priority testing through GOV.UK. Where agency staff are being used, they should not be switching between different shelter sites. Providers should keep staff in the same teams and rotas as much as possible to minimise contact. This may include arranging staff so that the same people are working on the same shifts and not mixing these where possible. This may mean that staff work several shifts or nights in a row so that guests are less likely to come into contact with several members of staff as they rotate through shifts. The majority of staff will not require PPE beyond what they would normally need for their work. PPE is only needed in a very small number of circumstances:
If possible, in the latter case , PPE should include a fluid-resistant surgical mask, single use disposable apron, single use disposable gloves, and if appropriate following risk assessment, eye or face protection (the use of eye or face protection can be risk assessed for the particular situation). Providers should use their local supply chains to obtain PPE. If they cannot obtain the PPE they need they should approach their local authority, who should support them to access PPE according to priority needs. If the local authority is not able to respond to an unmet urgent need for PPE, providers will need to make a judgement in line with their risk assessment as to whether it is safe to continue to operate. 7. Venue operationNote: The principles in this document should be implemented alongside the providers’ existing non-COVID health and safety, and building control measures. Providers, alongside their local public health team, should consider how they can implement the following measures as much as possible to reduce the risk of transmission before the shelter opens. Providers may need to take additional measures if there are local restrictions in place for the local area where the shelter is located. See affected areas where local restrictions may be in place. 7.1 Hand and respiratory hygieneFrequent hand hygiene should be promoted for guests and staff throughout the shelter, with prominent notices and verbal prompts. Ensure information is displayed in appropriate languages. Hand washing facilities or hand sanitiser should be available throughout the shelter, and especially at entry points to the shelter and all shared areas. Consider making hand sanitiser available on entry to toilets where safe and practical, and ensure suitable handwashing facilities including running water and liquid soap and suitable options for drying (either paper towels or hand driers) are available. Respiratory hygiene should be promoted at all times. This means coughing and/or sneezing into a tissue and disposing of it immediately or coughing and/or sneezing into the crook of the elbow followed by hand washing. Provide disposable tissues and foot-operated waste bins throughout the setting. Providers should also support individuals to maintain social distancing in the venue (see section 7.3). 7.2 CleaningStaff should follow guidance for cleaning, which includes guidance on dealing with laundry and waste of someone with symptoms of COVID-19. Increase the frequency of cleaning, especially surfaces that are regularly touched by hand, such as tabletops, light switches and door handles. Ensure all resident areas are fully cleaned between use. Systematic, more frequent and effective cleaning of toilets should be implemented, verified and documented. Emphasis should be on hand touch surfaces such as taps, door handles and flush handles. If a shelter venue is usually used for day activities or for a day centre with additional guests, it is recommended that providers consider holding these activities in two different venues. If this is not possible, there must be a thorough cleaning process of the venue between the two different uses. Staff and guests should avoid handling personal belongings that are not their own. Staff should not handle the personal belongings of guests, for example for the purposes of laundry or storage, and should instead encourage guests to do so as far as possible. If this cannot be avoided, then staff and guests should wash their hands with soap and water for at least 20 seconds, or use a hand sanitiser after handling personal belongings that are not their own. 7.3 Maintaining social distancing and ventilationWherever possible, social distancing of 2 metres between guests and between guests and staff must be facilitated. Put up signs to remind guests of social distancing guidance, avoid sharing workstations, use floor tape or paint to mark out a 2 metre distance, and arrange one-way traffic through the venue if possible. Ensure sleeping areas are clearly marked out with at least 2 metre distancing between each resident. Minimise the number of accommodation residents, staff/volunteers, and other venue guests, to allow for social distancing. Stagger arrival and departure times to reduce social contact. Pay particular attention to social distancing at entry points and in shared areas such as smoking areas, dining areas and toilets. Use floor markings for 2 metre queuing points, and consider one in/one out systems. Where social distancing of 2 metres cannot be implemented, consider further mitigation measures such as plastic screens to protect residents and staff. Individuals experiencing rough sleeping and homelessness may face particular challenges to maintaining social distancing and other measures to keep themselves and others safe from COVID-19. It is recommended that providers work with local primary care and rough sleeping teams to consider how they can support guests that face these challenges. Providers should also work with local public health teams to understand additional measures they can put in place to encourage adherence to these measures. Ensure all areas of the shelter are well-ventilated, with open windows and doors wherever possible. Please see guidance on air conditioning and ventilation. Please note that these measures do not make a shelter completely safe but they can and should be used to reduce the risk of transmission. 7.4 What you need to know about COVID-19 and foodVenues should avoid meals involving sharing food and/or eating utensils. Guests should eat within ‘household’ groups where possible and maintain social distancing with non-household guests during mealtimes. Recommendations on keeping numbers to a minimum on site apply to considering who accesses any food provision. Although it is very unlikely that COVID-19 is transmitted through food packaging, as a matter of good hygiene practice staff should wash their hands frequently with soap and water for at least 20 seconds. This should be done routinely, including:
Food packaging should be handled in line with usual food safety practices and staff should continue to follow existing risk assessments and safe systems of working. For more information see guidance for food businesses on coronavirus (COVID-19). 7.5 Face coveringsFace coverings must be worn by residents and staff in all shared indoor places, unless exempt for health, disability or other reasons. Consider providing face coverings for all guests. See further guidance on face coverings. 8. Severe Weather Emergency Protocol (SWEP)We expect local authorities to begin planning their SWEP provision for the winter period alongside local providers as soon as possible, if they have not begun plans already. The guidance for SWEP sits outside of these operating principles, but areas should include these operating principles in their general winter provision planning. SWEP is an emergency response where there is a risk to life due to extreme weather, and so assessing if a shelter should open and balancing risk needs to take that into account. Homeless Link provides guidance and case studies to help areas develop suitable responses during the winter and periods of severe weather. 9. Other practical things for providers to considerTrustees and managers of night shelter projects should confirm that their insurance remains valid for re-opening with robust mitigations. You may also need to consider the impact of these mitigations on capacity of your accommodation provision and your organisation’s finances. By planning for these mitigations, you should seek to understand the maximum number of guests who can use your night shelter each night. Remember to include staff and volunteers in your planning. You should then seek to understand what impact this level of capacity will have on your service. If your shelter relies on Housing Benefit payments, there could be a financial impact. If you have a grant or contract based on a housing a particular number of people, this will need review. Assess whether it will be financially viable to re-open with fewer guests. 10. Other sources of informationOther sector guidance and collections that commissioners and providers of services to people experiencing homelessness and rough sleeping might find useful include:
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