RT Journal Article
SR Electronic
T1 Challenges faced by people experiencing homelessness and their providers during the COVID-19 pandemic: a qualitative study
JF CMAJ Open
JO CMAJ
FD Canadian Medical Association
SP E685
OP E691
DO 10.9778/cmajo.20210334
VO 10
IS 3
A1 Kathryn Hodwitz
A1 Janet Parsons
A1 Clara Juando-Prats
A1 Esther Rosenthal
A1 Amy Craig-Neil
A1 Stephen W. Hwang
A1 Joel Lockwood
A1 Paul Das
A1 Tara Kiran
YR 2022
UL http://www.cmajopen.ca/content/10/3/E685.abstract
AB Background: People experiencing homelessness are vulnerable to SARS-CoV-2 infection and its consequences. We aimed to understand the perspectives of people experiencing homelessness, and of the health care and shelter workers who cared for them, during the COVID-19 pandemic.Methods: We conducted an interpretivist qualitative study in Toronto, Canada, from December 2020 to June 2021. Participants were people experiencing homelessness who received SARS-CoV-2 testing, health care workers and homeless shelter staff. We recruited participants via email, telephone or recruitment flyers. Using individual interviews conducted via telephone or video call, we explored the experiences of people who were homeless during the pandemic, their interaction with shelter and health care settings, and related system challenges. We analyzed the data using reflexive thematic analysis.Results: Among 26 participants were 11 men experiencing homelessness (aged 28–68 yr), 9 health care workers (aged 33–59 yr), 4 health care leaders (aged 37–60 yr) and 2 shelter managers (aged 47–57 yr). We generated 3 main themes: navigating the unknown, wherein participants grappled with evolving public health guidelines that did not adequately account for homeless individuals; confronting placelessness, as people experiencing homelessness often had nowhere to go owing to public closures and lack of isolation options; and struggling with powerlessness, since people experiencing homelessness lacked agency in their placelessness, and health care and shelter workers lacked control in the care they could provide.Interpretation: Reduced shelter capacity, public closures and lack of isolation options during the COVID-19 pandemic exacerbated the displacement of people experiencing homelessness and led to moral distress among providers. Planning for future pandemics must account for the unique needs of those experiencing homelessness.