Tag: unsheltered homelessness

Health, homelessness, housing, human services

Marquee Plan to End Unsheltered Homelessness Depends on Federal Funding Source Some Call Risky
Image via We Are In.

By Erica C. Barnett

Last week, the King County Regional Homelessness Authority’s implementation and governing boards approved a 2024 budget proposal that assumes the agency will receive significant future funding from Medicaid to keep the Partnership for Zero program, which aims to end unsheltered homelessness in downtown Seattle, going. Currently, the program is funded by corporate and philanthropic donations through a public-private partnership called We Are In.

The federal funding would come through a statewide program for Medicaid clients called Foundational Community Supports that funds “pre-tenancy” services for chronically homeless people—everything from getting an ID to negotiating an apartment lease.

“Based on current research, we estimate that Medicaid will reimburse 85% of Partnership for Zero (PfZ) costs,” or about $5.2 million, the KCRHA’s 2024 budget says. In 2022, a group of corporate and philanthropic donors pledged $10 million to fund the initial downtown Seattle “demonstration project,” which pays case managers known as system advocates to connect people living downtown to services, shelter and housing. Over the next five years, KCRHA plans to expand Partnership for Zero countywide.

Several members of both boards, including Auburn Mayor Nancy Backus, expressed reservations about relying on a federal program that the KCRHA has never used before to fund one of the agency’s marquee initiatives. “I’m just concerned about approving [a budget] where you don’t have the money,” Backus said. “As someone who provides our budget to the council every two years, we never put anything in the budget … that’s aspirational.”

“I think that there were some estimates that were like, ‘this will make it rain money,’ and then there were other estimates that were like, ‘this will get you two nickels.’ We feel confident that this is a capturable amount of revenue.”—KCRHA CEO Marc Dones

“I would love not to spend more money than we have,” KCRHA CEO Marc Dones responded. “So what we’re doing is a number of dry runs with Medicaid billing while we’re still entirely grant- funded”—essentially, submitting invoices for real services to see what gets rejected and approved.

“Our current conservative estimate [is] an 85 percent reimbursement,” Dones added. “I think that there were some estimates that were like, ‘this will make it rain money,’ and then there were other estimates that were like, ‘this will get you two nickels.’ We feel confident that this is a capturable amount of revenue.”

But providers and advocates familiar with Foundational Community Supports, speaking to PubliCola on background, said that although the concept behind FCS is extremely forward-thinking—the six-year-old program treats housing as a form of health care, which is new for Medicaid—relying so heavily on FCS to fund a costly, high-profile effort like Partnership for Zero is a significant risk.

To understand why, it’s helpful to understand a bit about how nonprofits use the program to fund services for unsheltered people in King County.

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Foundational Community Supports is a fee-for-service program; it pays $112 for every documented “encounter” between a service provider and a client, up to a maximum of six encounters a month. (In the case of KCRHA, the government itself, rather than a nonprofit, will be the service provider). If a case manager has a dozen clients and manages to document six encounters with each of them every month for a year, that adds up to about $95,000. The starting salary for KCRHA’s system advocates—formerly homeless peers who serve as case managers and outreach specialists for Partnership for Zero—is $75,000, so a $95,000 reimbursement would more than pay for both’ salaries and benefits, with some to spare for administration and other costs.

So far so good. Except, service providers say, that it’s almost impossible to “max out” on providing services to unsheltered people this way. Case managers must document each encounter with an unsheltered person in detail, with case notes that demonstrate what service they provided and how that encounter got the person closer to their housing goal.

Opportunities for “wasted” time abound. If a case worker goes out looking for a client and doesn’t find them—a common situation when trying to find unsheltered people, especially in a city that sweeps encampments—that time doesn’t count. If a case manager is new and still in training, or in the process of convincing someone to sign up for the program, that time doesn’t count. And if everything goes perfectly but the case notes are too short, or too long, or don’t include the right kind of details to convince the third-party administrator reviewing a person’s forms, that time doesn’t count either.

Because Foundational Community Supports isn’t a reliable source of funding, service providers don’t typically rely on it to fund entire programs; instead, they “braid” FCS with other funding sources to create a stable foundation for ongoing programs. The constant documentation and pressure to monetize every interaction with unsheltered clients can make it harder to build relationships with unsheltered people. According to one experienced homeless service provider, FCS is “just not really how rapport-based type outreach services relationships work, or how they’re usually delivered.”

Multiple people with Medicaid billing experience mentioned the concept of the “golden thread”–  a consistent narrative through every piece of documentation that explains why the person needs specific services and how each of those services are helping them achieve their self-determined goals. Failure to convincingly document that “thread” is “why a lot of claims get denied,” one former service provider said.

“We are comfortable that that’s a good number, but we’re not going to know until we start doing it and we’ll build a better and better understanding of what a successful reimbursement package is.”—KCRHA Chief Administrative Officer Meg Barclay

Facing pushback from board members last week, Dones pointed that the agency still has money left over from We Are In’s original $10 million commitment to pay for the program through 2023 and potentially beyond, if getting funds through Medicaid proves more challenging than the agency anticipates. And, KCRHA Chief Administrative Officer Meg Barclay noted, the KCRHA is consulting with the Corporation for Supportive Housing, which trains service providers to do Medicaid billing, to learn how to maximize their reimbursements.

Even so, Barclay added, Medicaid is “kind of a black box—sort of strange. So we are comfortable that that’s a good number, but we’re not going to know until we start doing it and we’ll build a better and better understanding of what a successful reimbursement package is.”

Debbie Thiele, CSH’s managing director for the western United States, told PubliCola last year that FCS is “designed to be as user-friendly as possible to a group of providers who are not health care providers.”

One implementation board member, Simha Reddy, said he saw the KCRHA’s effort to fund Partnership for Zero through Medicaid as an experiment that could be helpful to other nonprofit providers who could “jump on the bandwagon” and “learn alongside us.”

And Dones pointed out that the KCRHA won’t be the only government entity to rely on Medicaid funding to run a homelessness program—Spokane, they said, “funds a huge portion of their system” with Foundational Community Supports.

“I do think that the discussion around the difficulty of these dollars is not actually borne out by even our neighbors in Washington,” Dones told the implementation board last week. However, service providers who spoke with PubliCola said Spokane is both smaller (with a homeless population of around 1,800) and more affordable than King County, making it easier to house people in private-market housing and help them stay there.

The budget both boards approved last week isn’t a final spending plan. The KCRHA will send it to its two primary funders, King County and the city of Seattle, later this year, and adopt a finalized budget in December. What the votes represent is a bet on Dones’ plan to fund Partnership for Zero, which will otherwise run out of funding next year.

Editor’s note: Due to a transcription error by the author, the original version of this story incorrectly attributed Backus’ quote to Seattle Deputy Mayor Tiffany Washington.

homelessness, housing, King County, Mayor Harrell

Ambitious New Plan Says King County Needs to Spend Billions a Year on Homelessness. But is that Realistic—or Even Necessary?
A downtown encampment mid-sweep

By Erica C. Barnett

When King County and the city of Seattle established the King County Regional Homelessness Authority in 2019, the two governments signed an agreement that required the new agency to adopt a five-year implementation plan that would include, at a minimum, “strategies to reduce homelessness in at least the following populations: youth and young adults, families, veterans, single adults, seniors, and those experiencing acute behavioral health challenges.” 

The draft plan the KCRHA released late last month later goes far beyond that mandate, proposing a series of actions that would—in combination with separate investments in permanent housing—effectively eliminate unsheltered homelessness in King County within five years, mostly by investing in shelter.

Overall, the plan proposes spending between $1.7 billion and $3.4 billion a year to add 18,000 new temporary spaces for people to live, including 7,100 new shelter or “emergency housing” beds, 3,800 medical respite beds for people with acute health-care needs, 4,600 new safe parking spaces for people living in RVs or their cars, and 2,600 beds for people who need addiction recovery support. Altogether, the proposal represents a more than fourfold increase in shelter beds and safe parking spots over just five years. Separately, the plan says the region will need to invest around $8.4 billion in one-time capital costs for permanent and “temporary housing,” a term that encompasses all kinds of shelter. 

The focus on shelter and other forms of “temporary housing,” like recovery housing for people struggling with addiction, represents a turnaround from the region’s previous strategy of de-emphasizing shelter in favor of programs like rapid rehousing, which aims to move people directly from the street into private apartments, where they receive short-term subsidies but are expected to pay full rent within a matter of months. Rapid rehousing programs still exist (and can be successful), but they are no longer touted as a panacea the way they were during the Ed Murray administration.

“The plan is really structured around ending unsheltered homelessness, not all forms of homelessness, and that is important,” KCRHA CEO Marc Dones told PubliCola earlier this month. “We built this draft plan in relationship to what would be necessary in order to significantly reduce or eliminate folks sleeping outside, acknowledging that that doesn’t address the other forms of homelessness, like couchsurfing [or people living] doubled up. Things that like are also a significant concern. But we decided that we needed to go towards one thing first, and it was ‘people shouldn’t sleep outside.'”

Implementing the new plan would cost an order of magnitude more than what the region currently spends on homelessness. One reason for that is that the KCRHA, using a model created by the state Department of Commerce, now estimates that there are far more unhoused people in King County than any previous study has concluded—around 56,000, or roughly one out of every 50 people. That number dwarfs the county’s own 2021 estimate; it’s also significantly larger than the US Department of Housing and Urban Development’s estimate of 25,000 people experiencing homelessness across the entire state of Washington. 

“For every unit of permanent, affordable housing that comes online, we don’t need as much temporary stuff. If there was a big push to site and develop permanently low-income housing, we could retool [the plan] literally over the course of a week.”—KCRHA CEO Marc Dones

Here’s another data point: As part of its effort to identify and permanently house everyone experiencing homelessness in downtown Seattle, Partnership for Zero, the KCRHA has spent part of the last year creating a “by-name list” of everyone experiencing homelessness in the area, which extends from Belltown to the Chinatown-International District. So far, they’ve identified around 800 people. Even assuming that number is an undercount, it suggests that almost all the homeless people in King County live outside downtown Seattle—an area originally chosen, in part, because it has one of the highest concentrations of homelessness in the county. 

KCRHA community impact officer Owen Kajfasz, who leads the agency’s data team, said 56,000 only represents the “floor” for homelessness in King County—in other words, it could be an undercount. However, he acknowledged that the new estimate includes everyone who identified as homeless at any point during the year—including those who were only homeless for a short period, such as a week or a day, and who found places to live on their own.

The KCRHA’s Five-Year Plan includes no new spending on tiny houses, and actually assumes a reduction in the number of tiny house villages over the next five years.

Numerous studies, spanning decades, have concluded that a large number of people “self-resolve” their homelessness within a few days or weeks, although at least one recent analysis has found that number is decreasing. If the number of people who need longer-term interventions, such as case management and temporary housing, is only a fraction of the total people who are homeless in King County every year, the cost to shelter and assist those who need more help could be lower than the KCRHA’s eye-popping estimates.

“To say we need to stand up 18,000 emergency shelter beds, in absolute terms, for 53,000 people experiencing homelessness in King County doesn’t make sense,” said Low Income Housing Institute director Sharon Lee, whose organization operates low-income apartments and “tiny house village” shelters around the county. “The costs of adding spaces just for RVs and car safe parking total $139 million! This is not the correct strategy nor is this in any way financially feasible.”

Local political leaders praised KCRHA for laying out a plan to address unsheltered homelessness, but also seemed unconvinced that the proposal is politically or financially realistic.

A spokesman for Mayor Bruce Harrell, for example, said that while Harrell “supports KCHRA’s dedicated focus on ending unsheltered homelessness and prioritizing immediate and long-term solutions to help get people indoors with access to services and a path to recovery,” the city already funds the majority of the KCRHA’s budget and increased its contribution slightly last year “despite a significant budget deficit.” Last year, the KCRHA asked the city for an additional $54 million to fund 400 new shelter beds and 130 safe-parking spaces; they didn’t get it.

“For budget estimates included in the five-year proposal, we look forward to better understanding how existing investments will be applied and how we can unite support from local, state, and federal governments—along with private and philanthropic sources—to realistically meet budget expectations and advance solutions that drive tangible positive impact,” Harrell’s spokesman, Jamie Housen, said.

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Seattle City Council homelessness committee chair Andrew Lewis said he has “faith and confidence that that (cost) number does reflect probably what the investment would be to truly end homelessness and have a flexible system where homelessness is brief, people can get rapidly rehoused, and everything else. That said, the product I would like to see is a corollary tactical, substantive plan … that we can implement in one to two years with things like pallet shelters, RV safe lots, tiny houses—things that people can see and have confidence that we can get on top of this problem.”

His fear, Lewis said, is that if Seattle doesn’t make a visible dent in unsheltered homelessness, people will lose confidence in strategies that work, like low-barrier housing for people struggling with addiction. “We did, in this biennium, make a half-billion-dollar investment in housing [through the city’s capital budget], and for a city, that is a really big contribution to the regional solution. So I think it is possible for us to build on that and continue to be a partner within the reasonable constraints of our means. But,” he added, “I do think it requires us to demonstrate visible progress with a shorter-term, tactical plan” that will build “currency” for larger investments later.

Lewis has been a longtime advocate for tiny house villages, noting that people living in encampments will often “accept” a referral to a tiny house after saying no to traditional shelter. Dones, in contrast, has argued repeatedly that tiny houses cost too much and don’t get people into housing fast enough. Notably, the Five-Year Plan proposes spending no new money on tiny houses, and actually proposes decreasing the number of tiny-house units by 55—a stark contrast to the rest of the proposal, which proposes large new investments in every other type of shelter.

According to the plan, just 1 percent of people experiencing homelessness told KCRHA researchers that they preferred tiny house villages to other forms of shelter.

However, that conclusion is based on extrapolation from 180 interviews in which researchers asked people a list of open-ended questions, such as “what things or people have been helpful to you?” These interviews were also used to estimate the number of people experiencing homelessness in last year’s “point-in-time count,” and to describe the living conditions of the county’s homeless population as a whole.

Researchers never asked respondents to identify which type of shelter they preferred. Instead, they asked then to describe, in an open-ended way, “an optimal condition that would support them to move on in their housing journey,” Dones said. The things they mentioned, Kajfasz added, “were very infrequently aligned with the tiny own village model.” For example, some people said they would prefer to have their own restrooms, or running water in their unit—in other words, a hotel room.

According to the plan, just 1 percent of people experiencing homelessness told KCRHA researchers that they preferred tiny house villages to other forms of shelter. However, that conclusion is based on extrapolation from 180 interviews in which researchers asked people a list of open-ended questions, such as “what things or people have been helpful to you?”

Lee called the KCRHA’s plan, which singled out tiny houses while lumping all other forms of shelter, including hotels, into a single category, “anti-tiny house,” adding, “we question the methodology and numbers.”

For example, “How come they don’t have breakout categories for congregate shelters, noncongregate shelters, hotels, and overnight shelters?” Lee said. “We actually need all of them.” During a recent meeting of the KCRHA’s implementation board, several speakers urged the committee to support funding for tiny house villages. After listening to their comments, board member and former Bellevue mayor John Chelminiak said, “I agree with the speakers today who say, ‘Don’t take options off the table,’ and this [plan] takes options off the table.”

Dones said the authority put tiny houses in their own micro-category because “the community has sort of held [tiny houses] apart from other forms of shelter investment,” adding, “I recognize this is a departure, but what I heard [from the interviews] is that folks do prefer hoteling or emergency housing. … There is a point at which ‘because they told me’ is enough.”

Even if the KCRHA were able to secure funding for a sizeable portion of its five-year plan, some of its elements—like the proposal to secure and open hundreds of parking lots across the county for people living in RVs and cars—seem obviously unworkable based on the region’s recent history trying and failing to open even one such lot.

Consider, for example, the fact that the city of Seattle has been trying unsuccessfully for well over a decade to create a single safe lot for people living in their cars or RVs. So far, every attempt has been a failure. Just last year, plans for a small RV safe lot in SoDo were scaled back, then shelved, due to opposition from people living in the adjacent Chinatown/International District neighborhood—long before neighborhood opposition doomed an adjacent shelter expansion.

LIHI, which was the only applicant for a contract from KCRHA to open an RV safe lot last year, told KOMO recently that they’ll need a 30,000-to-40,000-square-foot parking lot to hold just 35 RVs. After six months of looking, they have not found a suitable lot.

Dones said the plan could change based on feedback the KCRHA receives about the draft, including the public. (The three-week public comment period closed on February 8). The level of need the plan anticipates, they added, could change dramatically if state and regional invests in housing quickly. “For every unit of permanent, affordable housing that comes online, we don’t need as much temporary stuff,” Dones said. “If there was a big push to site and develop permanently low-income housing, we could retool it literally over the course of a week or so to say ‘Now we need this much.” The question, for many of the officials who’ve staked their hopes on the new authority, may not be “how much” but “how?”

homelessness

The County’s Annual Homeless Estimate Won’t Include A Physical Count This Year. Here’s How It Will Work.
Slide from a recent presentation on how the homelessness authority will use interviews and statistical analysis to estimate and characterize King County’s homeless population.

By Erica C. Barnett

Later this week, the King County Regional Homelessness Authority is expected to announce the results of the process iabot’s using this year in lieu of the traditional point in time count of the region’s unsheltered homeless population—historically, an in-person count in January whose results have always been considered an undercount, combined with interviews at homeless service providers and shelters to gather “qualitative” data about people’s day-to-day experience of homelessness.

Over the years, the count has incorporated various methods to estimate the unsheltered population (such as assumptions about the number of people occupying tents and cars) and has used statistical methods to extrapolate demographic and other information from interviews with 1,000 or more individuals.

The US Department of Housing and Urban Development requires agencies like KCRHA to conduct a “point in time count” of their unsheltered populations every two years. The KCRHA initially planned to opt out of the mandatory count this year, but announced in mid-December that HUD had given them an exemption from its usual requirements, allowing the authority to replace an in-person count with a statistical extrapolation from interviews with unsheltered King County residents conducted over several weeks. As a result, the final “point in time count” number won’t come from a point in time, nor will it represent an actual count.

The process the KCRHA selected, called Respondent Driven Sampling, had two stages. First, volunteers and outreach workers went out to places where people are living unsheltered, such as encampments, to interview people and recruit them to distribute coupons to people in their networks. People who completed an interview received a prepaid $25 debit card and their own set of coupons, each redeemable for a $25 debit card for each recruit who participated in an interview. Those recruits, in turn, would get more coupons to distribute. Through successive waves of recruitment, the system is designed to reach people with no obvious connection to the initial group of recruits.

A spokeswoman for the authority said new approach enabled KCRHA to “capture people’s stories the way they want them to be told. This is not a knock on previous methods; but it is a different approach that allows for rich data collection, honors people’s experiences, and builds relationship with community.”

“Because interviewees identified the next set of interviewees, this helped us interview people we might not otherwise have been able to engage with, including people who are less service-connected,” KCRHA spokeswoman Anne Martens said. The approach, developed in the 1990s, has been used to reach people in “hidden” populations, such as male drug users who have sex with men, in sociological studies ever since.

The benefit of respondent driven sampling, according to University of Washington assistant sociology professor Zack Almquist, who recommended RDS to the authority and helped develop its approach, is that it captures groups that don’t show up with traditional sampling methods, such as random-digit dialing. 

The KCRHA’s researchers started with a large group of “seeds,” Almquist said—the original group of recruits who went out and recruited people in their social networks—with the goal of reaching a broad sample of unsheltered people. Then they sat down with them for in-person interviews at nine designated “hubs” around the county, asking them how they first became homeless, where they currently sleep, and other probing questions about their personal and family history and experience being homeless. Two of the hubs were in Seattle—one in Georgetown and the other on Aurora Avenue N—and the other seven were scattered across South and East King County; the furthest east was in North Bend and the furthest south was in Auburn.

The questions are similar to, but far more detailed than, the VI-SPDAT—a staccato, yes/no list of questions that homelessness agencies across the country are phasing out because it leads to racially biased results. Earlier this year, the KCRHA began using COVID vulnerability criteria (a list of conditions the agency can verify without talking to a person directly, such as age, race, and pregnancy status) in lieu of the VI-SPDAT—in part, the agency said, because the VI-SPDAT’s questions were potentially retraumatizing and invasive.

Martens said the combination of RDS and in-depth interviews enabled KCRHA to “capture people’s stories the way they want them to be told. This is not a knock on previous methods; but it is a different approach that allows for rich data collection, honors people’s experiences, and builds relationship with community.”

Some members of the KCRHA’s governing board have raised concerns about the authority’s methods and called the process rushed and mysterious. Auburn Mayor Nancy Backus, who sits on the KCRHA’s governing board, recently said the KCRHA had given her “no clue what was going on” with the interviews, and Redmond Mayor Angela Birney, also on the board, questioned the authority’s choice of “hub” locations and the decision to limit interviews to business hours.

The method has its critics, who question whether statistical extrapolation, based on interviews with a small subset of the homeless population, can produce an accurate estimate of the number of people experiencing homelessness in an area or characterize the conditions under which they live.

“In the past, the reason we did the point in time count the way we did is that we went to people where they were—we didn’t expect them to have to travel or get transported or find a location,” Birney said during a March board meeting, when the KCRHA was in the middle of doing interviews. “I’m a little curious about bringing people to a hub, what kind of disruption that creates.”

Respondent-driven sampling has its critics, who question whether this kind of statistical extrapolation, based on interviews with a small subset of the homeless population, can produce an accurate estimate of the number of people experiencing homelessness in an area or the characterize the conditions under which they live.

Academic critiques of the approach have focused on the fact that people experiencing homelessness often have loose and transitory social ties, making their social networks unreliable; the likelihood that “coupons” redeemable for money or goods (like the $25 debit cards) end up being used as a form of currency or in violation of the rules set for recruitment; and that “hub” sites aren’t equally accessible for everyone, both because of physical distance and because more marginalized or vulnerable people are less likely to go to an official government interview site.

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The list of questions the interviewers asked are extensive, and not everyone answered all of them; some people responded to most of the questions, but wouldn’t answer questions about their social network and were excluded from the data, according to Almquist. The result is that although the authority initially said it would base its count on around 1,000 initial interviews, they ended up with a usable sample of between 550 and 574 people. “People had to answer questions about their social network, because respondent driven sampling relies on us knowing about” the people survey respondents interact with and “weighting the population based on their network properties,” Almquist said—factors like the number of people a person says they know and how well they know them.

At a meeting of the Seattle City Council’s homelessness committee earlier this month, KCRHA CEO Marc Dones said the authority was planning to do a “Phase 2” of the surveys, which would add to the qualitative data portion of the count—the kind of information the county used to gather by going to homeless service providers and talking to people who showed up to access services. Continue reading “The County’s Annual Homeless Estimate Won’t Include A Physical Count This Year. Here’s How It Will Work.” →

Health, homelessness, human services, King County

As COVID Cases at Encampments and Shelters Rise, Many Are Reluctant to Enter County Quarantine Sites
Kent isolation and quarantine facility
Screenshot: King County Youtube

By Erica C. Barnett

An alarming increase in COVID cases among people experiencing homelessness has been exacerbated in recent weeks, homeless service providers say, by rumors that if people enter a county-run isolation and quarantine site, they won’t be allowed to leave.

And even before these rumors began circulating widely, many unhoused people who tested positive for COVID were reluctant to enter isolation and quarantine, for reasons that ranged from active substance use to the fear that if they left an encampment, they would lose everything they had—a not unreasonable assumption, given the recent uptick in encampment sweeps.

“The resistance, in my experience, has been across the board,” Dr. Cyn Kotarski, medical director for the Public Defender Association, said. “I haven’t met anyone so far who doesn’t have some fear and some resistance to go, and that’s mostly just because it’s overwhelming. It can feel pretty scary to think that you don’t know where you’re going or why, especially when you’re taking someone out of their own environment and their own community,” Kotarski said. The PDA is a partner on several efforts to move unsheltered people into hotels during the pandemic, including Co-LEAD and JustCare.

Although early reports suggested that people living outdoors are less susceptible to COVID infection than those living in group quarters like congregate shelters, the more contagious delta variant could lead to more infections in both indoor and outdoor locations. During the week that ended September 10, King County counted 41 people experiencing homelessness who tested positive for COVID—an undercount, since it only accounts for county testing events.

According to King County Public Health spokeswoman Kate Cole, as of last week, there were 22 active COVID cases associated with encampment outbreaks, defined as two or more people who have tested positive at an encampment—an “increase from baseline” of “one to four cases per month associated with encampments.” A review of the county’s weekly reports shows a steady increase in cases that began in early August and hasn’t abated.

“The facilities are not secure, and staying is totally optional. When people come in, we say, ‘Your isolation period is this long, your quarantine period is this long. If you do not want to stay the whole time, let’s talk about it.'”—Hedda McClendon, King County

The increase in COVID cases has impacted every part of the county’s service system. The county’s public health department offers testing and transportation for people who test positive, but service providers and county officials say the system is stretched thin, with long waits for transportation and even testing. According to Cole, the current wait for a test by the county’s HEART E Team, one of two teams that performs testing at homeless encampments, can be as long as five to seven days. When someone living in an encampment tests positive, an outreach provider often must wait with them for hours until a county vehicle arrives to take them to isolation and quarantine, increasing the likelihood that they’ll give up and decide not to go. 

Just getting someone on the phone, outreach workers say, can be a challenge. “You call in and they take your number, but if you call back, it’s an automated line and you have to try to reach the person you were talking to,” Dawn Shepard, the south district outreach coordinator for REACH, said. If an outreach worker or unsheltered person misses a call from the county’s COVID hotline, Shepard says, they’ll have to start the whole process over again, “and by that point the person’s just losing interest.” Currently, Shepard added, “It’s taking us about eight hours from coordination to pickup.”

The county, through a partnership with T-Mobile, has handed out about 500 cell phones for outreach providers to distribute to clients, according to Cole, but Stewart says they need more, along with rapid COVID tests so that people don’t have to wait for days to get tested. Currently, rapid tests are hard to come by and expensive when they are available.

Meanwhile, the number of people staying at the Kent isolation and quarantine site, where 60 rooms are currently available, has increased from zero to 50 virtually “overnight,” King County COVID Emergency Services Group director Hedda McClendon said, stretching resources thin. If all the rooms fill up, the county will have to start triaging people based on test results, exposure, and other qualifications, turning people away if their cases aren’t severe.

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Shepard said that in the early days of the pandemic, “we really didn’t see folks that were living outside contracting the disease…  largely because the viral load is much lower when you’re outside. Now, though, I think it’s safe to say that with the delta variant, our clients don’t have the same protection, because we’re seeing it all over the city.”

Shelter providers, including Compass and WHEEL, also confirm that they’ve seen an increase in cases; according to WHEEL organizer Michele Marchand, COVID “is ripping through many, many homeless programs and communities,” including WHEEL’s women’s shelter at First Presbyterian Church on First Hill, which has seen at least 11 positive cases in the past few weeks. “We’ve had to stop doing intakes now because of this outbreak,” Marchand continued, adding that the organization is seeking funds for hotel vouchers “to meet the immediate need during this current crisis.”

Charlene Mitchell, the program manager at the Compass Housing-run women’s shelter Jan and Peter’s Place, said that the shelter requires people who test positive to stay “in their bed area” while they wait to be taken to the site in Kent, a process that’s considerably faster than testing and moving people living unsheltered. (Currently, the county uses Yellow Cabs for this purpose). She can remember one recent case when a woman left the shelter for the Kent site and decided not to stay. “She turned around [after arriving] and stayed outside in the streets and at the bus stop” after family members refused to take her in. “She recovered, but I don’t know who all she infected” while she was contagious, Mitchell said.

Shepard says that she’s encountered an increasing number of unsheltered people who tell her they have COVID-like symptoms but don’t want to be tested or go into isolation and quarantine because they’re afraid they won’t be allowed to leave. “There was this big push, when isolation and quarantine opened, that they were not going to hold people against their will, but now there are stories coming out about that happening to people.” Shepard says she takes these stories “with a grain of salt—when I’ve asked who has had that experience, it’s just like, ‘everyone knows'”—but says they’ve had an impact nonetheless. “The big thing I’m hearing right now is, ‘No, I don’t want to go because they won’t let me leave.'” Continue reading “As COVID Cases at Encampments and Shelters Rise, Many Are Reluctant to Enter County Quarantine Sites” →