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Reducing homelessness is critical to long-term community health and the fight against COVID-19

As St. Paul’s newest homeless shelter, Bethesda Hospital will play an important new role in addressing our community’s growing housing crisis.

The economic damage wrought by the COVID-19 pandemic has forced hundreds of people out of their homes this year. Out of options, many of those people began living in city parks or under bridges across St. Paul. But as city and social service organizations moved aggressively to support them, they found many of the usual solutions to the crisis were not available.

“Because of the pandemic, shelters can’t expand to support more people without the risk of becoming overcrowded,” explained Laura Reed, RN, DNP, Chief Nursing Executive and Chief Operating Officer.

The need for social distancing means shelters have to limit the number of people they can serve. And those who might have stayed with friends or family are finding fewer options. These challenges have left nearly 400 people on the streets in St. Paul in 2020, a dramatic increase from previous years. As winter arrives, supporting unsheltered people in our community has become an urgent need - one that grows more urgent each day.

In late October, our leaders had the opportunity to visit a local tent encampment with City of St. Paul officials and see the needs of the people in the encampment firsthand. While social service organizations worked to provide food, sanitary services and other support at the site, leaders witnessed how challenging it was to coordinate services and maintain ongoing support in a setting not intended for shelter.  

“I was struck by how many people had basic needs,” Reed said. “They needed food. They needed shelter. One resident I met said he was ready to get back on his feet, but he just needed help to build the foundation that would get him there.”

Without stable housing, many were unable to manage health conditions appropriately, Reed said. They also were at greater risk if they contracted COVID-19 and didn’t have help managing the illness.  

“They have a harder time getting medications. There are multiple factors that result in their having a harder time accessing mental health or chemical dependency treatment. As a result, they’re more likely to end up in the emergency department,” Reed said. “But it doesn’t have to be that way.”

“We know even without a pandemic, homelessness is closely linked to health,” said Fairview President and CEO James Hereford. “We saw this crisis growing throughout 2020, and with winter quickly approaching, we believed Bethesda could provide a solution.”

Ramsey County public health officials will convert Bethesda into housing for 100 people. There, residents will have private rooms, meals, and bathroom and shower facilities. The county will coordinate mental healthcare and chemical abuse treatment on site, as well as a variety of other social services such as employment assistance. Those with COVID-19 symptoms will have access to treatment and the ability to isolate from other residents in a separate area of the building. The first residents will be welcomed as early as December. 

As the first residents arrive, our leaders are actively holding conversations with Ramsey County about how we can provide additional clinical support services onsite to ensure the wellbeing of Bethesda’s new residents. We will draw on years of experience partnering with organizations such as Catholic Charites and its downtown St. Paul Opportunity Center, where we operate telehealth hubs. These private rooms with computer equipment provide patients with access to virtual mental and chemical-health counseling. We will also leverage our experience operating the Coming Home program in partnership with Guild and Hearth Connection. This effort disrupts the cycle of homelessness and improves health by addressing social factors like access to food, clothing, furniture and employment.

Evidence shows people who are homeless experience higher rates of both mental and physical health issues, are more likely to have multiple health concerns, and have less access to primary care services, according to the American Public Health Association. As a result, they are more likely to seek care through hospital emergency departments, which are more costly and less likely to address long-term health needs. This cycle means people who are homeless die an average of 12 years sooner than the general U.S. population, according to the National Health Care for the Homeless Council.

Health issues may also be a cause of homelessness in the community. Ongoing health concerns may make it difficult for people to maintain regular employment, forcing them to miss work or take unpaid medical leave, while making it more difficult to perform normal job duties. Once a person is unsheltered, existing health issues often worsen, making it more difficult to regain employment. Breaking this cycle is critical to maintaining the health of our communities.

“At Bethesda, we can help support these health needs, and we can do it in a more coordinated way in partnership with the County,” said Hereford. The site will also reduce the risk of COVID-19 spread among unsheltered people and play an important role the state’s ongoing pandemic response.

“Visiting the encampment had a profound impact on me, and I was so proud of the fact that we could help,” said Reed, who also recently joined the board of Twin Cities Habitat for Humanity to further support programs that deliver improved health through housing. “I hope this partnership can serve as a model for how we can address health needs in our community early, before they progress.”