In early March 2020, NYC was on the cusp of true panic mode related to the Coronavirus, with calls for mass isolation and social distancing, a rush to buy vast quantities of toilet paper and supplies of hand sanitizer and masks rapidly exhausted. Very little guidance was in the public domain outside of hand washing recommendations, and government agencies were still figuring out suitable emergency policies and procedures for health providers and community-based agencies. At Concern for Independent Living, a 48-year old supportive and affordable housing provider serving 1500 adults and 250 children in Brooklyn, the Bronx and on Long Island in a variety of residential settings, we had already learned of the death of three of our tenants from COVID-19 complications and quickly realized that local inpatient and emergency room systems could no longer be relied upon as a readily available resource to care for our tenants and staff who may get sick. In essence, we needed to prepare our existing housing stock to become de facto healthcare settings for likely treatment and quarantine.
With fear and trepidation in our hearts and on our minds, Concern looked to develop an emergency housing and healthcare model that would protect our community and sustain us with hope and compassion for the long haul. To bolster the planning of our journey, we turned to several universal principles of mindfulness and compassion learned from work retreats at the Garrison Institute in upstate New York along with our common mission and purpose, notably:
- Loving Kindness – we tolerate uncertainty by helping others, gain resilience and grow from our self-reflection as a community
- Mindfulness – by living in the moment, we genuinely embrace our fears and concerns. We try to be present with our thoughts and feelings
- Self-Kindness – we cannot take care of others unless we support, nurture and encourage ourselves
- Common Humanity – we are all in this together and as an agency, we rise to the challenges together, leaving no one without a voice
Our model is still evolving as we learn more about the virus and ways to flatten the curve of the pandemic, but centers around five main points of intervention:
Safety and Security – we have focused on widespread PPE acquisition for staff and tenants, working with local pharmacies, vendors, trade associations, government partners and other providers to acquire masks, gloves, sanitizers, wipes, sprays, disposable thermometers and finger pulse oximeters wherever available, in both small and large quantities, through bulk buying and single purchasing (allowing for enough PPE to last several months). We purchased infrared thermometers for every site so that temperatures of staff and tenants can be taken without a need to touch the skin. Direction was sent that all staff are to take their temperatures at home in the hours before reporting for a shift and again when they arrive on site. Anyone with a temperature in keeping with current guidance is to be sent home. Staffing across sites and multiple shifts has been reduced to limit exposure. All single site common areas, such as libraries, fitness rooms and recreational spaces have been temporarily closed. Plexiglass barriers and safeguards have been erected at in lobby and reception desks. All non- essential guest privileges have been suspended. The best medicine has been prevention.
Flexibility & Support – staffing schedules have been revised to reduce exposure and offer some relief with a combination of both on site and remote work, as well as a change of shifts to fit staffing needs at home and in the workplace. As has been discussed citywide, we see the major risk of infections coming from staff members who are contagious and come to work. As such we have focused on educating staff and setting clear policy to discourage anyone from coming to work while potentially contagious. We have provided guidance to all staff that no one need feel that they have to choose between working and being paid if they are ill or showing symptoms of illness. The agency is making sure that everyone who is ill or potentially ill is paid. In addition, persons who wish to remain at home because they have a compromising medical situation and/or are simply wishing to avoid exposure are being allowed to use their time – and even to go into negative time banks – so that they can feel safe and comfortable. This flexible use of accrued time off and paid compensation for those without has relied on principles of agency support without judgement on requests to stay home (no fear or worry underplayed). Payroll bonuses for on-site work and those who went above and beyond have been valuable incentives for staff and will be evaluated on each payroll cycle. On Long Island we hired a Nurse Practitioner to be available two days a week to consult with staff and tenants and to help facilitate communication with medical providers, as needed. In New York City we hired a physician’s assistant, a former US Airforce medic who has good experience with infection control and behavioral health, to triage tenants and provide vital healthcare engagement. A consulting psychiatrist through JANIAN Medical Group has been providing ongoing remote healthcare through video conferencing on Doxy.me one day per week.
Communication and Contact – Concern has engaged in a broad sharing of information to all employees and tenants. Each department and region have engaged in regular ZOOM based support meetings to hear concerns and discuss problem solving on shared issues. In many ways, we are communicating better than before the crisis. In response to a lack of remote connectivity with some tenants, we have purchased prepaid cell phones for weekly contact and provided widespread signage and tenant/ staff education materials. Remote contact can often seem distant and disconnected, so everyone at Concern has tried to approach each other with warmth and gratitude, recognizing tenants and staff as valuable members of our community. Online support groups and conference calls for tenants are also being developed to respond to emotional and healthcare needs.
Teamwork and Support – we have witnessed a heightened collaboration between agency administration, human resources, accounting, property management, compliance, employment and housing sites, with regular communication around staff and tenant needs. For example, our property maintenance staff have modified their responsibilities all over the agency to spend their time at congregate sites cleaning and sanitizing daily. We have adapted procedures at all sites to make it possible for staff to reduce the amount of contact they have with tenants when supervising medications. We have encouraged program leadership to buy extra food, items to entertain and occupy tenants to help encourage them to stay at home. In our scattered site apartments, we have been delivering food and other essential items. Any tenant who tests positive or is showing symptoms is instructed to quarantine in their apartment or room. In two of our supervised sites, tenants share bathrooms and kitchens. As a result, we have recently secured the rental of a RV in the event that a person residing in one of the residences has a positive test result and needs to self-quarantine. That way, they can remain close enough to the program for us to continue to support their needs but can be separated from the other tenants. With recent active COVID-19 cases, we have also brought in an outside cleaning contractor to sanitize apartments and workspaces.
Collaboration and Funding – Concern has maintained active and ongoing collaboration with partners and stakeholders – government, trade associations, board members, other housing providers – to share ideas, learn from others and stay ahead of the resource curve. The measures described in our initiatives to date have been costly, but we made a decision as an agency that we would do anything we can to safeguard our tenants and staff. We have been diligently applying for any emergency funding that is related to COVID 19, including a Paycheck Protection Plan with our primary bank, FEMA funding and foundation grants to help fund our expenses and offset current costs.
In summary, we hope that by sharing this model of intervention we can offer some insight and support to our colleagues in the housing industry, as we survive this pandemic together and learn from our experiences. Thankfully and likely as a result of our interventions, our numbers of those getting infected have remained low. The model is likely indicative of further health and housing collaboration during challenging times and we hopefully provide a blueprint for future design. It is perhaps best summed up by the words of one of our peer counselors, who emailed this message at the end of his work week, “I believe the job that I do and you do makes us special because of the danger you walk into and you just keep on walking. The heroes are everywhere, some can be seen and some that can’t. Concern is the hero that also has a goal, to save the lives of the people they serve. True heroes often remain in the shadows but keep doing the job to the best of their ability. That is why I am proud to be a part of Concern. From the inside and the outside, that gives me a view of the goodness you do, and to share with the clients on a level they feel comfortable with sharing how they truly feel. So, for them and for myself, thank you.”