Guidance

[Withdrawn] COVID-19: guidance for commissioners and providers of hostel services for people experiencing homelessness and rough sleeping

Updated 4 April 2022

This guidance was withdrawn on

The information in this guidance has been superseded by guidance on testing in homelessness, domestic abuse refuge and respite room settings.

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This publication is available at https://www.gov.uk/government/publications/covid-19-guidance-on-services-for-people-experiencing-rough-sleeping/covid-19-guidance-for-commissioners-and-providers-of-hostel-services-for-people-experiencing-homelessness-and-rough-sleeping

This guidance is being updated in line with changes to testing that came into effect on 1 April 2022. The updated guidance will be published shortly.

What has changed

There is no longer a legal requirement for people with coronavirus (COVID-19) infection to self-isolate. The public health advice for people with any of the main symptoms of COVID-19 or a positive test result is to stay at home and avoid contact with other people.

Who this guidance is for

This is updated guidance for commissioners, managers and staff of hostels which provide services for single adults experiencing homelessness and rough sleeping.

The government has published its plan for living with COVID-19. COVID-19 has not gone away and everyone should continue to take precautions.

See coronavirus: how to stay safe and help prevent the spread for more information.

This guidance covers:

  • hostels with individual self-contained rooms with en-suite facilities that have shared kitchens
  • hostels without individual self-contained rooms and that have communal facilities

This guidance does not cover night shelters.

In addition to hostels, a range of accommodation has and continues to be used as part of the COVID-19 response to support people who were experiencing homelessness and rough sleeping. This includes hotel, bed and breakfast and supported accommodation. While this guidance does not cover night shelters, some of this guidance may be relevant to other types of accommodation.

Some of this guidance may also be relevant for temporary accommodation with shared facilities which is provided by local authorities to fulfil statutory homelessness duties.

Local providers will need to make an assessment on which areas of this guidance are most relevant for their circumstances and setting. Factors determining this could include the extent to which any facilities are shared, and the staffing set-up in the accommodation.

Symptoms

The main symptoms of COVID-19 are recent onset of any of the following:

  • a new continuous cough
  • a high temperature
  • a loss of, or change in, your normal sense of taste or smell (anosmia)

For most people, COVID-19 will be a mild illness. However, if anyone has any of the symptoms above, even if these symptoms are mild, they should stay in the accommodation setting, avoid contact with other people and should be helped to arrange testing.

General guidance for all hostel settings

The homeless population is likely to be at higher risk of severe outcomes from COVID-19, and less able to manage the risk of transmission of infection. Hostels should implement daily monitoring of COVID-19 symptoms among residents and staff. Each resident should be assessed for the main symptoms listed above.

Everyone should follow these general principles to help prevent the spread of infections caused by COVID-19 and other respiratory viruses:

  • ensure ventilation of all spaces in the hostel
  • washing hands frequently with soap and water for at least 20 seconds, or use a hand sanitiser. This is especially important after you blow your nose, sneeze or cough, before you eat or handle food, after coming into contact with surfaces touched by many others, such as handles, handrails and light switches, and after coming into contact with shared areas such as kitchens and bathrooms
  • avoiding touching eyes, nose, and mouth with unwashed hands
  • cover coughs or sneezes with a tissue, then throwing the tissue in a bin and washing hands or using a hand sanitiser. If there are no tissues available cough or sneeze into the crook of the elbow, not onto hands
  • cleaning and disinfecting frequently touched objects and surfaces in the hostel, such as door handles, handrails, tabletops, and electronic devices (such as phones)

Some individuals are at a higher risk of becoming seriously ill if they were to catch COVID-19. Providers should think particularly carefully about supporting these individuals to take the precautions described in the guidance for people with COVID-19 and their contacts.

Face coverings

COVID-19 spreads through the air by droplets and aerosols that are exhaled from the nose and mouth of an infected person. Face coverings are mainly worn to protect others but can also protect the wearer. By covering the nose and mouth, they reduce the amount of virus released when people breathe, speak, cough or sneeze.

Face coverings reduce the risk of spreading COVID-19, the government suggests that you continue to wear one especially when there is close contact between people in enclosed, crowded or poorly ventilated spaces. Providers of hostel accommodation are strongly recommended to support the use of face coverings in these circumstances.

Hostel providers should consider providing face coverings at reception for all residents. It is important that face coverings fit securely around the face so as to safely cover the mouth and the nose. Multi-layered face coverings are recommended as they provide greater protection. Further guidance on face coverings is available.

Staff may need to wear face masks in some circumstances as part of personal protective equipment (PPE) use.

Testing

The main symptoms of COVID-19 are recent onset of a new continuous cough, a high temperature, or a loss of, or change in, your normal sense of taste or smell. If a resident has any of these symptoms listed above, even if their symptoms are mild, they should follow the guidance for people with coronavirus (COVID-19) infection and their contacts and arrange to have a PCR test.

They should not go to a GP surgery, pharmacy or hospital except in an emergency.

Around 1 in 3 people with COVID-19 do not have any symptoms. This means they could be spreading the virus without knowing it. Regular testing with LFD tests increases the chances of detecting COVID-19 when a person is infectious but is not displaying symptoms, helping to make sure people do not spread the infection.

Rapid lateral flow testing is currently still available for free to anybody.

Those working in hostels are included in the list of essential workers prioritised for COVID-19 testing. Find out more about how to get LFD tests.

Residents and staff should consider taking an LFD test if they will be spending time in crowded and enclosed spaces and before visiting people who are at higher risk of severe illness if they get COVID-19.

Vaccination

People who experience homelessness and rough sleeping are likely to have underlying health conditions, which can make them vulnerable to COVID-19. The Joint Committee on Vaccination and Immunisation has therefore prioritised them for being offered COVID-19 vaccines.

COVID-19 vaccines are available to everyone free of charge.

Accommodation providers should work with local public health teams to support the development of solutions to deliver COVID-19 vaccinations for people experiencing homelessness and rough sleeping. This includes informing people about the vaccine and in supporting them to feel confident in having it. They will also have a role in helping to identify the population and access appropriate sites to deliver vaccinations. There are leaflets and posters about the vaccination programme available.

There is no requirement for people to have an NHS number or to be registered with a GP to receive the COVID-19 vaccine. The COVID-19 vaccine is also available irrespective of immigration status and no data will be shared with immigration authorities when a vaccination offer is accepted. It is important to communicate that GP registration is not necessary in order to get the vaccine.

Some vulnerable people may not respond as well to the COVID-19 vaccine as others and may remain at higher risk of serious illness if they catch the virus. For these individuals, extra care should be taken to help reduce their risk of infection.

Caring for residents during the COVID-19 pandemic

Managing the hostel

People who live in the same household as someone with COVID-19 are at the highest risk of becoming infected because they are likely to have prolonged contact.

To use this guidance in local settings, hostel providers will need to interpret the meaning of ‘household’ based on the set-up of their hostel. This will depend on the layout of the accommodation and how it is organised.

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 for this guidance. In complex situations, hostels can seek advice from local Health Protection Teams (HPT).

Hostel providers should make local assessments and draw up a plan for how to manage the hostel space and avoid spread of COVID-19 infection for:

  • residents who have symptoms of COVID-19 and may be waiting for a test result (possible case)
  • residents who have received a positive test result for COVID-19 (confirmed case)
  • residents considered to be in the same household as someone with symptoms or who has had a positive test (household contacts)
  • residents who have been identified as contacts of a confirmed case who they don’t live with (non-household contacts) are at lower risk of becoming infected. They should carefully follow the guidance on coronavirus: how to stay safe and help prevent the spread

Ideally, all people in the above categories should have their own self-contained accommodation (with their own bathroom and kitchen). If this is not possible, ‘cohorting’ based on COVID-19 status may be used to minimise health risks. Cohorting is a strategy which can be effective in limiting the spread of disease by gathering people into different areas depending on their status. For example, confirmed cases can be in one area of the hostel and residents without symptoms in another.

Residents with suspected or confirmed COVID-19 should not mix with, be cohorted with, or spend time in rooms next to residents who have an underlying health condition that puts them at higher risk of severe illness if they were infected with COVID-19. This includes not sharing bathrooms or communal areas within the hostel.

The Clinical homeless sector plan published by Pathway provides more details on cohorting in the context of emergency accommodation for people experiencing rough sleeping.

Where hostels have a mix of residents with symptoms and/or confirmed cases and residents who are asymptomatic, they should consider:

  • whether residents can safely avoid contact with other people in their own room with an en-suite bathroom and have access to their own kitchen
  • if residents cannot safely avoid contact with other people in the hostel, what other local options are available to support them
  • the physical layout of the hostel to ensure that there is no contact between groups outlined above
  • arranging staff teams so the same people are consistently working with the same staff group
  • seeking advice from UKHSA’s local HPTs in complex situations

Suspected or confirmed cases of COVID-19

As part of close working with local HPTs and local authorities, hostel providers should ensure plans are in place for each setting that cover the standard processes for prevention and response to COVID-19 cases and outbreaks, including when to contact the local HPT and the local authority.

Local authorities need a clear picture of all alternative local provision that could be used in the case of an outbreak. Where local authorities are unable to meet the emergency needs of a hostel provider, they should liaise with the Strategic Coordination Group of their Local Resilience Forum (LRF) for additional support. Contact details for the LRFs can be found at Local resilience forums: contact details.

If someone has COVID-19 symptoms or has a positive COVID-19 test result

Anyone who develops COVID-19 symptoms, however mild, should stay in the accommodation setting, avoid contact with other people and get a PCR test even they have received one or more doses of COVID-19 vaccine. Those who test positive should stay in the accommodation setting and avoid contact with other people. For further details on the duration, see the guidance for people with COVID-19 and their contacts. They should not go to a GP surgery, pharmacy or hospital except in an emergency. Where a resident has symptoms, managers should support residents to arrange to have a test to see if they have COVID-19 – this can be arranged online.

If their symptoms do not get better after 10 days, or their condition gets worse, use the NHS 111 online coronavirus service, or call NHS 111 if internet access is not available. For a medical emergency call 999.

Hostels should provide support to residents with a positive test result. Guidance for people with COVID-19 and their contacts should be followed even if the resident does need to go to hospital.

Staff should follow guidance for cleaning in non-healthcare settings, which includes guidance on dealing with laundry and waste.

If a resident is identified as a contact of someone with COVID-19 symptoms or of someone with a positive COVID-19 test result

Refer to the section on Managing the hostel for help in determining if a resident is a household or non-household contact.

Residents considered to be in the same ‘household’ as someone who has symptoms of, or has received, a positive test for COVID-19 are considered ‘household contacts’. They are advised to limit close contact with other people outside their household, especially in crowded, enclosed or poorly ventilated spaces and should follow the guidance for people with COVID-19 and their contacts.

Managers of hostels should encourage residents to tell them if they need to avoid contact with other people because they are a non-household contact. Carefully follow the guidance on coronavirus: how to stay safe and help prevent the spread.

If a household or non-household contact develops COVID-19 symptoms at any time, even if these are mild, they should avoid contact with other people, be helped to arrange to have a PCR test and follow the advice in the guidance for people with COVID-19 and their contacts.

Meeting the health and wellbeing needs of residents with COVID-19

As well as having their own room, residents with COVID-19 infection who are avoiding contact with other people should have personalised plans in place, which include:

  • provision of food and water
  • support for physical and mental health (including drug, alcohol and nicotine dependence and/or treatment needs)
  • wellbeing
  • communication (for example being provided with a mobile phone)
  • Homeless Link has guidance on trauma and psychologically informed approaches

Visitors where a resident has COVID-19 and is avoiding contact with other people

If a resident with COVID-19 symptoms or is a confirmed case and is avoiding contact with other people:

  • do not invite or allow social visitors to enter the hostel. This includes visitors for all members of the hostel, not just the symptomatic resident or case. If residents want to speak to someone, they should use the phone or social media
  • if the resident is receiving essential care, then carers should continue to visit and follow the relevant adult social care guidance to reduce the risk of becoming infected

Visits that are unavoidable (for example, for health reasons or to undertake urgent repairs in the hostel) can be conducted providing the visitor does not have symptoms. Routine infection control measures such as environmental cleanliness, good ventilation, hand hygiene, minimising contact and wearing face coverings should be maintained to minimise the risk of infection and cross-contamination.

No-one with symptoms of COVID-19 should visit a hostel, including staff and visitors.

Personal protective equipment use

The majority of staff will not require personal protective equipment (PPE) beyond what they would normally need for their work.

PPE is only needed in a very small number of circumstances:

  • if providing care to a resident whose care routinely already involves the use of PPE
  • if there is a known risk of contamination of blood or body fluids from the resident (regardless of their COVID-19 status)
  • if providing care to someone displaying symptoms or who has had a positive test, and close contact cannot be avoided
  • if spending prolonged time (greater than 15 minutes) at closer than 2 metres distance from someone displaying symptoms or who has had a positive test

PPE should include a fluid-repellent surgical mask, single use disposable apron, single use disposable gloves, and eye protection if appropriate following a risk assessment about the risk of splashing into the face or eyes. Further information on what PPE to wear and when is available. It is also important to make sure staff put PPE on and take PPE off safely to avoid self-contamination.

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.

If the local authority is not able to meet the PPE needs of providers, the local authority should approach their nearest LRF.

If neither the local authority or LRF are 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.

Transferring residents between accommodation

If a resident is suspected of having COVID-19 and needs to be moved for assessment, to avoid contact with other people or for treatment, inform staff at the receiving destination that the patient is suspected to have COVID-19.

If residents who are symptomatic or who have received a positive COVID-19 test result require transfer, public transport should not be used. Individuals should be separated from others within well-ventilated transport vehicles, social distancing should be maintained, and face coverings should be worn by all passengers and operators unless exempt through health, disability of other reason. If PPE is needed this should include a fluid-resistant surgical mask, single use disposable apron, single use disposable gloves, and eye or face protection (the use of eye or face protection can be risk assessed for the situation). See COVID-19: safer transport guidance for operators for further guidance.

Safeguarding

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.

Hostel managers and staff should pay particular attention to increases in self-neglect, the possible criminal exploitation of residents (for example in supplying drugs) and increases in intimate partner violence.

Commissioners, providers and their staff should refer to COVID-19 and safeguarding resources and positive practice in adult safeguarding and homelessness.

Providing care after death

Should someone die while staying in a hostel due to a suspected or confirmed COVID-19 related death, please refer to the guidance for care of the deceased.

Other sources of information

NHS England and Improvement has produced a homelessness and rough sleeping mobilisation support pack, which can be accessed by joining NHS England’s online Homelessness and Inclusion Health workspace:

Other 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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