Understanding the Homeless Response System

Section 3 of the training series on discharge planning with patients experiencing homelessness or housing instability.

The Prevalence of Homelessness

In order to best partner with the homeless response system and support patients experiencing homelessness or housing instability, it is important to understand what homelessness looks like in Massachusetts. The following section provides information on the prevalence of homelessness, the homeless response system, and the realities of the shelter experience.

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The Homeless Response System

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Realities of Shelter

While shelter is an important safety net for those without a place to stay, the reality is that staying in shelter can be a traumatizing and dehumanizing experience. Shelter should be the last option after all other options have been explored.

If an individual is referred to a shelter they may encounter the following:

• Congregate settings   
  • No private space for sleeping/hygiene/eating.  
  • Many shelters do not guarantee the same bed every night. 
• Lack of assistance with taking care of personal needs. Individuals in shelters must be capable of taking care of their own needs, including but not limited to:    
  • Bathing, toileting, dressing, eating, administration of medication, all daily activities.   
• Lack of sleeping options. Many shelters utilize bunk beds and individuals may need to be able to climb to a top bunk.  
• Lack of daytime indoor options. Many shelters ask guests to leave during in the early morning and allow guests to return in the evening, which leaves individuals open to the elements if they cannot locate a day program or alternative during daytime hours.   
• Time limited stays. Some shelters may have time limits on length of stay.     
  • Shelters funded through DHCD do not enforce time limits for shelter stays but non-DHCD funded shelters may impose their own limits.  
• Lack of availability. Many shelters have reduced capacity due to COVID and may not be able to immediately accommodate a need for a shelter bed due to these limits.   

The obstacles presented by shelter mentioned above have led some people experiencing homeless to choose  to stay outside instead. Staying outside does not require compliance to rules, can allow for more privacy, and allows for individuals to stay with a partner or pet. Many shelters are separated by gender, which is difficult for  people with gender diverse identities and for couples.

While these obstacles are common, each shelter has their own policies and procedures. This includes entry and exit times, storage availability, what items can be brought into the shelter, etc. 

It is also important to know that while people staying in shelter can be connected to housing services, there are not sufficient housing resources to meet the needs of all people experiencing homelessness. Most shelters also have limited staffing, whose primary purpose is for operations and safety of shelter guests. Shelters often do not have medical staff or staff to provide services to guests. 

Shelters, specifically shelters funded by the State, are expected to support discharge planning efforts in the following ways:

• May not place geographic/community of origin restrictions on access; however shelters may help individuals return to a shelter or housing in their home community
• May not refuse entry to any individual taking prescribed medication, including, but not limited to, opiates, oxygen, and benzodiazepines.
• Should be prepared to receive and be receptive to inquiries from hospitals who may have an individual who previously resided in shelter. In these situations the shelter should:
  • Share information about the individual’s housing history and any other support systems they may have (family, friends, case managers, housing leads, etc.)
  • Coordinate placement from the discharging facility into shelter if space is available in the shelter, the person does not require higher levels of care, and no other safe alternative placements exist.
• Should be prepared to receive and be receptive to inquiries from hospitals who may have an individual who may not be known to the shelter. In these situations shelters should: 
  • Engage in conversations with discharge staff to determine if an alternative placement or safe and alternative housing would be appropriate, and use Rapid Transitions for Individuals funds where possible

Coordinate with placement from the discharging facility into shelter if space is available in the shelter, the person does not require higher levels of care, and no other safe alternative placements exist.