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Homelessness and COVID-19

Older Adults and Black Californians Face Severe Health Risks

April 2020 | By Monica Davalos and Sara Kimberlin

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On a given night, more than 150,000 Californians are homeless. These individuals face significant risk of exposure to COVID-19 and serious barriers to following stay home orders to limit the spread of infection. Due to older ages and high rates of physical health conditions, they are also at high risk of severe complications or even death from the virus. Black Californians are greatly overrepresented among homeless individuals, making their health especially endangered by COVID-19. Policymakers should make sure the urgent housing and health needs of Californians who are homeless are met, to protect their health and the broader public health and to address racial health disparities exacerbated by this pandemic.

  • Nearly 3 in 4 Californians experiencing homelessness are unsheltered– living on the street, in cars, or in other places not meant for habitation. Lack of proper housing makes it impossible for these individuals to follow stay home orders or even practice basic hygiene, such as washing their hands.
  • Social distancing and self-quarantine are also a challenge for Californians staying in emergency shelters and transitional housing, due to shared sleeping, eating, bathroom, and living spaces.
  • The lack of housing and inability to consistently follow public health recommendations puts Californians who are homeless at greater risk of contracting COVID-19. This also hinders statewide efforts to stop the virus from spreading.

  • Older adults are at high risk of developing severe health complications from COVID-19. According to the US Centers for Disease Control and Prevention (CDC), adults age 50 and over have the highest rate of hospitalization due to COVID-19 — and those age 55 and older accounted for 92% of provisional COVID-19 deaths as of April 21, 2020.
  • Even prior to the pandemic, the aging of the homeless population meant that older adults are now – and will continue to increasingly be – a large portion of Californians experiencing homelessness. In Los Angeles County, about 2 in 5 homeless adults are older than 50.
  • Further, homeless individuals demonstrate rates of illnesses and geriatric conditions on par with or higher than adults with stable housing who are 20 years older, increasing their risk of complications from COVID-19.

  • People with chronic health conditions also tend to have worse COVID-19 outcomes. A preliminary study by the CDC found that adults with COVID-19 who had at least one  underlying health condition or risk factor were significantly more likely to require  hospitalization or ICU admission, compared to those who did not.
  • In addition, experiencing homelessness exacerbates existing health conditions and can lead to new ones, such as chronic illnesses and infectious and communicable diseases. In a national study of homeless single adults, more than 8 in 10 unsheltered individuals (84%) reported having at least one physical health condition.

  • Racial disparities linked to current and past discriminatory policies and practices are startlingly apparent in Black Californians’ overrepresentation both within the homeless population and among severe health outcomes and deaths related to COVID-19.
  • While Black Californians only comprise 6% of the state population, nearly 1 in 3 individuals experiencing homelessness are Black, and therefore face high risk of COVID-19 exposure and significant barriers to preventing and addressing infection.
  • Black Californians accounted for 12% of COVID-19 related deaths statewide as of April 19, 2020 — double their share of the state population. In Los Angeles County, where 1 in 11 residents (9%) are Black, they have accounted for 1 in 6 deaths (16%) due to COVID-19 as of April 18, 2020.

Federal and state policymakers have taken initial steps to address the needs of Californians experiencing homelessness during the COVID-19 crisis, such as providing support to house some individuals in hotels and allocating funds to local jurisdictions to address local homeless services needs. This support for individuals without a permanent home will be needed as long as the pandemic lasts. It is also critical to ensure that Californians at high risk of severe COVID-19 health outcomes – including older adults and individuals with chronic health conditions – do not fall into homelessness. Strong interventions are also important to avoid further exacerbating the disproportionate burdens of homelessness and COVID-19 among Black Californians. Given the high risk and devastating consequences for both individuals’ health and broader public health efforts, policymakers should prioritize the urgent COVID-19 health and housing needs of homeless Californians, while taking steps to address the state’s long-term homelessness challenges and racial health disparities.

Covid-19
Housing & Homelessness

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Choosing between paying the bills or caring for their families has never been an easy choice for California workers, and COVID-19 health and economic conditions have only exacerbated that dilemma. The federal Families First Coronavirus Response Act temporarily addresses workers’ lack of paid time off in the United States by requiring employers to provide both paid sick days and job-protected paid leave to care for a family member (see Table for more details). While the federal government will provide tax credits to businesses to cover the cost of the required leave policies, the federal law has exemptions that allow some employers to opt out of providing paid time off to workers, many of whom earn low wages, have limited benefits, and are at heighted risk of being exposed to COVID-19.

Workers ineligible for new federal leave laws may be able to rely on California’s family and medical leave laws, but these policies also have limitations that create barriers for workers taking paid time off from work. These barriers are particularly acute for workers with low wages – disproportionately women, Black, and Latinx workers. Finally, some workers may be covered by their employers’ benefits, but workers with low wages are far less likely to have paid time off via workplace benefits. This means that even as state leaders work to stop the spread of COVID-19 and have directed people to stay home, some workers cannot access paid time off to care for themselves or family members and still support their household needs.

How are workers caught in the paid time off gap?

Caught in the Gap: A part-time cashier at a nationwide pharmacy needs several weeks away from work to stay home to care for her spouse who is gravely ill and is under an isolation order, but she is ineligible for federal paid time off because she works for an employer with more than 500 employees. While this worker could use California’s paid family leave, she would not be able to take leave with job security because she works just 20 hours a week, which does not meet the requirements for job-protected leave under California law. Closing the Gap for Workers:

  • Federal policymakers should require large businesses with more than 500 employees who are currently excluded in the Families First Act to provide paid time off. This could reach millions of additional workers in California.
  • State policymakers should extend job protections to all workers who take family and medical leave regardless of the size of the employer, hours worked, or tenure.

Caught in the Gap: A single mom working at a small, local grocery story finds herself without care for her children due to the closure of local schools and day care centers. Her employer has told her that providing her with paid time off to care for her children would be a hardship that would jeopardize the business, and she is not eligible to utilize federal paid leave. California’s paid family leave program is not an option for parents who suddenly find themselves without care for their children due to a public health emergency. Her only option is to apply for unemployment insurance benefits. Closing the Gap for Workers:

  • Federal leaders should limit small-business exemptions to those who would be forced to immediately close if they gave their employees paid time off under this new federal leave program. Currently, the Department of Labor definition of hardship is vague and requires only self-certification by small employers. Small businesses should also be required to submit a simple form to the federal Department of Labor, rather than current practice, which is to self-certify without any documentation.
  • State policymakers should include care for a family member due to the closure of school, child care center, or adult day center during a public health emergency or natural disaster as a reason one can utilize paid family leave.

Caught in the Gap: A worker in the cleaning and maintenance department of a small, rural hospital fears he might have been exposed to COVID-19 when he dropped off groceries for his mother who has since tested positive for the virus. He knows he should self-quarantine for the recommended 14 days, but he only has three days of sick time under California’s paid sick days law and he’s worried about paying his bills. His employer has already informed him that he is considered a health care worker, and they won’t be providing any paid sick days under new federal laws. He could apply for state disability insurance, but he needs medical certification. Unfortunately, even though he works in a hospital, he does not have a primary care doctor, has been unable to schedule an appointment with a new doctor, and is afraid to go to urgent care due to the risk of spreading the virus or increasing his risk of exposure. Closing the Gap for Workers:

  • Federal policymakers should provide health care workers and emergency responders with paid time off to care for themselves or their family. The regulations are overly broad and allow employers to exclude many workers, many of whom have a greater chance of being exposed to COVID-19, and they may need time off, too. Adding to their dilemma and economic hardship, many of these workers likely earn low wages, such as janitors in hospitals and factory workers building medical supplies.
  • State policymakers should increase the minimum required number of paid sick days provided by all employers, which is currently just three days or 24 hours, to the equivalent of two weeks during a public health emergency and seven days when not in a public health emergency. Governor Newsom recently signed an Executive Order expanding paid sick days, but just for essential workers in the food sector who work for large employers currently excluded from federal law.
  • State policymakers should waive medical certification necessary for state disability insurance or paid family leave during a public health emergency to ease the strain on the health care system.

Everyone needs time off to care for themselves or their families, and the COVID-19 pandemic has only heightened the necessity for all workers – crisis or not – to know they can safely keep their jobs and care for the health and well-being of loved ones. State and federal laws create a patchwork of policies to address the need for paid time off but leave notable gaps and workers without a reliable way to care for themselves and others. Both state and federal policymakers should take additional action in the midst of this public health and economic crisis to support California’s workforce in the same way workers show up for the economy every day.

Support for this work is provided by First 5 California. 

Covid-19
Poverty & Inequality

Source: Budget Center analysis of federal and California state law and administrative documents.

1 The law doesn’t apply to workers covered under a collective bargaining agreement with certain provisions, to certain public employees, and certain airline employees.

2 Certain employees and certain types of employment are exempt and don’t contribute to state disability insurance. In addition, employers or a majority of employees can opt into voluntary disability plans 

in lieu of state disability insurance and paid family leave with approval from the state.

3 Businesses with fewer than 50 employees can opt out of providing paid sick days or paid leave for workers who need time off to care for family due to a closure of a care facility if it would jeopardize the         

business.

4 Employers can opt to exclude health care workers and emergency responders.

5 The definition of “family member” varies across state and federal laws.

6 May be prorated for part-time work.

7 The 2019-20 budget agreement extended the duration from six weeks to eight, effective July 1, 2020.

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Millions of California workers have lost jobs or seen their work hours significantly cut back as a result of the public health measures that state and local governments have put in place to slow the spread of COVID-19. While necessary to protect the state’s health care system and mitigate the spread of infection, these disruptions seriously threaten the economic stability of a significant share of California workers – and their families. Yet these disruptions do not affect all Californians equally, with a greater burden on California workers with less education, those who are immigrants, and California’s children and adults of color.

To understand who may be most affected, this piece examines the demographics of workers and the families of workers in California industries that are directly and immediately affected by the business slowdown and closures due to the COVID-19 pandemic.

 

In this fact sheet you will learn about:

  1. Who are the State’s Struggling Workers: Many Californians Face High Risk of Economic Devastation from the COVID-19 Business Slowdown
  2. Wage & Educational Disparities: Workers With Low Wages and Less Education Face High Risk of Losing Work
  3. Job Hits Worsen Racial Inequalities: Californians of Color and Their Children Are Particularly Vulnerable to Economic Instability
  4. Impossible Situation for Immigrants: California’s Immigrants Face Financial Crisis, With Millions Left out of Public Support
  5. Opportunities Now & Beyond: Policymakers Can Address Racial and Economic Inequities with COVID-19 Responses
Covid-19
Poverty & Inequality

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The federal Supplemental Nutrition and Assistance Program (SNAP) — known as CalFresh in California — is one of the nation’s most powerful antipoverty programs, helping millions of people buy the food they need to support their families and households. Even with a strong economy in 2019, CalFresh provided food assistance to nearly 1 in 10 Californians. Program participation varied across the state’s 53 Congressional districts, but was especially high in the 8th District (R-Cook), 16th District (D-Costa), and 21st District (D-Cox) (see Map 1). CalFresh enrollment will increase dramatically in the coming weeks and months as many across the state lose jobs and income due to the COVID-19 public health and economic crisis.

SNAP is also one of the federal government’s most effective tools in boosting the economy when participants purchase food in their communities. While recent federal legislation responded to the COVID-19 pandemic by enacting temporary provisions in the SNAP program to streamline administration, maintain participation, and provide emergency benefits, more needs to be done. Federal policymakers should take additional actions to help households put food on the table and to boost the economy. Until the public health emergency is over and the economy improves, policymakers should increase SNAP’s maximum benefit and minimum monthly benefit and halt any administrative actions that would limit SNAP food assistance.


Covid-19

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The COVID-19 public health crisis has upended the lives of Californians. Millions of people have experienced serious disruptions to their jobs following social distancing public health recommendations and state and local shelter-in-place orders aimed at slowing the spread of the virus. While necessary to prevent overwhelming the state’s health care system, the business reductions and closures forced by these orders will have a severe economic impact on Californians as well as on regional economies.

This Fact Sheet shows that the major industries most immediately impacted by the COVID-19-related economic shutdown – leisure and hospitality, retail trade, transportation and warehousing, and other services – employ large numbers of Californians in the state’s largest metropolitan areas.1 Without a sufficient federal response to help workers and their families, the shutdown will have a ripple effect throughout local economies as people who lose work will lose income and be forced to cut back on their spending, thus reducing demand for business more broadly.

Covid-19

1 Although many people employed in leisure and hospitality, retail trade, transportation and warehousing, and other services have lost work in recent weeks, there are notable exceptions. For example, within retail trade, grocery stores and pharmacies remain open; within leisure and hospitality, some restaurants have remained in business by providing takeout service instead of in-house service; and within transportation and warehousing, there has been increased demand for jobs supported by online shopping. Due to data limitations for metropolitan areas, it is not possible to present job figures for the industries within these sectors that have been most immediately impacted by the economic shutdown. For these figures at the state level, see The California Industries Hit Hardest by COVID-19 Economic Shutdown: These Industries Employ Millions of Californians.

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The COVID-19 public health crisis has upended the lives of Californians. Millions of people have experienced serious disruptions to their jobs following social distancing public health recommendations and state and local shelter-in-place orders aimed at slowing the spread of the virus. While necessary to prevent overwhelming the state’s health care system, the business reductions and closures forced by these orders will have a severe economic impact on Californians and will hit those with low incomes especially hard.

This Fact Sheet shows that the types of occupations most immediately impacted by the COVID-19-related economic shutdown typically pay low wages, providing annual incomes near or below the poverty line based on the Supplemental Poverty Measure for Los Angeles, even for full-time work.1 This means that the Californians who will bear the brunt of the economic slowdown live paycheck to paycheck even when work is plentiful and are unlikely to have savings to fall back on when their jobs disappear.

Covid-19

1 Although many people employed in these occupations have likely lost work in recent weeks, there are notable exceptions. For example, within transportation and warehousing, there has been increased demand for jobs supported by online shopping.

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The COVID-19 public health crisis has upended the lives of Californians. Millions of people have experienced serious disruptions to their jobs following social distancing public health recommendations and state and local shelter-in-place orders aimed at slowing the spread of the virus. While necessary to prevent overwhelming the state’s health care system, the business reductions and closures forced by these orders will have a severe economic impact on Californians and the state’s economy.

This Fact Sheet shows that the industries most immediately impacted by the COVID-19-related economic shutdown employ several million people in California.1 Without a sufficient federal response to help workers and their families, the shutdown will have a ripple effect throughout the economy as people who lose work will lose income and be forced to cut back on their spending, thus reducing demand for business more broadly.

Covid-19

1Although many people employed in these industries have likely lost work in recent weeks, there are notable exceptions. For example, within transportation and warehousing, there has been increased demand for jobs supported by online shopping.

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In the 1950s and 1960s, policymakers in California and elsewhere began reducing the use of state hospitals to treat people with mental illness – a policy known as “deinstitutionalization.” However, the lack of robust treatment alternatives led to a growing number of people with mental health conditions becoming homeless and, in many cases, incarcerated.1 As a result, prisons and jails have been turned into “America’s…new mental hospitals,” even though it is clear that correctional facilities are highly inappropriate places to house and treat people with mental illness.2

State prisons. Nearly 37,000 people incarcerated at the state level – almost 29% of the total – received mental health treatment in December 2018.3 This was up from about 32,500 – less than 25% of the total – in April 2013. California is projected to spend about $800 million on mental health care in state prisons under Governor Newsom’s proposed 2020-21 state budget. This is more than one-fifth (22%) of total projected health-related spending for state prisoners ($3.6 billion).

County jails. In September 2019, California’s county jails housed 72,806 people on any given day (average daily population).4 Many of these individuals need mental health care. Point-in-time statewide data for September 30, 2019 show that 20,023 people in jail had an open mental health case and 18,020 were receiving psychotropic medication.5 In Los Angeles County, which has the largest jail population in the state, an average of 30% of people in jail on any given day in 2018 — about 5,100 out of roughly 17,000 — “were in mental health housing units and/or prescribed psychotropic medications.”6

While California must continue to improve health care for people who are incarcerated, reforms are also needed to address the connections between mental health and the criminal justice system so that Californians who need mental health treatment receive the appropriate care in a timely manner rather than being confined in state prisons or county jails.

 

For more information on the state’s system, check out “Mental Health in California: Understanding Prevalence, System Connections, Service Delivery, and Funding”.

Support for the Budget Center’s work on behavioral health is provided by the California Health Care Foundation.

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Justice System

1 E. Fuller Torrey, et al., The Treatment of Persons With Mental Illness in Prisons and Jails: A State Survey (Treatment Advocacy Center and National Sheriffs’ Association: April 8, 2014), pp. 11-13; Jen Rushforth, “Guilty by Reason of Insanity: Unforeseen Consequences of California’s Deinstitutionalization Policy,” Themis: Research Journal of Justice Studies and Forensic Science 3 (Spring 2015), pp. 30-35;  Matt Vogel, Katherine D. Stephens, and Darby Siebels, “Mental Illness and the Criminal Justice System,” Sociology Compass 8 (June 2014), pp. 629-630.

2 The quotation is from E. Fuller Torrey, et al., More Mentally Ill Persons Are in Jails and Prisons Than Hospitals: A Survey of the States (Treatment Advocacy Center and National Sheriffs’ Association: May 2010), p. 1. See also Stanford Law School Three Strikes Project, When Did Prisons Become Acceptable Mental Healthcare Facilities? (February 2015).

3 Prison population and expenditure data cited in this paragraph are from the California Department of Corrections and Rehabilitation and the Department of Finance, respectively.

4 Statewide jail population data cited in this paragraph are from the Board of State and Community Corrections.

5 State data do not indicate how many people fall into both categories; the overlap may be substantial. Average daily population data are not directly comparable to point-in-time data. Point-in-time data for several counties were unavailable, so the reported numbers of open mental health cases and people receiving psychotropic medications are likely somewhat low.

6 Stephanie Brooks Holliday, et al., Estimating the Size of the Los Angeles County Jail Mental Health Population Appropriate for Release Into Community Services (RAND Corporation: January 2020).

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