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The D.C. government has been moving unsheltered residents who need to quarantine due to possible exposure to COVID-19 into hotels that are empty for lack of tourists. Traditional homeless shelters can easily become hotbeds of infection because it’s nearly impossible to practice social distancing due to the lack of space. And while hotel rooms have become a safer alternative for individuals experiencing homelessness during the coronavirus pandemic, one provider is concerned about the care offered.
Caitlin Apo, the clinical director for the McClendon Center, a mental health clinic certified with the Department of Behavioral Health, says her patients staying at quarantine hotels have received inadequate medical care and food. One of Apo’s patients who tested positive for COVID-19 was left alone in a room at Hotel Arboretum on Bladensburg Road NE for three days before anyone checked on him.
“No one on-site at the hotel even knew he was there,” Apo tells City Paper.
She says it was not until the patient left his room and found someone in the hallway that on-site staff, including nurses, learned of his stay. Despite feeling “gravely ill” at the hotel for the last two weeks, the patient has not received in-person medical care, says Apo. Another patient of hers staying at Days Inn on Connecticut Avenue NW opted to leave after testing positive for COVID-19 because she said she was not receiving adequate care. Apo knows that four of her patients have quarantined in hotels and suspects more are, but can’t know for sure because officials have declined to tell her.
D.C. is using five hotels to isolate individuals experiencing homelessness who tested positive for, are awaiting lab results, or have been exposed to COVID-19. These individuals’ stays aren’t indefinite; they stay for a few weeks until they are cleared or decide to leave early. Unsheltered individuals who are at high risk of severe illness due to their age or medical status are also being offered rooms before they become infected with COVID-19. D.C. has about 430 rooms reserved for isolation. As of April 21, 236 rooms were filled with residents and of that, 125 were high-risk patients, according to Christopher Geldart, the incident command lead for the D.C.’s COVID-19 response. The number will likely increase in the coming weeks as DC Health is now encouraging providers to test some asymptomatic individuals in congregate settings like homeless shelters.
In an interview with City Paper, Geldart stressed that hotels used for quarantine are not medical facilities. Residents are given three meals a day (typically boxed food that essential employees also eat) and access to medical staff. A doctor is available Monday through Friday during business hours, as well as five registered nurses and medical assistants on rotating shifts throughout the day. Medical staff are there to check on residents who might “decompensate” from the disease and need to be transported to the nearest hospital, but they are not necessarily treating these individuals.
There are no mental health providers on-site, even though the homeless population sees higher rates of severe mental illness. Instead, the protocol is that hotel residents should contact DBH’s Access HelpLine or Community Response Team using the phones in their hotel rooms if they need help in this way.
“We are not taking patients into care,” Geldart tells City Paper. “The type of people that we have in there are those that would normally, but for their circumstances, be convalescing at home or healing from the disease at home.”
Moving individuals from homeless shelters into hotels has been a “pretty big undertaking,” says Geldart, who is also the director of the Department of Public Works. Admittedly, he notes, the executive could do a better job at communicating with providers in an unsheltered individual’s network, including mental health care providers. “There is no purposely withholding any information,” he tells City Paper. He assures providers whose patients are moved into quarantine that they will be notified of hotel stays at some point in the process so treatment outside of COVID-19 continues. But COVID-19 response, like contact tracing, is the priority.
The Department of Human Services has so far declined Apo’s requests that she receive a list of where McClendon Center patients are staying if they move into hotel rooms for isolation, so staff can continue to provide care. She only knows of her patients’ stay when they tell her. She spoke with a 10-year patient of the McClendon Center on April 20 after learning from a hospital that he was moved into quarantine, but he declined to disclose his location because he believed he was being followed. He’s typically very paranoid as part of his symptomatology.
The McClendon Center serves adults diagnosed with mental illness and provides antipsychotic medications along with counseling. Medication management, like prescription drop-off, continues even though the clinic’s doors are closed due to the pandemic. The mental health clinic also coordinates other treatments if, say, a patient has diabetes and needs insulin.
“We’re responsible to be accountable for all of these patients,” says Apo. “But during this specific crisis, there’s no access to care, which would be fine if they were receiving care at the sites that they’re at. But we find that hasn’t been the case. So let other providers come in and do the work for you. I don’t mean face-to-face, let us do things over telehealth.”
Apo has visited Hotel Arboretum twice to check in on the patient who was left alone in his room for three days. She learned he was there after reading a hospital document and believing he died due to COVID-19. Apo immediately called his phone and he answered. That’s when she learned he wasn’t dead but was desperate for help. After the McClendon Center advocated on his behalf, the patient received a call from a nurse. But Apo remains concerned that there is no overnight medical staff. Her patient still suffers from nausea and vomiting, so Apo dropped off meals he can stomach like soup and crackers because all he’s being offered is food like TV dinners. McClendon Center staff has had to talk him out of leaving the hotel several times because he is so frustrated by the care he’s received.
“His motivation has been that he does not want to spread it to anyone,” says Apo.
Apo acknowledges the patient who left the Days Inn on April 20 is more difficult and could have benefited from a on-site mental health care provider. Had she known of her hotel stay earlier, Apo could have advised on-site medical staff to build a rapport.
“That’s a very difficult situation for us,” says Geldart when asked about this person’s decision to leave quarantine despite testing positive. Individuals are asked to stay in their rooms to slow the spread of the virus. “If somebody just stood up and said, ‘I don’t want to be here anymore. I want to leave,’ we can’t—we’re not—going to arrest them for doing that.”
“Just like we’re not making you, if you were positive, be locked into your home or else you’ll be arrested, we’re not going to do that to this community,” he adds.
Apo also reached out to At-Large Councilmember David Grosso for further assistance. He too remains concerned about the impact the pandemic is having on vulnerable populations, including unsheltered residents.
“Last week my staff brought these concerns to DHS and the agency acknowledged shortcomings in the rollout of these sites. Now I am hearing that the problems persist, at least for some individuals,” Grosso tells City Paper via email. “While DHS is doing great work in many ways, we cannot have vulnerable people fall through the cracks.”