Housing and Isolation Team provided safe, non-judgmental support to those who needed it to isolate during COVID

Members of Public Health’s HIP team meet virtually.
Members of Public Health’s HIP team meet virtually.

“Stay the blazes home.” Most Nova Scotians clearly remember this instruction during the first wave of the pandemic. In April 2020, memes, t-shirts, songs and mugs appeared with the catchy refrain. And while this statement struck a chord with many Nova Scotians, others couldn’t follow this advice – people without housing or who were insecurely housed, living in crowded housing, or fleeing domestic violence. For individuals in those types of circumstances, Public Health’s Housing and Isolation Program, known as the HIP team, has been there to help.

“How can you isolate if you don’t have a home or aren’t safe in your home?” said Nancy Green, member of Public Health’s Housing and Isolation team, based on the South Shore in Nova Scotia Health’s Western Zone. “If there’s no one there to provide the services to help people isolate safely, people are going to break isolation.”

The HIP team represents an addition to Public Health that didn’t exist before COVID-19, born out of an urgent need. The current team is made up of health promoters and nutritionists from across the province who would ordinarily work for Public Health’s Science and Systems Performance and Healthy Communities teams. The team has expanded at times throughout the pandemic to include staff from across Nova Scotia Health, including community home visitors, youth health centre coordinators, primary health care staff, community health board coordinators and public engagement advisors. The HIP team also works closely with the Public Health COVID response team and public health nurses to coordinate support efforts.

Housing as a determinant of health

“In Public Health, we’ve always talked about housing as a determinant of health,” said Christine Johnson, Housing and Isolation team member in Antigonish.

While the Public Health team was well aware of the impact of housing on health, the pandemic exacerbated the problem and gave the team a better sense of the complexity and scope of homelessness and insecure housing. “Through the pandemic, we’ve seen how fast-paced the spread of communicable disease (contagious illnesses) like COVID-19 can be. It’s caused us to reflect on how we deal with communicable disease management and disaster/emergency preparedness for people who experience inequities such as housing insecurity. The intersection between policy and living conditions and the impact on health became really clear. Normally it’s harder to show that relationship because the inequitable outcome is something like developing heart disease 50 years down the road.”

Collaboration to ensure safe isolation

Throughout the pandemic, the HIP team has worked with partners across the province to ensure people have what they need to isolate safely. Each individual and family has unique needs that include access to food, accommodations, transportation, health care and more. Often the team asks, “What’s the barrier here?” and works together and with community partners to overcome it.

The success of this work has in large part been due to these supportive partnerships and connections. Partners include hotel operators, taxi companies, community organizations, restaurants, grocery stores, pharmacies, street health providers, shelters, transition houses, harm reduction agencies, immigrant and newcomer support organizations, police and border services, Nova Scotia Health departments such as Primary Care and Mental Health and Addictions, as well as provincial and federal government departments.

In addition, community groups such as Feed NS, 211 and the Antigonish Good Neighbours Program worked to meet the needs they saw emerging in community related to COVID-19 and isolation.

Unique needs, unique supports

For individuals fleeing domestic violence, the pandemic added another layer of stress and challenge.

“It was so important that transition houses supporting these individuals remained open and could continue to accept new clients,” said Johnson. “Teams at these organizations helped us understand the operational challenges and how clients needed to be supported. One example was people needing to cross borders to flee dangerous situations. They needed help to pre-plan so that they could get through the border, going through the government’s compassionate exemptions process. This need wasn’t on our radar previously.”

The HIP team, along with Department of Health and Wellness, medical officers of health, public health nurses, and the public health mobile unit, also worked in partnership with shelters and transition houses to help manage outbreaks. Beyond outbreaks, the team also worked with shelters and transition houses and other health system partners to coordinate vaccine clinics for guests.

 “Shelters have been able to keep operating under what must have been the most trying of circumstances. They’re just amazing. They deserve so much credit for keeping people safe. We’ve really just come in as a supportive partner,” Johnson added.

Team members shared that the pandemic has shifted and deepened Public Health’s relationship with shelters and transition houses.

“Prior to COVID-19, our relationship with shelters and transition houses was very different. It was more focused at the advocacy level. They might have attended a coalition that our team was also attending. They’re working to put out fires every day. We’ve been there helping them put those fires out. I think our relationship has been strengthened significantly.”

Johnson reflected on the unpredictability of the work in this way: “Just when we think we’ve seen it all, we haven’t.”

Support without judgement

During the pandemic, the HIP team was able to put into practice many of the foundational principles and values that guide Public Health work, including equity, partnership, understanding, innovation, respect and courage. Key to the HIP team’s success was to use a person-centred, trauma-informed, equity-based approach in every interaction. To complement this work, the HIP team received training in Mental Health First Aid, Understanding Harm Reduction Approaches, Trauma Informed Care, Health Equity Impact Assessments, and Diversity and Inclusion.

Johnson noted, “We noticed from clients this pleasant surprise of being listened to, having their needs met and being supported and not judged.”

In addition to those types of practical supports, “we’ve been able to provide connections to services that clients never would have been engaged with before. For some of our clients, we’ve been a stepping stone. We’ve connected them with partners in the community that can help them to find a place to live or find supports within their community.”

Working as a team

Some HIP team members have been doing this work since the service was first formed, while others have joined along the way. Collaboration with public health nurses and Public Health’s COVID response team has also been an important part of their success. A spirit of compassion, innovation and teamwork has kept them all going.

 “I’ve never worked on a more supportive team, commented Green.

Learning and moving forward

With each wave, isolation requirements have changed in relation to the shifting epidemiology of the virus. As Nova Scotia moves toward living with COVID-19, Public Health’s HIP team may look different than it does today. However, Public Health will carry forward the valuable learning and relationships that have been strengthened through this work.

“Everyone is committed to the work and understands the importance of this work,” said Green. “It’s given us so much more perspective on what’s happening in our communities. Hopefully going forward, this will help move us to a better understanding of the determinants of health within our health system and allow us to really reach out to those who most need our support.”