From the streets to a hotel: a qualitative study of the experiences of homeless persons in the pandemic era

Abstract

In the wake of COVID-19, programs for housing homeless individuals in hotels have emerged in the U.S., though research has yielded little information about the impact of these programs on participants expressed in their own words. In this qualitative study conducted in a major northeastern city, 13 previously street homeless individuals recount their experiences of hotel housing during the pandemic. Participants were recruited from an advocacy-initiated collaborative that operated with a housing first approach, providing private rooms without requirements or intrusive oversight typically found in shelter environments. Benefits of hotel housing reported include improvements in physical health, sleep, personal hygiene, privacy, safety, nutrition, and overall well-being. Inductive coding by consensus and thematic development yielded three themes. Participants described hotel living as (1) a platform for stability; (2) protection from COVID and other hazards; and (3) freeing mental space for future planning. As research shows hotel programs’ success, an unprecedented opportunity has arisen from the pandemic to end homelessness for many. Given current federal budget increases, it is recommended that hotels become part of a larger effort to reduce shelter populations and increase access to independent housing.

Introduction

As the COVID-19 pandemic escalated to an imminent public health danger in March 2020, it became obvious that congregate shelters for people experiencing homelessness were potential sites of rapid transmission of this deadly virus. Simultaneously, tourist and business travel dropped precipitously, and hotels became virtually empty, with a sizable number facing bankruptcy. In response, many municipalities took advantage of temporary funding from the Federal Emergency Management Agency (FEMA) to move shelter residents into empty hotel rooms to protect them from COVID-19 transmission. In New York City, over 9000 congregate shelter residents were moved into hotel rooms, while Los Angeles County moved 4300 street homeless individuals into hotels.

What was a public health emergency reaction also became a revelatory change in the lives of homeless persons who had been previously living in crowded shelters or on the street. While some cities provided single hotel rooms to all individuals, others, including New York City, placed individuals in either shared (two to a room) or single rooms. Individuals who previously had lived in congregate settings, sharing rooms and bathrooms with many other residents, found themselves with greater privacy in the form of hotel rooms. Although located at the lower cost end of the market, many hotels had rooms equipped with microwaves, small refrigerators, coffee makers, and other amenities.

This major shift in homeless services did not take place without inevitable change – shelter staff had to adjust to losing surveillance of shelter residents in large open settings, and some hotels were in neighborhoods where NIMBY (“not in my back yard”) reactions could be strong (Slotnik, 2020). The eventual loss of emergency FEMA funding continues to be a sobering reminder that this major realignment of homeless services for thousands of shelter residents across the nation could end within a matter of months.

Perhaps not surprisingly, the idea of buying and converting many of the hotels into affordable long-term housing became an unforeseen opportunity for homeless advocates and political leaders desperate to find safe housing for the growing population of homeless persons in the United States. California was one of the first states to use FEMA funds to rent thousands of hotel rooms under Project Roomkey, where 22,300 unsheltered individuals were placed in hotel rooms (Baldassari, 2020).

Clearly, an important inflection point has been reached, and questions emerge – e.g. will residents be able to remain in the hotels or moved back to shelters? What changes take place when homeless persons transition from shelters (or the streets) to hotel living? How do these transitions affect exposure to COVID-19?

Little is known about the hotel residents’ experiences expressed in their own words. A longitudinal study currently underway in Seattle used interviews and administrative data to track individual outcomes related to hotel living. Preliminary findings are predominantly positive: reduced rates of COVID infection, better mental and physical well-being, reduced inter-personal conflicts (and 911 calls), more exits to permanent housing, as well as increased engagement with service providers (Colburn et al., 2020).

While there is a broader research literature on homeless persons’ experiences in varied housing arrangements, there are no additional direct comparisons given the recency of the pandemic and the moves from shelters to hotels. However, the Seattle study’s findings are consistent with the positive outcomes associated with independent scatter-site living and permanence as is characteristic of the Housing First approach (Padgett et al., 2016). The hotel rooms that are the focus of this study were temporary but in other ways reflect having a “home of one’s own,” especially in comparison to a shelter bed or a shared room in transitional housing.

As noted in a report in the Harvard Public Health Review (McCosker, 2020), the voices of those living in temporary accommodations (including hotels) need to be demarginalized and given priority as longer-term solutions are sought at this unprecedented juncture. This report is intended to help fill this gap by documenting transitions from street homelessness to hotel residency, which were made possible by a consortium of homeless advocate organizations unaffiliated with the shelter system of a large northeastern city. Through qualitative interviews with 13 hotel residents, we addressed the following research questions:

1. How has life changed for residents since moving into the hotels? Specifically, how has residents’ health and emotional well-being changed (if at all)?

2. How safe do residents feel in regard to COVID-19 protection and other threats they have experienced in the past?

3. How do residents describe their thoughts about the future?

Methods

Setting and background of the study

This study was part of a larger advocacy effort in which a coalition of member-led homeless advocacy organizations came together to place street homeless persons directly into market-rate hotels as the COVID-19 pandemic intensified. Using funds raised through the online platform GoFundMe, the coalition was able to quickly place thirty unsheltered individuals into private hotel rooms beginning in April 2020. The 30 participants chosen by the coalition were (1) relatively well-known to them through informal outreach to street homeless persons conducted by organizational staff; (2) were available for rapid hotel placement given the urgency of the pandemic conditions at the time.

Once sheltered, staff from three of the organizations provided light case management and support services by telephone (as part of COVID-19 protections) to hotel residents. The terms of their residencies stood in direct contrast to the city’s homeless shelter services which moved shelter residents into hotels and duplicated many of the restrictions of the shelters, including curfews, high security involving metal detectors and bag inspections, lack of privacy and interrupted sleep due to frequent room checks and no personal room keys, shared accommodations (two to a room), and on-site staff who enforce sobriety and prohibit illicit drug use.

Instead, the advocacy-initiated hotel housing program followed a housing first (HF) philosophy of consumer choice in hotel location, individual occupancy, and harm reduction rather than enforced sobriety (Padgett et al., 2016). Residents had private rooms with their own key and no additional security beyond hotel staff already in place. One notable exception to this resemblance to HF is the fact that the hotel housing was (and remains at this writing) impermanent. In the few instances in which there was an issue reported by the hotel staff (e.g. excessive noise), affected residents were moved to another hotel by the advocacy group and provided with brief counseling around the stated concern. While admittedly a temporary resolution, staff and members of the coalition organizations worked diligently to advocate for continued hotel residency until housing rental vouchers and subsequent permanent housing could be secured. Participants were aware of these efforts and understood that their future housing situation was unknown.

Recruitment

Interviews were conducted from August through October 2020. Using convenience sampling, participants were recruited through staff of the non-profits involved with placing residents into the hotels. Flyers and information about the study were distributed to hotel residents in emails as well as through non-profit staff at weekly advocacy meetings. All 30 participants staying in the hotels as part of the larger advocacy efforts were eligible for participation in this study. As all interviewing was done remotely due to the COVID-19 pandemic, participants called the primary investigator (X) to confirm their interest in participation, at which point they were connected with XX or XXX to schedule a time for the interview at the convenience of the participant. Participants who agreed were compensated with $20 in cash, which was either mailed to them or delivered to them in a socially distant manner at their hotel. All study protocols were approved by the institutional review board of the authors’ university.

The recruitment procedures as described do not convey some of the difficulties in enrolling study participants in a pandemic through electronic communications only (given the stress of the pandemic, we kept outreach to a maximum of three telephone messages). Staff related to us that the hotel residents kept busy schedules, taking advantage of their hotel stability to “make up for lost time” by getting needed medical care and spending time enrolling in entitlement programs. Reliance solely on electronic communications likely reduced the engagement that often creates openness to participation in a study.

Data collection

Each in-depth interview was completed over the phone (with participants using their own mobile phones or their hotel room phones) and audio recorded. For privacy and to ensure clarity of the recordings, participants were asked to conduct the interview from their hotel room. At the beginning of each call, participants completed a verbal consent process and agreed to be audio recorded before recording started. The guide used for interviews was developed using the authors’ knowledge of homelessness, housing, and experiences related to these topics. Prior to beginning interviews with participants, the interview guide was pilot tested which resulted in minor changes related to wording of one of the questions.

Interviewers were trained in social work and psychology and had experience in working with homeless individuals. Interviews focused on the individual’s living situation prior to moving into the hotel, their current living situation and changes since moving into the hotel, the coronavirus pandemic, and plans for the future. At the end of each interview, sociodemographic information for each participant was collected. The research team met regularly to discuss any issues that emerged during the interviews.

Data analysis

Each audio-recorded interview was transcribed by a member of the research team (X).

Transcripts were then uploaded to Dedoose (Version 8.0.35, 2018) for analysis. First, all three authors reviewed three transcripts, starting with a few a priori codes based on the interview guide (e.g. future plans, benefits of hotel) while also identifying other salient codes related to our research interest, in line with a template approach to analysis (Brooks et al., 2015; Padgett, 2015). At this point, all three authors came together to discuss codes and create an initial codebook, composed of both a priori and inductive codes. The authors reread these transcripts, applying the initial codebook. Then, the authors returned to make slight modifications to the codebook, such as combining similar codes. Using this finalized codebook, all transcripts were coded by XX and XXX.

Following a modified grounded theory approach to thematic development (Padgett, 2015) the authors came together to examine the coded excerpts in relation to the study’s aims. Using memos and repeated engagement with the data, themes were derived to address the research questions. Upon further scrutiny of the interview data, the authors also documented the benefits of hotel living in the categories described below.

Results

Characteristics of the study sample

Of the 30 residents in the hotel housing program, we were able to recruit 13 for in-depth interviews conducted via telephone. Two additional individuals expressed interest but were unable to be reached despite multiple attempts. As described in Table 1, the sample consisted of 9 males (69.23%) and 4 females (30.77%), with an average age of 48.3 years old. The majority of participants (84.62%) reported experiencing homelessness for a length of time longer than one year before moving into the hotel (see Table 1).

Table 1.

Demographics of participants (N = 13).

Age (years)
Mean (SD)	48.3 (13)
Range	27–78
Race/Ethnicity	Frequency	%
Black	5	38.5%
White	5	38.5%
Hispanic	1	7.7%
Bi-racial/Mixed race	1	7.7%
Other	1	7.7%
Gender
Male	9	69.2%
Female	4	30.8%
Marital status
Single	10	76.9%
Partnered or married	3	23.1%

The benefits of hotel living

As shown in Table 2, the benefits of hotel living were uniformly positive. Given the open-ended nature of the interviews (asking about any changes good or bad since moving into the hotel), not all residents mentioned all positive benefits, but negative comments were very few. Some participants expressed concerns about the uncertain and temporary nature of their hotel residencies, and one participant reported a previous negative experience with another hotel resident (who was subsequently re-located).

Table 2.

Hotel benefits.

Benefit	Quote
Physical health	“they have you constantly on the move.…. And your feet start to swell up and you start noticing these things about your body…since I’ve been in the hotel the swelling has gone down.” (SP7)
	“It’s definitely a lot better because I have ulcerative colitis…. so I can rest.” (SP1)
	“it’s given our health back and we want to go out and want to work so yes it’s helped us physically a lot” (SP5)
Sleep	“It was great, I was able to get rest. I was getting rest on the street but you still can’t sleep that hard. We had a time when somebody would try to attack us…When I was in the hotel I didn’t have to worry about that and I would personally feel rejuvenated early in the morning….” (SP13)
	“I can just get under the covers, I can sleep in peace no matter what the situation is now and I wake up and it’ll be another day tomorrow and it helps your body and your mind and your spirit and having a place to recover throughout the day…” (SP5)
Hygiene	“Since I’ve been in the hotel, I’m like the best smelling thing that walks through the hall (laughing). I’m really humble that I have a bathroom and it’s a great feeling mentally, spiritually to walk around smelling clean and feeling clean and be confident around people…it’s just great to be at one with your mind, body and soul when you smell good.” (SP7) “I have a place to sit and wait for a call, take a shower and be clean and presentable – really a big help.” (SP2)
Better nutrition & diet	“what I like most about being in the hotel is that I have control over what I eat now.” (SP8)
	“But it’s definitely I would say have one of the biggest impacts. I definitely look a lot younger than I did just 6 months ago and it’s all from lack of eating properly, lack of even being able to get a glass of water. You’re very much at the mercy of what people give you.” (SP9)
Privacy & safety	“You can say you know I have a place and I’m safe and I don’t have to worry about my stuff getting stolen and I can rest.” (SP5)
	“I feel much safer in the hotel because there could be a couple of days that I don’t even come out of the hotel. I might go downstairs to get toilet paper or stuff like that, like clean towels but once I’m in the room …, I’m relaxing…” (SP3)
Emotional well-being	“But I suffered from post-traumatic stress disorder for a long time..and on the street many of the symptoms continued to get worse whereas now that I have a stable living situation that’s more comparable to what your everyday person has, I hope to make a lot of progress, I feel better mentally and emotionally” (SP9)
	“Since I was in the hotel…I was able to do a lot because I was stable, because I didn’t have to worry about where would I spend the night, where would I get food…now I don’t have to do that anymore…Being in the hotel has really stabilized me in a big major way.” (SP6)
	“And ok if today was a bad day, I can get up in the morning and I shower and it’s a new day. When you have that it gives you so much back mentally, emotionally and physically. You can be healthy and strong but when you’re in a bad place mentally every day, it just drains on your mind, your heart and your soul and your spirit and it takes away from your physical being…so I’ve noticed even though things are stressful I am grateful. I can take a deep breath…and it’s taken such a burden off my shoulders.” (SP5)

Table 2 covers a number of direct benefits of hotel living voiced by participants arranged in six categories – benefits that are not typically available in a congregate shelter or on the streets.

As shown in Table 2, participants reported positive changes in physical health, in sleep and rest, in maintaining personal hygiene, privacy and feeling safe, nutrition, and emotional and mental status. Illustrative quotes in Table 2 document these improvements in their own words. We note that these quotes, chosen to typify the phenomenon, were repeatedly echoed in the other interviews. Participants were clear in contrasting these benefits with their previous lives on the streets. Indeed, the inter-connectedness of these benefits, e.g. better sleep, nutrition, and hygiene, enhanced physical well-being and all of these combined synergistically with feeling safe and having privacy to enhance their mental state (as further described in the themes below).

Inductive themes

Participants were urged to speak freely about their experiences before entering the hotel as well as their daily lives. In repeated examinations of the data across the interviews, we derived three themes that capture over-arching meanings participants expressed in their interviews. These are (1) a platform for stability; (2) safety from COVID-19 and other hazards; and (3) mental space for future planning.

A platform for stability

Participants described the value of having a stable address, access to a telephone (many also had mobile phones but could not afford to use them when their minutes ran out), and easier access to entitlements and benefits such as SNAP (food stamps), SSI disability status, and Medicaid. Visits to providers were easier to keep with an address or phone for reminders or changes in appointments. Below are some illustrative quotes from participants (identified by ID number).

SP8: Someone said without stability there is no mobility and since I’ve been inside a hotel, I have health insurance now. I have the clarity to take care of myself. I’ve applied for food benefits. I didn’t realize I qualified for unemployment.

SP12 Being able to go and sit down and actually do the paperwork [for social security benefits], you know, and now I don’t have to worry about the fact that I haven’t showered in a month.

SP3: I didn’t actually have no food stamps when I got into the hotel, and I said you know what, let me apply for it now that I’m inside, now I can get more healthier things to eat.

SP6: Since I was in the hotel I was able to fill out for food stamps. I was able to get in contact with doctors. I was able to do a lot because I was stable, because I didn’t have to worry about where would I spend the night, where would I get food…now I don’t have to do that anymore.

Participants also mentioned the value of having a shower and clean clothes for job interviews as well as a place to store their belongings. Personal hygiene was one of the greatest challenges of street life and severely inhibited entering the competitive job market.

SP10: I don’t have to go to my storage to get clean clothes…. I can just go a few feet, turn on the shower and get in it. These things are comfortable for me.

SP5:…now I’m in a hotel and I go out and I look for jobs…. And I have an opportunity to go out in the summertime to look for jobs, and I come home and I shower, and I have a place I call home. I fill out [an] application in person or online, and I can put an address down. And I look clean; I’m showered and shaved, and it gives me some dignity back about myself that I can go out and do these things.

SP13: Like I said, getting some rest, I’m more focused now. I have more time to look for other jobs. I’m more focused on my job, and I’m able to do it at a higher level than I was before.

SP2: I have a place to sit and wait for a call, take a shower and be clean and presentable—really a big help. And it is proof that that I can take care of my hygiene, so yeah, it’s been a big help.

Safety from COVID-19 and other hazards

For participants, occupying a private hotel room, with access to showers and handwashing as well as social distancing, contributed to a heightened sense of safety from COVID-19.

SP10: We all have our own room and our own bathroom, something that I personally was seeking because I noticed when COVID-19 [came along], most public bathrooms had been shut down. And I was concerned about sharing bathrooms, sharing rooms with people, and so this was perfect for me.

SP9: I did kind of feel like if you’re out on the street and you can’t bathe or clean yourself properly, then you’re far more likely to contract a virus…. So if you have a respiratory infection, it’s just ripe for COVID to get in.

SP6: It’s amazing, amazing. I tell you if it wasn’t for them and all the people fighting for us, I don’t where I’d be. I’d probably have contracted the corona-virus. And I’d probably be dead or sick because I’d still be [living] in my car.

SP7: I didn’t care [about hotel location] as long as I had a place to isolate, to stay safe, and it was much better than what I was doing before out there with the masses.

Staying in the hotel also brought feelings of safety and security from the violence of life on the streets and subways. Being able to lock a door without worrying about harassment or violence was a new and welcome experience.

SP3: And the big difference is [with being in the hotel] you didn’t have to worry where you’d sleep at night, especially when COVID got really bad, the streets were deserted and more dangerous no matter where you were at, so I think that’s been the big change.

SP1: I definitely feel much more safer because we would go to bed at night and we’d be worried that someone might just intentionally cough on you or spit by you or something. So we don’t have to worry about somebody in our space, and he [SP’s fiancé] doesn’t have to stay up all night and worry, you know.

SP13: We had a time when somebody would try to attack us and things like that, and you had to be very vigilant. When I was in the hotel, I didn’t have to worry about that, and I would personally feel rejuvenated early in the morning.

Mental space for future planning

In regard to housing and access to services, participants expressed that they finally had the “mental space” to contemplate a future and plan accordingly. As shown in Table 2, benefits in the form of improved emotional well-being as well as a healthier diet and daily routine freed participants from the rigors of daily survival.

SP7: My mental wellness has gotten back to a point where I don’t think about where I’m going to sleep. I can really think about what do I see myself doing in the next six months.

My priorities hasn’t changed too much…it’s about me moving forward and getting that one-bedroom apartment that I never had. It’s about me to continue to take care of myself and be part of the human family and be productive in this up and coming world.

SP5: It’s emotional, but mostly it’s mental. Because when you know you have a place to come home to. Life is stressful enough when you’re homeless….but you have a place to come home to…and just consider things, how your day went or how your life is or…every situation, it helps you..I don’t know how to say this, but it’s helps your mental state…having a place makes you want so much more—it’s the beginning of everything.

SP3: I think my priorities…what’s different is I have a place now to put those priorities in place, no distraction. That’s been a big change.

All of these themes have overlapping content even as they capture independent domains (a Venn diagram of sorts). Thus, safety from COVID-19 and street violence in combination with a stable “platform” frees up mental space for future planning. Feeling safe and protected interacts with having a platform for applying for benefits to secure food, income, and medical care. And mental space includes having the capacity to apply for these benefits as well as to consider going back to school or pursuing employment. At the same time, each theme has its own meaning distinct from the others. Individually, these themes also illustrate that beyond a listing of benefits (as shown in Table 2) lie broader impacts of this temporary housing opportunity with manifest implications for policy and practice.

Discussion

Our findings echo those of the University of Washington study of hotels in Seattle with positive outcomes (Colburn et al., 2020). Thus, in answer to our research questions, participants unanimously emphasized improvements in health, mental health, and an improved sense of safety and well-being. These findings are all the more meaningful since they took place in the midst of a highly infectious pandemic when protection from COVID-19 was the prominent reason for the hotel living that produced these positive outcomes.

The policy implications of this major change in homeless services have been a topic of lively public discourse (Dougherty, 2021) as homeless advocates and policymakers alike have taken notice of the win-win of hotels staying economically viable while inhibiting the spread of COVID-19 and providing homeless persons with a welcome respite from the streets and shelter system (Padgett & Herman, 2021).

California’s success with Project Roomkey inspired Project Homekey in June 2020, an initiative to purchase hotels for longer-term housing. Project Homekey provided funding for over 6000 new units of housing with plans to invest in hotels and vacant buildings (California Department of Housing and Community Development, 2021). Support services are also part of the project, including case management, educational and employment assistance, and health and mental health services (Lara, 2021). By comparison, New York City’s Department of Homeless Services began returning the residents back to the shelters in June 2021 despite an extension of FEMA funding for the hotels until the end of 2021 (Blau, 2021). The trend toward repurposing existing vacant properties and taking advantage of an unprecedented infusion of new funding under President Biden’s administration – five billion dollars dedicated to permanent housing for homeless persons, including purchasing and repurposing hotels – represents a positive shift in the midst of the devastation of the pandemic (Schnell, 2021). There are clearly feasibility issues that present significant obstacles, including restrictive zoning, soaring construction costs, lengthy permit requirements, and NIMBY reactions, among others. However, it is difficult to argue for the status quo of building more shelters and maintaining the outdated notion that homelessness is a passing trend which will disappear eventually (after 40 years and counting).

Limitations of the study

Although not unusual for a qualitative study, we believe the relatively small sample size is a limitation given both the larger population housed by the advocacy effort and the much larger group of homeless individuals who were living in hotels across the nation. At the same time, in-depth qualitative interviews with hotel residents during the COVID 19-pandemic are absent from the literature, and any report relying on residents’ own words is a contribution to a national discourse that all too often takes place among providers and policymakers only. Future studies that document the longer-term effects of hotel living are needed, although this phenomenon – dependent on both the availability of funding and political will – is likely to change in the current political climate (Blau, 2021; Schnell, 2021).

We also recognize a limitation in the relative absence of “complex needs” in our sample (i.e. individuals with diagnoses of serious mental illness or problematic substance use). Thus, it is possible that selection bias influenced who was offered hotel rooms by the advocacy groups and, therefore, who was available to be recruited for the study. Relatedly, we acknowledge that the overwhelmingly positive valence of the findings might be questioned. To this, we answer that we sought to capture a full account of participants’ experiences, whether positive or negative.

Conclusion

Though we cannot predict that a new era of increased affordable housing will take place with the impetus of additional federal funding, the obvious advantages of hotel living as voiced by the formerly homeless residents in this study point to an unprecedented opportunity to end homelessness for thousands (Padgett & Herman, 2021). Just as the pandemic amplified existing inequities, it has also catalyzed the potential for transformative change. To ignore this once-in-a-life-time opportunity to restructure our response to homelessness would be to deny our most marginalized citizens the chance to regain a life in a home.