The path to that first testing site was not linear. It was fairly early in the State’s ramp up of testing and most everyone’s focus was on hospital capacity, nursing homes and congregate care facilities, and trying to survive under the stay-at-home order. Most everyone, that is, except the PHA.
Early on in the crisis, the PHA recognized a need to connect with the residents living in public housing and participants of its Section 8 programs. PHA staff members are not ones to sit back and wait. Instead, each department jumped into action finding ways within their existing work and cross-departmentally where they could provide that support and aid. The Emergency Resident Outreach Log (EROL) was created to track each call made to check on residents, updated their emergency contact information in the event of illness, and to see what other struggles they faced at the start of the crisis.
As the COVID-19 crisis continued, the agency continued making its calls – to schedule food delivery to high rise tenants, to conduct a well-being checks, to assist with filing for assistance programs. Thousands of calls and, yet despite instituting strict limits on visitors to high rise buildings, sending messages about safety precautions including serious warnings from the governor, and twice-daily disinfecting in the high rises, the PHA continued to hear tenants self-disclose that they were sick and either suspected or confirmed that they had COVID-19. In April, the PHA actually set up a dedicated COVID hotline, encouraging tenants to call and let management staff know if they were sick so they track the virus’ spread in public housing, protect other tenants and staff from the virus the best they could, and to assist tenants in isolation with the services and resources they might need. And it quickly became clear that pockets of self-disclosed positive cases were beginning to emerge among the elderly and disabled living in the high-rises.
“The hotline is a critical piece of the puzzle,” said Julie Piccolo, PHA’s Director of Resident Services. “It gave us a glimpse at what turned out to be a greater problem than we knew in some of our buildings and allowed us to advocate for access to on-site testing for a vulnerable population.”
As the number of self-reported cases in some buildings grew, the PHA began deliberately contacting households to ask residents if they were sick. These calls ultimately led to the PHA swiftly mapping an intervention.
Mapping their way to COVID-19 Testing
On May 19th, the National Guard and staff members from the PHA came together at one of the PHA’s elderly only high rises in Providence where reports of cases were highest, with support from the RI Department of Health. The goal was to test as many residents of the 194-unit development as possible and connect seniors with the care needed to prevent further spread of the novel coronavirus throughout the building.
“From the beginning, our team understood that our high-rise buildings were home to the most vulnerable making them at higher-risk to have complications with the virus. We realized that so many public housing communities have individuals and families who live in very close quarters making it hard for them to isolate and stay home. We were lucky because we planned for the worse-case [a large number of infections] from the start,” said Melissa Sanzaro, Executive Director of the PHA. Still, the organization had less than 24 hours to prepare for the testing that first time. Property Management and Resident Services staff called residents until 10pm that night, and again reached out in the morning, to let them know what was happening and to collect critical information for paperwork needed ahead of the tests, while the Facilities Management team worked on logistics and site set up to maximize social distancing and efficiency as the PPE gear worn by the National Guard volunteers was only meant to be worn for 3 hours.
“It was a daunting process, but I am so glad that the PHA team had increased engagement with our residents so early in the pandemic because it allowed us to talk with residents, build upon our relationships and produce very high participation rates. Another factor that allowed us to successfully meet the challenges of our first testing site was that the team was able to replicate the PHA’s food distribution safe service delivery model which creates a very controlled environment, conducive for testing ,” Sanzaro said.
Refining the COVID-19 Testing Model
Since that first experience, where 138 residents and 8 PHA staff members were tested, the PHA has refined the testing delivery model. When the agency decided it wanted to do testing at every high rise, it pursued a connection with a local hospital system that the National Guard helped to make. From June to August, PHA and Lifespan Community Health Institute partnered to offer testing to more than 1,000 high rise tenants. Each site brings unique challenges in staging and resident dynamics but the organization maintains several consistent best practices.
“We always test outside of the building and stage the areas to limit person-to-person contact as much as possible,” reports Jackie Martinez, Associate Director of Property Management. The team is mindful of weather, providing tents for shade and seating that can be quickly disinfected for those with mobility issues. Tenants are called down floor-by-floor to control lines and crowds in elevators and stairwells. Forms are pre-filled for those who register ahead – though residents can still get tested if they didn’t sign up. Masks are required for all in attendance.
“It is an all-hands-on-deck effort. Every PHA department is represented and plays an important role in the success of each site,” Sanzaro said. “No two sites are exactly the same but because of the cross-department planning, we are prepared for each site’s quirks and know how to capitalize on the strengths and our relationship with tenant leaders within each development to maximize participation in the testing.”
The organization has facilitated testing at four of its high-rise developments with two more sites planned in August. Through the first week of August the PHA had tested 479 residents and continues to receive self-reports through their voluntary hotline. They monitor case numbers closely and maintain strict safety protocols while addressing address residents’ needs at its sites.
“States may be re-opening but we are proceeding with caution” states Sanzaro. She continues “Our people are vulnerable and are communities are condensed. Vigilance now, especially at our elderly and disabled high rises, is helping save lives.”
Assistance Multiplier Throughout COVID-19
Just as the National Guard helped set the PHA up for success as an “assistance multiplier,” the PHA worked with its peer agency, the Central Falls Housing Authority (CFHA), located in the only city in Rhode island worse hit by the virus than Providence. On August 6, after having visited multiple PHA test sites, the CFHA worked with Lifespan and successfully tested 140 tenants at its Forand Manor development, using nearly all of the components of the PHA’s testing site model.
For their part, the Lifespan Community Health Institute have remained open and flexible, allowing the local agencies on the ground to guide the site models and outreach strategies. “We are really enjoying doing this testing with PHA and your residents,” said Carrie Bridges Feliz, Director of the Institute. “For us, it’s truly a dream partnership. We see ourselves as being in a service industry. We may not be in a uniform with McDonald’s golden arches, but we are no less responsible for providing a high-quality experience that values and respects our clients. What’s special is that you all [at Providence Housing] clearly feel the same. And your commitment to excellence- helping our collaborative effort get better and better each time, is lock step aligned with our values.”
The experience has also helped to further strengthen the PHA’s bonds with its residents. “We are very lucky to have the PHA working for us. They have been an amazing resource to us [the residents] through the whole pandemic – from providing food boxes to consistent disinfecting and now testing,” noted Lawrence D’Alfonso, a PHA Commissioner and president of the Carroll Tower Resident Association. “They have shown they really care.”