Shelters: Difficult to Manage

Editor’s note: The following article is an excerpt from “Advances in the Biology and Management of Modern Bed Bugs,” a 472-page reference book that was released 2018. The book was co-edited by bed bug experts Stephen L. Doggett, Department of Medical Entomology, NSW Health Pathology, Westmead Hospital, Westmead, Australia; Dini M. Miller, Department of Entomology, Virginia Tech, Blacksburg, Va.; and Chow-Yang Lee, formerly with School of Biological Sciences, Universiti Sains Malaysia, Penang, Malaysia, but now with University of California, Riverside. To order, see the box below.

Throughout the world, there are people without permanent homes who turn to shelters to avoid the nightly outdoor elements. The purpose of a shelter is to provide a safe, protected place in which people can avoid exposure to domestic violence, drugs and alcohol, and the dangers of sleeping in a public place. Unfortunately, shelters have also become a haven for bed bugs.

There are many types of shelters, including homeless shelters, emergency shelters, group homes and transitional living centers, which provide housing, food and overnight lodging for varying periods. In some situations, shelter facilities also will provide educational, counseling, and vocational services to individuals and families, with the goal of preparing these people to find and maintain a stable living environment. Each type of shelter will present unique challenges when it comes to bed bug management.

CHALLENGES IN SHELTERS. All shelters are unique when it comes to their management (government, religious, community), patronage (age, gender, sexual orientation, families), resources (education, child care, vocational support) and capacity. However, there is a commonality among shelters in that multiple people utilize a shelter at once, and that the population can change daily, with new people arriving and former residents departing all within a matter of 24 hours.

It is this commonality within shelters that presents the greatest challenge to bed bug management. With multiple and different people entering a particular shelter on a daily basis, bed bugs have the potential to be brought in frequently and repeatedly. Generally, shelter management personnel have no control over where patrons and their belongings have previously been located or stored. Similarly, patrons often cannot ensure that their belongings are bed bug-free prior to entering a shelter.

An additional challenge with regard to bed bugs in shelters is that homeless people (frequent patrons) have a three-fold greater risk of being exposed to insect bites (including but not limited to bed bugs, lice and mosquitoes) and skin infestations (such as scabies) than the housed population. These bites and infestations are thought to be the result of living in crowded or outdoor environments, combined with the inability of homeless people to regularly bathe and launder their clothing, and their potentially poor physical and mental health. Ultimately, the increased probability of bites and skin infestations on patrons correlates with an increased probability of those patrons bringing parasites into shelter facilities.

OBSTACLES TO SUCCESS. In addition to these unique challenges, shelters also face multiple limitations when controlling and managing bed bugs. The first of these limitations is financial. The local governments and communities that support shelters are often challenged by funding limitations. Facility maintenance (which often includes pest management) remains a high priority in shelters throughout the world. However, the fact remains that many facilities do not currently, and will not in the future, have the funds to repeatedly pay for bed bug control. The fear of budget reductions is a prevalent concern for shelters throughout the world.

An example from the United Staets is the New York City Department of Homeless Services (NYC DHS), which operates 73 single adult shelters, 22 facilities for adult families, 95 facilities for families with children, and 49 hotels and 17 cluster (group home) sites throughout the city. In 2016, the NYC DHS was subject to a budget cut of approximately $192 million for the 2017 fiscal year. The reason for the budget cut was an anticipated decline in the shelter population because of incoming homeless population reduction initiatives, despite ongoing high levels of homelessness in the city. Budget cuts such as those in New York are highly problematic for shelter facilities that already have stressed budgets.

Another consequence of the financial limitations in shelters is the lack of space. The facilities that house shelters are often either used for other purposes during the daytime (churches, schools and so on), or have been used for other purposes in the past (old schools, hotels, hospitals). In cases where these buildings serve multiple purposes and may be continuously occupied, shelters do not have the physical space to alter the facility in order to incorporate bed bug management strategies, such as introducing additional bed bug inspection areas into their check-in processes, or space for storing sleeping furniture or mats that are less conducive to bed bugs.

While bed bug prevention methods can be conceptualized and promoted — for example, the installation of monitoring devices and mattress encasements, facility inspection protocols, purchase of appropriate sleeping furniture or mats, increased personal hygiene — many shelters are so resource-limited that such steps are rarely implemented. When bed bug problems arise, it is prudent for shelters to have bed bug policies in place, which staff and volunteers can refer to, but shelters can often be limited further by a lack of communication between patrons and management.

METHODS OF CONTROL. Central to bed bug control in shelters is the implementation of a management policy. The implementation of these policies must be reinforced by providing education to patrons and staff to ensure that the policies are well-known and adhered to. In the United States, there are academic and professional organizations that have produced guidelines to assist shelter staff and management in developing their own bed bug policies for use in their facilities. The New York State IPM Program published a 40-page set of guidelines specifically for the prevention and management of bed bugs in shelters and group living facilities. These guidelines are tailored toward both public and private facilities and thoroughly cover bed bug identification, best management practices for bed bug prevention and control, shelter intake procedures, and personal protection for patrons and staff.

The Michigan Department of Community Health and the Michigan Bed Bug Working Group produced a 118-page Manual for the Prevention and Control of Bed Bugs to provide “comprehensive guidance to identify, prevent and manage bed bugs.” The Michigan Department of Community Health manual contains a guide for shelter intake and assessment procedures, which are intended to be used when screening new shelter patrons. The manual recommends that bed bug screening be incorporated into medical queries and be phrased in compassionate language, such as, “Bed bugs, lice, scabies and other things can cause medical concerns. Do you need help with a bed bug, or any other pest, issue?” The manual also suggests that shelters create a “Bed Bug Treatment Agreement” in addition to their other bed bug preparedness policies. This agreement is intended to facilitate and encourage cooperation between shelter patrons and management.

KEYS TO SUCCESS. Ideally, shelters and other temporary housing facilities should have a pest management plan in place to appropriately deal with bed bugs before they become a problem. In an article in the American Journal of Infection Control (see references online), the authors implemented a successful multidisciplinary approach for bed bug elimination in a 30-bed homeless shelter in northern Texas. They stated that the two key components to the plan’s success were that the plan was long-term and included “ongoing routine inspection…at frequent consistent intervals.”

A long-term plan for bed bug management in shelters should include intake instructions for patrons’ belongings, where the items are inspected and either treated or quarantined if bed bug evidence is found. Long-term or ongoing plans also should include continual monitoring of the sleeping and recreation areas within a shelter. Long-term and ongoing recordkeeping also will help to identify those areas or situations that are most conducive to bed bug infestation.

Education for both staff and residents is paramount when attempting to manage bed bugs in shelters. For example, a 2008 survey of homeless shelters in Hawaii found that shelter staff and management personnel obtained most of their bed bug knowledge from the internet, and would only begin looking for bed bugs and their evidence after residents complained of bites. Had the staff been educated about bed bugs, they would have implemented preventative intake procedures and bed bug management efforts prior to receiving bite complaints from the shelters’ patrons.

A unique program that has been applied in Canadian shelters is the “Bug and Scrub” program, which was developed by the Toronto Public Health Department. The Bug and Scrub program provided real employment opportunities to homeless people, by teaching them proper and efficient bed bug management techniques, such as inspection, steam-cleaning, laundering and the handling of infested personal items. In locations where this program was implemented, both shelter staff and patrons had a functional knowledge of bed bug management procedures and were able to effectively avoid further infestations.

Overall, bed bugs will continue to be a problem in shelters because shelter patrons come into contact with bed bugs frequently in their transient lifestyle. Shelters also face physical and financial resource limitations when trying to control bed bugs in their facilities. With the implementation of both proactive and reactive bed bug management policies, as well as educational efforts aimed at shelter staff and patrons, shelters will be more prepared to appropriately manage bed bug problems.