On March 15, 2020, Karla Thennes, Executive Director of Porchlight, Madison’s only men’s homeless shelter, got word of the pandemic. With the shelter still serving 140 people and lines forming outside of Grace Episcopal Church in the cold mid-March temperatures, Thennes immediately began addressing the new challenge of how to keep this community safe and healthy.

That first week, a small team of four staff and volunteers assembled with the goal to screen every man who entered the shelter. They started screening, using only a short list of five questions.

Without question, the COVID-19 pandemic has presented new challenges across the nation in both healthcare settings and within communities. These challenges increase in complexity at organizations like Porchlight, where vulnerable populations, such as the homeless, experience multiple health disparities and often do not have the resources to follow recommended health guidelines.

Now, with a COVID-19 Response Grant from the Wisconsin Partnership Program at the UW School of Medicine and Public Health, collaborators at Porchlight, Inc. and Nurse Disrupted LLC, are addressing these challenges by harnessing technology to reduce the spread of COVID-19 within the city’s homeless community. The partners are using an innovative technology-enabled solution of virtual nursing volunteers to screen homeless shelter guests safely and accurately each day before entering the shelter.  

A nurse seeing a patient via telehealth technology
Nurse Disrupted staff set up a virtual health screening system to safely screen men experiencing homelessness prior to entering the shelter.

For almost 40 years, Porchlight has collaborated with the community to reduce homelessness in Dane County. Its efforts center on providing shelter, affordable housing, and supportive services. Its partner, Nurse Disrupted, provides virtual nursing volunteers and aims to bridge gaps in healthcare through technology, nursing process, compassion, social media, community partnerships and creativity.

In the early days of the pandemic, Porchlight’s guest who were ill stayed in the foyer of the church while the healthy guests walked past them and into the basement. Thennes knew this wasn’t sustainable or safe, so she contacted the City of Madison and requested a trailer. The very next day, there was a heated trailer outside the door to help divert people waiting in line to enter the shelter.

In addition, to aid in slowing the spread of COVID-19, Madison and Dane County Public Health set up two hotels – one for those who were high risk, 65 or older and a minimum of one underlying condition, and the other a medical respite hotel for symptomatic people who tested positive for COVID-19.

Although Porchlight had an abundance of committed volunteers that had served meals to the community since the shelter was founded, Thennes knew most of these volunteers were a part of the older, higher risk age groups. So, in the middle of the night, she put out a Facebook message expressing their need for volunteers to help in conducting health assessments.

“This is not for the weak at heart, these people are cold and hungry,” said Thennes. “There’s a virus out there and we’ve been told ‘everybody be safe at home’ – but none of the people that I work with can do that.” Amazingly, this plea for help resulted in people from all different walks of life volunteering their time, including those with healthcare experience.

A homeless shelter
The Porchlight Inc. shelter at Madison’s Warner Park.

Bre Loughlin, MS, RN, Co-Founder and Chief Executive Officer of Nurse Disrupted, LLC, saw and responded to Thenne’s plea for help. With a background in healthcare solution design and a drive toward easy to understand, simple health care technologies, Loughlin and Nurse Disrupted brought practical solutions to Porchlight. By using virtual technology and volunteer nurses, they can now safely and effectively screen for COVID-19 at the shelter.

“The point was to do what we could. We could see the problem and we could see the technology that could bridge that problem along with the nursing resources,” said Loughlin. Within 48 hours, she set up a table with two donated tablets on each side of the trailer and a wireless internet access device ready for use. Once a guest enters the trailer for screening, he simply taps the screen of the tablet and a nurse appears ready to ask screening questions and provide support as needed.

Nursing students have been integral to the success of this grant and have gained invaluable experience in the process as well. When Loughlin presented her idea to help Porchlight with screening procedures to The Wisconsin Nurses Association, the Associate Dean of Marian University offered up a cohort of nurses who were unable to graduate because of the decrease in practicum hours due to the pandemic.

The number of volunteers has grown over the course of the grant, with the addition of 160 nurses from five different Wisconsin universities – University of Wisconsin-Madison, University of Wisconsin-Milwaukee, Marquette, Edgewood College, Madison College and Marian University – and some 400 practicum hours have been fulfilled. The nurses are educated on current protocols that come from the Centers for Disease Control and the Wisconsin Department of Health, which they use to then educate additional in-person volunteers and screen Porchlight staff, further improving and reinforcing education.

Along with permitting constant up-to-date education for volunteers, this grant has been able to provide Porchlight and Nurse Disrupted with crucial technology resources. Documenting each screening, keeping track of symptoms, improving screening software, establishing high-speed internet, and developing a device management solution have all been important outcomes of this grant that are sustainable in the future.

This community collaboration has built a nursing volunteer pipeline to combat some of the challenges that the pandemic is presenting. “COVID-19 is making us separate, but the technology allows us to get over that hurdle and connect those nursing students with the people who need them,” says Loughlin.

Six months into this global pandemic, Porchlight and Nurse Disrupted have helped prevent COVID-19 within Madison’s homeless population and Porchlight residents, while also establishing trusting relationships within the community. Nurse Disrupted has conducted more than 8,000 screenings, and as a result, Porchlight has been able to keep outbreaks to a minimum with additional contact tracing and utilizing medical respite hotels.

Loughlin talks about the increased capacity in chronic disease management and mental health crisis intervention that this technology brings to Porchlight. “I think the most important thing for our underserved population is that, once we get them wired, post pandemic they’re going to have the technology. This grant isn’t a moment, and it’s not just a COVID-19 moment. This grant is actually establishing a telehealth presence in the shelter that can go far beyond the pandemic.”