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Resilience in care organisations:
challenges in maintaining support for
vulnerable people in Europe during
the Covid-19 pandemic
Kati Orru, Kristi Nero, Tor-Olav Nævestad, Abriel Schieffelers, Alexandra
Olson, Merja Airola, Austeja Kazemekaityte, Gabriella Lovasz, Giuseppe
Scurci, Johanna Ludvigsen, and Daniel A. de los Rios Pérez1
The Covid-19 pandemic has challenged the resilience of care organisations (and those dependent
on them), especially when services are stopped or restricted. This study focuses on the experi-
ences of care organisations that offer services to individuals in highly precarious situations in 10
European countries. It is based on 32 qualitative interviews and three workshops with managers
and staff. The four key types of organisations reviewed largely had the same adaptation patterns
in all countries. The most drastic changes were experienced by day centres, which had to suspend
or digitise services, whereas night shelters and soup kitchens had to reorganise broadly their work;
residential facilities were minimally affected. Given the drastic surge in demand for services,
reliance on an overburdened (volunteer) workforce, and a lack of crisis plans, the care organisations
with long-term trust networks with clients and intra-organisational cooperation adapted easier.
The outcomes were worse for new clients, migrants, psychologically vulnerable people, and those
with limited communicative abilities.
Keywords: Covid-19, organisation, pandemic, resilience, social care
Introduction
Crises bring unwanted and negative consequences that exceed what individuals,
organisations, and communities have institutionalised as ‘normal’ activities and cir-
cumstances (van Laere, 2 013). The Covid-19 pandemic of 2020–21 has put to the
test social care organisations and their clients’ abilities to cope with extraordinary
routines. Furthermore, the resilience of the services (and those dependent on them)
was brought into question when the work of care organisations was stopped to
mitigate the spread of the virus or impeded owing to a shortage of personnel. At its
extreme, the halting of governmental or non-governmental services sets at increased
risk the people who are dependent on these services for basic needs such as food
and shelter (The World Bank, 2020; Choolayil and Putran, 2021). The loss of ser-
vice to users already vulnerable due to domestic violence, homelessness, or drug or
alcohol addiction may have dramatic ramifications. Furthermore, the stigmatisation
of immigrants, Roma, and homeless persons as the spreaders of disease in many places
throughout Europe (Holt, 2020; Mukumbang, 2021) calls for swift action by care
doi:10 .1111 /disa.1252 6
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Kati Orru et al.
organisations and the research community to protect human rights and prevent fur-
ther marginalisation of those in already vulnerable situations.
Crisis in general results in circumstances which cannot be handled by normal
resources and organisation and involves a transformation in the focus of operations
in comparison to usual proceedings (Deverell and Stiglund, 2 0 15 ). The Covid-19
pandemic has concentrated the lens on existing structural inequalities and disadvan-
tages, while simultaneously altering the reality within which social service provid-
ers negotiate practice (Banks et al., 2020; Nisanci et al., 2020). What is more, the
pandemic may offer insights into how the nature and practice of social service pro-
vision can be redefined in response to an emergency.
This paper spotlights the experiences of four key types of care organisations (soup
kitchens, day centres, temporary shelters, and residential facilities) that offer services
to individuals in highly precarious situations or to those living on the street. The
study examines the resilience of care services during the first wave of the Covid-19
pandemic (March–June 2020), and its aims are threefold: (i) to explore if and how
the activities of care organisations were altered due to the challenges introduced by
the Covid-19 pandemic; (ii) to identify the factors facilitating or impeding the abil-
ity of care organisations to provide relevant help to their users—that is, their level
of resilience; and (iii) to analyse the outcomes for the different groups of clients of
the care organisations.
To meet these objectives, the paper draws together the experiences of care organi-
sations in major urban centres of 10 selected countries in Europe: Czech Republic;
Estonia; Finland; Germany; Hungary; Italy; Lithuania; Norway; Portugal; and The
Netherlands. These countries were chosen because they are democratic EU nations
with different welfare and socioeconomic security levels and varied infection rates
that may shape the pandemic’s impacts on care organisations and their clients. Only in
a few of them have first steps been taken to assess and tailor systematically mitigation
measures to address social vulnerabilities in crises (Orru et al., 2021). The study applies
an inductive multiple case study approach (Yin, 2014), which is based on 32 semi-
structured interviews and three workshops with managers and staff at care organisa-
tions (see Tables A1 and A2 in the Appendix).
The analytical level on which we focus in the present study is care organisations:
local and international non-governmental organisations (NGOs) whose services are
targeted at those in materially (and psychologically) difficult situations in cities (not
long-term care for the elderly or those with disabilities). We chose this level as it is
the one that to a large extent defines resilient responses in the reviewed countries,
such as by establishing teams across care organisations (for instance, the Salvation
Army offices in large cities) for coordinated efforts. Whereas the gathered material
does not allow for in-depth comparisons between the 10 countries, our main focus
remains on the variance of coping patterns within and across the different types of
organisations in different national framework conditions.
This study offers important insights into what could be the strategies and the role
of social care providers when faced with health crises. The Covid-19 pandemic has
Resilience in care organisations
provided an opportunity to reflect on the nature and practice of social service pro-
vision in order to increase preparedness for similar events in the future. It is necessary
to learn from these experiences to facilitate better preparedness and optimal strategies
for adaptation.
The resilience of care organisations:
theoretical perspectives
The impact of crises on organisations
Existing studies indicate that large-scale and abrupt changes may challenge the core
elements of organisations: their goals, available capacities and resources, and estab-
lished routines, as well as the organisational structures that support their operations
in normal times (Boin and ’t Hart, 2006). A crisis is characterised by an organisation’s
inadequacy concerning the ability and expertise required to handle an event as its
impacts exceed what the organisation is designed to deal with (Deverell and Stiglund,
2 0 15 ). During the first wave of the pandemic, while the demands for services increased,
the care providers’ financial means and (human) resources diminished, and some ser-
vices had to close due to financial stress and operating restrictions (Amadasun, 2020;
Banks et al., 2020).
Formal and informal aspects influencing organisational resilience
In the present study, we analyse the responses of care organisations to the Covid-19
pandemic in terms of organisational resilience. Resilience refers to a system’s capac-
ity to absorb and return to a stable state after a disruption. Barabási and Pósfai (2016,
p. 303) note that: ‘A system is resilient if it can adapt to internal and external errors
by changing its mode of operations, without losing its ability to function’.
One of the most well-known approaches to organisational resilience is high reli-
ability organisation (HRO) research, which focuses on the common characteristics
of high-risk organisations (such as aviation and nuclear facilities) that perform better
on safety than one would expect (LaPorte and Consolini, 1991; Weick, Sutcliffe,
and Obstfeld, 1999). HRO researchers largely relate the concept of high reliability
culture to resilience (Wildavsky, 1988), arguing that cultural modes of control are
essential in crisis situations. By means of organisational culture, HROs may switch
between different structural modes of operation: while routine operations involve
traditional, bureaucratic organisation, critical operations entail delegation premised
on a centralised culture (LaPorte and Consolini, 19 91). The foundation for this flex-
ible structure is the existence of an integrated culture, centralising members around
the same decision premises.
We take the Pentagon model as our point of departure in analysing the factors
influencing the resilience of care organisations during the Covid-19 pandemic
(Schiefloe, 2011). The model originally centred on the organisational level, but in
Kati Orru et al.
line with Rolstadås et al. (2014), we have adapted it, including some factors related
to framework conditions. There are several different theoretical models that can be
used to assess organisational resilience (see, for example, Gallopin, 2006; Deverell and
Stiglund, 2 015 ), yet a number of them are often tailored to specific settings or types
of analysis. The main advantages of the Pentagon model are two-fold: (i) as a gen-
eral sociological model, it can be applied in explorative analysis in various empirical
settings, ranging from fire protection to blowouts in the oil sector (see, for exam-
ple, Schiefloe and Vikland, 2006; Rolstadås et al., 2014; Halvorsen, Almklov, and
Gjøsund, 2017); and (ii) it allows for a multifaceted (including technology, structure,
and culture) and multi-layered analysis, with the organisation as the main actor in
the study and influencing factors related to the organisational level (meso level) and
framework conditions (macro level).
Organisational aspects
The Pentagon model (see Figure 1) focuses on five key organisational aspects: struc-
ture; technologies, infrastructure, and equipment; culture; leadership and communi-
cation; and social relations and networks (Schiefloe, 2 011). The first two concentrate
on formal aspects of organisations, whereas the latter three centre on informal aspects.
Below, we briefly integrate these aspects into previous research by NGOs and in ref-
erence to the Covid-19 pandemic:
• Structure. This concerns not only defined roles, responsibilities, and authority
in the formal organisation, but also its procedures, regulations, and working require-
ments. Care NGOs are frequently part of a larger organisational network of branches,
headed by a central organisation, and often rely on a voluntary workforce.
• Technology, infrastructure, and equipment. This denotes the hardware, tools,
and infrastructure that members of the organisation are dependent on or use to
perform their activities. In a care institution this will include physical buildings
and rooms, as well as hygiene facilities to protect against infection transmission
(Tan and Chua, 2020). Okorley and Nkrumah (2012) point to the availability and
quality of material resources for work as a factor that influences the performance
of local NGOs.
• Culture. This refers to factors such as shared concepts, values, norms, knowledge,
and established expectations related to common ‘ways of working’. The shared ways
of thinking (also related to identities and emotions) and acting provide a basis for
interpreting the world, and (re)creating these interpretations in social interaction
as a way of motivating and legitimising actions (Schein, 2004).
• Leadership and communication. This entails management practices, work
processes, flows of information, communication, cooperation, and coordination.
Previous research indicates that leadership is the most important factor influencing
the organisational sustainability of the needs-based and demand-driven programmes
commonly carried out by NGOs (Okorley and Nkrumah, 2012). Top managers
Resilience in care organisations
play a central role in adjusting the managerial and operational levels (including their
own leadership, competencies, and styles) to deal with abrupt and large-scale
changes (Schein, 2004; Deverell and Olsson, 2 010 ) and the need for extraordinary
management and improvisation (Stern, 2009).
• Social relations and networks. This refers to the informal structure and the
social capital of the organisation. Key words and phrases are trust, friendship,
access to knowledge and experiences, informal power, alliances, competition, and
conflicts (Rolstadås et al., 2014). Quality and availability of personnel is a prin-
cipal factor here. A situation like the pandemic will often involve lower numbers
of actively working staff because of the lockdown health security measures, due to
the decreasing levels of economic resources (Nisanci et al., 2020), fear of infec-
tion, and burnout (Sim and How, 2020).
According to the Pentagon model, next to internal dynamics, the organisation’s
functioning is shaped by the context in which it operates: the external framework
conditions.
External framework conditions
We divided the external framework conditions into four categories. First is external
networks with other care organisations or state institutions. A crisis for an organisation
can be described as a situation where an actor alone cannot handle a specific event based
Figure 1. The Pentagon model with five key organisational aspects: structure; tech-
nologies, infrastructure, and equipment; culture; leadership and communication;
and social relations and networks
Source: authors, adapted from Schiefloe (2011).
Kati Orru et al.
on the goals, capacities, routines, and structures to which the organisation must relate
(Deverell and Stiglund, 2 0 15 ). Collaboration becomes a pivotal part of how organisa-
tions are expected to respond. Good relations that have been fostered before the crisis
benefit organisational coping during the event (Alpaslan, Green, and Mitroff, 2009).
The second is what we refer to as the societal framework, that is, the national eco-
nomic, legal, and political contexts. This refers to economic and other types of sup-
port from national and local authorities, social care providers, and NGOs. Previous
research indicates that the availability of funds is crucial for successful NGO per-
formance (Okorley and Nkrumah, 2012). Impending crises may lead to financing
difficulties, such as halted donations due to economic hardship (Nisanci et al., 2020).
However, next to financial security, public recognition of individuals in vulnerable
situations and the need for support organisations facilitate their crisis response work
(Oostlander, Bournival, and O’Sullivan, 2020).
Third is the social welfare context, which concerns the national unemployment level
and the national welfare level. These factors will influence care organisations’ abili-
ties to help, as they affect the degree of poverty and the help supplied by the welfare
state. This indicates the need for the societal assistance that NGOs can provide.
Fourth is the level of Covid-19 infection in the studied countries/cities at given
points in time. This is the ultimate indicator of the need for help extended by
NGOs in society, as it offers a measure of health status in society. In addition, high
levels of infections are generally accompanied by lockdowns and restriction of activi-
ties, entailing higher numbers of unemployed people and rates of poverty.
Materials and methods
We combined qualitative personal interviews and workshops with document analy-
sis, and carried out 32 qualitative interviews and three workshops with managers and
staff of government services and NGOs (such as the Red Cross and the Salvation
Army) across 10 European countries. A purposive sampling strategy was employed
during the country studies to capture the experiences of four key types of organisa-
tions providing various services:
• soup kitchens (and food banks) attended by homeless or those with difficulties
coping due to their material or psychological situation;
• day centres that offer counselling and hygiene facilities to the homeless and indi-
viduals with coping difficulties;
• temporary shelters, including night shelters and refuges, for individuals who spend
their day elsewhere; and
• residential facilities offering 24/7 services, including resocialisation and alcohol and
drug rehabilitation activities, which clients utilise for up to several months.
Upon written informed consent, the semi-structured inter views with partici-
pants focused on: (i) the ways in which the organisation responded to the challenges
Resilience in care organisations
introduced by the first wave of the Covid-19 pandemic; (ii) what helped or hindered
the response; and (iii) what were the effects on the organisation’s clients. All together,
32 interviews (lasting approximately 60 minutes each) were conducted between May
2020 and April 2 021. Key informants were determined on the basis of their level of
experience and involvement in addressing pandemic-related influences on the care
organisation, whereas many interviewees were engaged with or overseeing several
care organisations.
The same research questions were administered in three online workshops with
the representatives of care organisations in Estonia and Norway from June–September
2021. The study team members first introduced the results of individual interviews
and then asked for participants’ reflections on the findings from the perspective of
their organisation.
As background for the interviews and workshops, we analysed, inter alia, publicly
accessible policy documents and official guidelines, including state- and municipal-
level government regulations in response to the pandemic. We looked for docu-
ments concerning restrictions and changes in the availability of financial support as
well as the care organisations’ responses to these factors. In addition, we evaluated
stories in major daily newspapers that related in particular to the situation of vulner-
able groups during the pandemic. Altogether 38 policy documents, 37 media articles,
and 29 other types of documents (such as reports on crisis response, statistics, and
care organisations) were scrutinised in line with the research questions.
Our research team members, who also performed the interviews, shared the task
of undertaking preliminary analyses of interviews and documents, with those in
languages other than English being read and summarised in case studies by native
speakers. For each country analysis there were two deliverables: an answer sheet with
brief answers to thematic questions about organisation responses and influencing
factors; and a longer more detailed country study narrative. We then used qualitative
thematic content analysis (Nowell et al., 2017) of the country reports to identify
major commonalities and differences in the ways in which organisations responded.
To understand the societal framework conditions that may affect the responses, we
searched for statistics on the state’s welfare level (OECD, 2020), as well as the infec-
tion rate per 10 0,000 (ECDC, 2020) and unemployment-level dynamics (Eurostat,
2020) between March and June 2020. The Organisation for Economic Co-operation
and Development (OECD)’s social expenditure percentage of gross domestic product
(GDP) was the indicator used to measure countries’ welfare level. This indicator is
suitable for our study because it considers social policy areas such as old age, survi-
vors, incapacity-related benefits, health, family, active labour market programmes,
unemployment, and housing. The infection rate per 10 0,000 was calculated based on
the total cases reported monthly in 2020 and the countries’ total population in 2019.
The raw data were provided by the European Centre for Disease Prevention and
Control (ECDC, 2020), and the unemployment rates were collected from Eurostat
(2020) and represent the percentage of the active population unemployed monthly
in 2020.
Kati Orru et al.
Results
We focused on the state’s welfare level
(OECD, 2020), the infection rate per
100,000 (ECDC, 2020), and unemploy-
ment-level dynamics (Eurostat, 2020) in
the period between March and June 2020.
Tab le 1 presents the figures.
The unemployment level increased in
the 10 countries in the period under
review, March–June 2020. The most
noteworthy changes were in Estonia and
Lithuania, where the unemployment rate
rose from 4.8 to 8.0 and from 6.6 to 8.8,
respectively. The infection rate per 100,000
peaked in April in all of the case study
countries (ECDC, 2020). On average, the
highest infection rates per 100,000 were
in Portugal and Italy, and the lowest was
in Hungary. Comparatively, countries
such as Estonia, Italy, and Lithuania had
higher unemployment levels than those
with higher peaks and average infection
rates per 10 0,000 (for instance, Germany
and The Netherlands). Case study coun-
tries’ welfare levels were, as noted, based
on the OECD’s social expenditure per-
centage of GDP. Countries’ social expend-
iture was between 16 and 30 per cent of
their GDP (OECD, 2020).
Responses to the challenges
introduced by the pandemic to
the care organisations
The first aim of the study was to explore
if and how the activities of care services
were altered due to the challenges intro-
duced by the Covid-19 pandemic. The
first-wave effects were mainly derived
from the declarations of an emergency
and lockdowns by the national govern-
ments and the regulations imposed to
prevent the spread of the virus. A more
Table 1. Case study countries’ welfare level, infection rate per 100,000, and unemployment dynamics in the study period, March–June 2020
Czech Republic Estonia Finland Germany Hungary Italy Lithuania Norway Portugal The Netherlands
Unemployment
Infection
Unemployment
Infection
Unemployment
Infection
Unemployment
Infection
Unemployment
Infection
Unemployment
Infection
Unemployment
Infection
Unemployment
Infection
Unemployment
Infection
Unemployment
Infection
March 2.1 28.2 4.8 53.9 6.7 23.7 3.8 74.5 3.7 5.0 8.5 167.1 6.6 17. 3 3.6 79.2 6.2 62.4 2.9 68.0
April 2.2 43.0 6.0 71.8 7. 3 65.1 4.0 117.1 4.1 23.4 7.4 16 8.7 7.8 31.9 4.1 64.6 6.3 177.9 3.4 15 6. 5
May 2.4 15. 5 7.0 15 .0 8.0 34.8 4.2 26.9 4.8 11. 2 8.7 48.2 8.5 10.6 4.6 14 .0 5.9 73.1 3.6 4 3.1
June 2.7 24.2 8.0 9.2 7.9 6.9 4.3 15.4 4.9 2.8 9.4 12.9 8.8 5.2 5.2 8.3 7. 3 94.5 4.3 22.9
Welfare level 19.2 17.7 29.1 25.9 18 .1 28.2 16 .7 25.3 22.6 28.9
Source: authors.
Resilience in care organisations
Table 1. Case study countries’ welfare level, infection rate per 100,000, and unemployment dynamics in the study period, March–June 2020
Czech Republic Estonia Finland Germany Hungary Italy Lithuania Norway Portugal The Netherlands
Unemployment
Infection
Unemployment
Infection
Unemployment
Infection
Unemployment
Infection
Unemployment
Infection
Unemployment
Infection
Unemployment
Infection
Unemployment
Infection
Unemployment
Infection
Unemployment
Infection
March 2.1 28.2 4.8 53.9 6.7 23.7 3.8 74.5 3.7 5.0 8.5 167.1 6.6 17. 3 3.6 79.2 6.2 62.4 2.9 68.0
April 2.2 43.0 6.0 71.8 7. 3 65.1 4.0 117.1 4.1 23.4 7.4 16 8.7 7.8 31.9 4.1 64.6 6.3 177.9 3.4 15 6. 5
May 2.4 15. 5 7.0 15 .0 8.0 34.8 4.2 26.9 4.8 11. 2 8.7 48.2 8.5 10.6 4.6 14 .0 5.9 73.1 3.6 4 3.1
June 2.7 24.2 8.0 9.2 7.9 6.9 4.3 15.4 4.9 2.8 9.4 12.9 8.8 5.2 5.2 8.3 7. 3 94.5 4.3 22.9
Welfare level 19.2 17.7 29.1 25.9 18 .1 28.2 16 .7 25.3 22.6 28.9
Source: authors.
detailed overview of the challenges posed by the pandemic, institutional responses,
influencing factors, and impacts on clients in the studied countries based on the results
from interviews and document analysis is presented in Table A3 in the Appendix.
Organisations providing care quickly made rearrangements that allowed for nec-
essary services to be offered while remaining in compliance with government regu-
lations. Based on our analysis, four key types of organisations could be distinguished
according to their nature of services and the related rearrangements owing to the
pandemic. Our evidence shows that inside these four key types, organisations fol-
lowed largely the same adaptation patterns in all of the studied countries:
• First, soup kitchens (food banks) could no longer serve food inside their prem-
ises. As a response, often with the help of volunteers and private companies, soup
kitchens transitioned from serving food on the spot to distributing packages on
a pick-up basis or delivering it to homes. ‘We closed our soup kitchen at first’ said
the interviewee from Estonia (29 May 2020), ‘but then we reminded ourselves
what our organisation stands for and found ways to continue providing food for
those in need’. Owing to the increasing numbers of individuals with economic
problems, and the halt of existing sources for the homeless, such as begging and
food leftovers from restaurants, the need for food support doubled or even tripled
in some cases. As a Lithuanian interviewee (8 July 2020) put it: ‘Before we had to
deliver for 60 individuals in one place, now the situation is as if we had to deliver
food for 60 individuals in 60 pl a ce s’.
• Second, the most drastic changes occurred in day centres, which were closed to
clients in response to government restrictions. That meant the suspension of phys-
ical meetings to provide services and amenities such as psychological support
(counselling, therapies, social interaction with clients and staff ), hygiene facilities
(toilets, showers, laundry), activities (newspapers, television, Wi-Fi, books), and
warm rooms (possibility to use a kitchen to make tea). In physically closed day
centres, communication, psychological assistance, and instructions to apply for
allowances and other support were given to the clients by telephone or via the
internet (e-mail, Skype). New solutions such as Wi-Fi networks extended to out-
side of the shelter, telephone-charging points, and laundry pick-ups were created
to help clients. In Estonia, one day centre provided clothes to the homeless by
noting a description of what they required by telephone. Furthermore, several day
centres transitioned to distributing food outside their premises. For example, a
day centre in Norway got the food delivery running in just two days after the
first lockdown. In addition, many care workers from day centres (Czech Republic,
Italy, Norway, and The Netherlands) changed the mode to operating on the
streets, looking for the homeless to furnish them with food, masks, and other
material resources.
• Third, night (temporary) shelters stayed open and, in many cases (Czech Republic,
Estonia, Germany, Hungary, and The Netherlands) shifted to 24-hour service
provision, to limit contact among clients who usually freely go around outside.
Kati Orru et al.
In many cases, the clients were provided with material goods such as special food
and cigarettes to curb a willingness to leave for the streets (Czech Republic and
Estonia). To entertain clients who typically spend their days moving about, the
managers supplied (reading and colouring) books and collections of old action and
war films and necessary equipment for watching them.
• Fourth, residential facilities stopped accepting new clients, but continued working.
To protect the health of clients and staff, everyday life was rearranged, including
the suspension of joint activities and one-to-one counselling sessions. While
movement outside of the premises was limited for clients, facilities faced diffi-
culties meeting social distancing requirements (because of a lack of space and the
unsuitable structure of buildings, such as common toilets). For the same reason,
changes were made to working schedules to avoid unnecessary mixing of per-
sonnel. Similar to temporary shelters, new activities were introduced in residential
facilities to entertain clients during restrictions on socialisation and movement. For
instance, a puppy was adopted by a residential centre in Portugal to calm clients.
All types of care organisations played an important role in the dissemination of
reliable information on message boards, in leaflets, and by telephone to keep clients
updated on the situation of the pandemic and government regulations. Overall,
many countries (Czech Republic, Estonia, Germany, Hungary, Italy, and Lithuania)
faced a significant increase in demand for both food aid and accommodation. The
latter was solved by the opening of emergency shelters in some countries (Czech
Republic, Germany, and The Netherlands), whereas some homeless people had to
stay on the streets in others due to overcrowded shelters or camps (Hungary and
Italy). A much higher workload along with many of the employees and volunteers
belonging to risk groups (elderly or with chronic diseases) created staff shortages.
Another common challenge in all countries was a lack of personal protective equip-
ment (PPE) at the beginning of the crisis and higher operating costs owing to the
rearrangements of work, an increase in services offered or the number of clients,
and additional disinfection.
Factors influencing the coping of care organisations
The second aim of the study was to identify factors facilitating or impeding the
care organisations’ abilities to provide relevant help to their users, that is, their level
of resilience.
Organisational structures to cope with high workload and stress
For the staff of all types of care organisations, but particularly for temporary shelter
and day centre personnel, the extended opening hours and/or the introduction of
additional services was physically exhausting and demanded extra workers. Many
organisations experienced shortages of staff, partly due to quarantines in the early
phase of the pandemic, and partly because a high proportion of the volunteers were
Resilience in care organisations
relatively old and hence were in the infection risk groups. Moreover, in the early
phase, the rosters involved risk of infection and/or quarantines: ‘everybody would
meet everybody’. This was changed to minimise social contact between workers and
to increase resilience.
A positive was that volunteers at organisations in most countries helped to fill the
gaps left by staff in risk groups (older age or chronic diseases). By drawing on the
resources and possibilities within the existing organisational structure, younger
volunteers were recruited. Nevertheless, it was not always easy to find new volun-
teers. As a soup kitchen representative said at the Estonian workshop (25 August
2021): ‘We pray every day that we would find someone, or they would find us’.
Regardless of the acquisition of some additional workers, operating on the verge
of burnout was commonly reported among staff members in most of the organisa-
tions. For example, a day centre representative reported to the Norwegian workshop
(28 June 2021) that care workers felt as if they were not able to do enough. This
sense was exacerbated by feeling obliged to assist with the digitalisation of services,
whereas normal services like self-help groups and one-on-one sessions were put
on hold.
Furthermore, in all types of organisations, it was emphasised that the intense work
and concern about infection were mentally stressful, and that supervision by and
psychological support from colleagues were limited. A source of emotional stress
for operators was having to implement the closure measures. In Italy, for instance,
the manager of a day care centre pointed out (16 July 2020): ‘It was very painful for
us, having to tell users that we couldn’t accommodate them’.
Culture
The culture of the care organisations was cited as an important facilitating factor by
many of the interviewees from all types of organisations. They said that their actions
and commitment to dealing with the crisis was guided by this common idea of the
mission of care NGOs in society: ‘to help vulnerable people in need’. The perse-
verance of staff helped with reaching out to clients who they had not been able to
connect with previously. ‘You keep on trying, and maybe the next day the client
is less intoxicated and is able to reason better, and then something clicks’, explained
a Norwegian workshop participant when talking about informing the clients about
risks and restrictions (28 June 2021). Some staff of social service centres, such as in
the Czech Republic, also shared positive feelings of being able to put their Christian
faith in action or feeling appreciated by their clients in a difficult period. And inter-
viewed staff members in Germany expressed their gratitude for being a part of the
response and assisting the most vulnerable in their community.
Technologies, infrastructure, and equipment
Interviewees generally reported that the physical facilities of day centres, temporar y
shelters, and residential facilities were unsuitable for a pandemic, including small
Kati Orru et al.
rooms and people sharing a toilet and hygiene amenities. A care centre representative
in Budapest, Hungary, clarified the space constraints (25 June 2020): ‘At one point
we had to recommend clients to stay on the street, forest, or any outdoor areas since
it was much safer there’. The downsizing of the scale of services met with a lot of
frustration, as was the case in other countries, such as Norway.
In some physically closed day centres, the transition to digital counselling enabled
the staff to maintain contact with their clients in new ways. However, experiences
of this were mixed, and it was not welcomed by all personnel. Interviewees high-
lighted that social work is by essence not suitable to being done from distance. It was
stressed that personal contact has to be established to help people open up about their
situation and real needs. A Lithuanian social worker commented (30 June 2020):
‘You can give consultations via phone, but this way you can’t see if everything is fine
through non-verbal cues, when [the] situation may be critical in real life’.
Internal relations between clients and staff
Enforcing hygiene and distancing regulations in temporary shelters and residential
facilities was challenging. Clients were somewhat negative and agitated at the begin-
ning of the crisis, yet they became increasingly more accepting of rules and grateful
for support. In some countries (Estonia and Italy), a need for ongoing persuasion to
follow safety instructions was needed and underscored. In the words of a social work
centre representative in Estonia (30 June 2020): ‘We explained and explained . . .
and explained once more . . . and this had finally a reassuring effect’. In soup kitchens
and temporary and residential facilities in some countries, such as Estonia, Finland,
Germany, Norway, and The Netherlands, it was underlined that good relationships
with clients were essential to conveying crisis messages and ensuring compliance
with restrictions.
Expressions of gratitude, the feeling of solidarity with other clients, and under-
standing and collaborative residents helped the staff to manage the situation as a
whole. For example, the Estonian workshop (25 August 2021) revealed that clients
of the temporary shelter that had turned into a 24-hour centre appreciated that staff
stayed around and were available for consultations every day throughout the lock-
down. The significance of a long-term relationship of trust between the staff and the
clients was cited as a key factor in successful adaptation to the situation in many organi-
sations. This relationship helped to reinforce the message that the restrictions are
purposeful: ‘If a rule is put into force, then there must be a reason for that’, noted
a participant at the Estonian workshop (25 August 2 021) while explaining compli-
ance attitudes.
Leadership, communication, and cooperation
In many cases, the organisation leaders relied on their long-term experience in the
field when adapting to Covid-19 and finding solutions. As one of the Estonian soup
kitchen representatives pointed out (25 August 20 21): ‘We have been in the field for
Resilience in care organisations
20 years, and we have seen other, even more severe crisis situations, and these expe-
riences have helped to overcome also current difficulties’. An interviewee at a
Portuguese day centre (14 April 2021) added: ‘The pandemic experience has taught
us to rethink the intervention model without losing the reason why we serve the
population that is in our care. More than ever, it is a mission far greater than the set
of tasks we must perform on a daily basis’.
Cooperation between different (types of ) care organisations grew even stronger.
For example, in Finland, collaboration occurred in the provision of food and clean
needles for the homeless, whereas in Lithuania, telephones and a workspace for
psychologists to establish a helpline were supplied. In Norway, care organisations
increased cooperation to synchronise food distribution in Oslo city centre, whereas
in Hungary, the existing alliance of care NGOs and government authorities was
employed to coordinate care work.
External framework conditions: social relations and networks
The public health and economic situation, crisis management context, and in par-
ticular, insufficient or delayed support from the authorities challenged the coping
of all types of organisations. Confusing official rules and a lack of guidelines were
repeatedly singled out, particularly by the representatives of temporary shelters. It
was said that social care for the homeless and other vulnerable groups tends to ‘fall
in between’ guidelines, as these organisations are neither health institutions nor care
homes. In the majority of cases, the first impression was that the generally under-
recognised groups had become even more invisible: ‘It felt like the city had forgotten
us’ (Helsinki, 9 June 2020).
In several cases, strong advocacy by social services helped to make their voices
heard. From the beginning of the crisis, managers of social centres were confronted
with policies and restrictions that did not account for the needs of social service centres
and their clients. In a couple of countries (Czech Republic and Hungary), care organisa-
tions brought their concerns to their local government and asked for clarification
regarding regulations and requested that the government provide PPE, financial
resources to care services, and emergency accommodation for the homeless.
In some other countries, it was easier for the care organisations to convey their
needs. For instance, interviewees in Germany and Norway, the countries with a
stronger relationship between social services and the government, noted that the
authorities were open to the requests of welfare organisations as they have an on-
going understanding of the needs of the populations with which they work. These
positive exchanges and the clarity of information received were vital for staff morale
and led to personnel not only feeling equipped to disseminate accurate information
to clients, but also knowledgeable about ways to rearrange services to align with
regulations. However, certain client groups served by organisations (migrant day
centre) were considered by the local government only after the second wave of the
pandemic, following a long lament (Norwegian workshop, 28 June 2021). Most
Kati Orru et al.
notably, in Hungary, the government and the Hungarian Association of NGOs for
Development and Humanitarian Aid were called into action to ensure that their
professional activities were coordinated without overburdening any organisations,
and that all assistance, including communication materials, was provided to all parts
of the country.
When it comes to societal recognition, some interviewees (Czech Republic, Estonia,
Hungary, Italy, and Norway) stated that general negative attitudes towards home-
less people in society worsened, as they were seen as spreaders of the virus and thus
stigmatised. Stark political resentment towards the homeless culminated in the
criminalisation of homelessness in the Czech Republic and further tightening of
the bans on the homeless staying in public places in Hungary. In Italy, some centres
closed; others resisted, having to make their own arrangements without much sup-
port or guidance from state institutions.
Overall, the interviewed staff members (in, for example, Czech Republic, Hungary,
Italy, and Norway) pointed out that the pandemic revealed the structural inequal-
ities that exist within the welfare systems for certain populations. The pandemic
aggravated the situation among some groups, such as migrants, who were not able to
receive the same services (attendance and emergency support) due to their different
legal status in Italy and Norway, among other countries.
As for material support, donations from communities and private companies, as well
as the voluntary workforce, were an important source of help in many countries.
Lastly, the fact that the beginning of the pandemic was in the spring of 2020 notice-
ably lessened the negative impact of day centres closing down, since it was not so
cold outside.
Outcomes of the pandemic for users
The third aim of the study was to examine the outcomes for different groups of
clients. Below, we summarise the results that are relevant to this objective.
First, the inter views revealed the multifaceted impacts of the Covid-19 crisis on
homeless people and the clients of care services. Clients of residential centres such
as rehabilitation or night shelters that reorganised to achieve full provision felt most
safe and taken care of.
Access to night shelters and soup kitchens (food banks) was mostly provided to
all who required it, although numbers increased significantly, and sometimes doubled
due to new, ‘first-time’ clients (Czech Republic, Estonia, Finland, and Norway).
Those who were managing (some economic hardship or difficulties with independ-
ent psychological coping) prior to the crisis faced more difficulties owing to the
decreasing chances of returning to work, meeting with social workers, and suspended
access to day centres during the emergency.
Country-by-country differences appeared among the homeless clients of night
shelters. Frustration manifested among the homeless because they lived a paradox
of not being allowed to be on the street and having nowhere to stay—they were
Resilience in care organisations
often fined and removed by police in the Czech Republic and Hungary. This also
occurred among migrant groups living on the street in Italy.
In most countries, homeless and other materially or psychologically disadvan-
taged clients lost their usual access to day centres and their services, such as toilets,
showers, entertainment, kitchen amenities, and a washing machine, as well as to
psychosocial assistance, including counselling, therapies, or other personal interac-
tion with staff. Those who were among the most fragile in these groups or who
lacked the means or skills to access digital counselling may not have reached out for
help at all.
The loss of the routine and social circle normally provided by the day and residential
centres was another reason for difficulties with the restrictions. Despite efforts to com-
municate with clients using telephones and the internet, social isolation and loneli-
ness were described, impacting more severely on those with psychological disorders.
Digital counselling was often not accessible due to a lack of digital literacy skills or
access to the internet. Certain client groups (such as migrants and refugees) did not
have the access permits or the digital and/or language skills necessary to commu-
nicate using digital services (Norwegian workshop, 28 June 2021). Furthermore, it
was difficult to help individuals who frequented drug and alcohol rehabilitation
centres and supply them with information and guidelines, as they are often difficult
to reach and do not show up to their appointments (Norwegian workshop, 28 June
2021). In addition, it was reported that clients with more private problems or who
were more closed in nature, as well as new clients, might have not expressed their
need for help by telephone. A positive was that many of the clients started to use the
internet—for example, using digital signatures and communicating via e-mail.
The psychologically fragile clients struggled the most due to increased fears and
paranoias. Interviewed personnel worried that the effect on their emotional well-
being would worsen in time.
Discussion
Challenges introduced by the Covid-19 pandemic on care organisations
The first aim of the study was to explore if and how the activities of care organisa-
tions were altered due to the challenges introduced by the Covid-19 pandemic. On
average, the highest infection rates per 10 0,000 were in Portugal and Italy, and were
the lowest in Hungary. Estonia, Finland, and Lithuania had higher unemployment
levels. Many countries faced a significant rise in demand for both food aid and accom-
modation, particularly for ‘first-time’ clients, but also for the homeless who were
banned from the streets. Linking the country statistics and interview results, the
increased demand for food and shelter appears to be particularly stark in those coun-
tries where the employment opportunities decreased the most (Estonia, Finland, and
Lithuania). These results are in accordance with descriptions from previous research
on the first wave, indicating greater demand for services, while the care providers
Kati Orru et al.
faced challenges related to diminishing means and operating restrictions (Amadasun,
2020; Banks et al., 2020; Dayson et al., 2021).
Our study reveals that across countries, the different types of services experienced
similar changes: immediate cancellation of socialisation activities and obligations
to close down some facilities. Night shelters and soup kitchens had to reorganise
broadly their work to minimise contacts, but residential facilities were minimally
affected. The most drastic changes were experienced by day centres, which had to
suspend a large proportion of their client services, such as hygiene facilities, social-
ising (comforting from staff and peers), and a warm room, due to the lockdowns.
Only in some day centres were psychological assistance and counselling regarding
applications for allowances and other support available by telephone or via the internet.
Yet, not all of the clients were able to access the digitalised services owing to a lack of
skills and equipment and being frightened by the new situation and requirements.
In all care organisations, staff invested effort in supplying information and guid-
ance to their clients and in reaching out to local homeless people to make sure that
they stayed safe. This role was particularly important to alleviate clients’ suscepti-
bility to rumours and false claims that may increase their risk (Hansson et al.,
2020), as was particularly evident during the Covid-19 crisis (Hansson et al., 2021).
Volunteers were involved in distributing food and other aid on the streets or deliv-
ering it to homes.
In the absence of specific guidelines in the early phases of the pandemic, organisa-
tions had to come up with their own rules to maintain operations safely and find
resources to support their clients without provision from authorities. This resembles
the core of the definition of resilience that we apply in the present study: the capacity
to adapt to internal and external errors by changing the mode of operations, with-
out losing the ability to function (Barabási and Pósfai, 2 016, p. 303). At the same time,
however, our results confirm the lack of consideration of social vulnerabilities in
risk assessments and crisis planning to support those who have fallen into a vulner-
able situation or seen one aggravated due to the crisis (Orru et al., 2021), including
among care organisations in European countries.
Factors facilitating or impeding the care organisations’ resilience
The second aim of the study was to identify the factors facilitating or impeding the
ability of social organisations to provide relevant help to their users, that is, their level
of resilience. Based on the Pentagon model of Schiefloe (2011), some of the main
factors impeding resilience were related to the formal aspects of the organisations,
in other words, the organisational structure. Most notable in this regard were a lack
of personnel, rosters that were unsuitable for a pandemic, a high workload and stress,
especially in night shelters that now turned into long-term shelters, and infrastruc-
ture (inappropriate physical facilities), particularly in day centres and night shelters,
but also in soup kitchens.
Resilience in care organisations
Additional factors were negative external framework conditions. The public health
situation and economic and crisis management context in many country cases were
characterised by insufficient or delayed support from the government and munici-
palities. Our results on the lack of information and guidelines issued by official
sources and the lack of authorities’ recognition of care organisations’ contribution
to providing safety to large population groups confirm earlier findings (Banks et
al., 2020; Oostlander et al., 2020). In some countries, a general negative attitude
towards homeless people in society worsened as they were seen as spreaders of the
virus and thus stigmatised.
We may conclude, based on the Pentagon model, that some of the main factors
facilitating resilience were related to leadership and culture, particularly in the day
centres and night shelters that had to reorganise their services to a large extent.
Leadership was central, as leaders, at different levels, were cooperating within and
across the organisation and were crucial in producing new solutions—this is in
accordance with previous research (Schein, 2004; Deverell and Olsson, 2010 ;
Okorley and Nkrumah, 2 012 ). Moreover, in several cases, strong advocacy by the
leaders of social services helped to make their voices heard.
The results also indicate that the mission to assist is an important component of
the organisational culture that guided their actions and commitment in dealing with
the crisis. Several institutions compensated for the challenging physical infrastructure
vis-à-vis infection control through innovative solutions, such as inventive ways of
entertaining quarantined clients, food deliveries and trucks, and approaching clients
on the streets. In these ways, they were still able to provide help to their clients,
that is, maintain organisational resilience. The development of such solutions was to
a great extent related to experienced staff ’s knowledge of their clients. This conclu-
sion that culture may be a crucial source of resilience, galvanising members around
the same decision premises, is in line with the focus of HRO research (LaPorte and
Consolini, 1991; Weick, Sutcliffe, and Obstfeld, 1999). However, when confronted
with a lack of human and material resources, pursuing the mission to aid risks the
physical and mental health of staff and cannot be sustained during a long-term crisis.
Social relations and networks were also important. The changed situation and
new modes of operating affected internal relations between staff and clients in all
types of organisation. Explaining and enforcing the safety restrictions and rear-
rangements required a lot of effort by staff members. Yet, in some countries (such as
Estonia, Finland, Germany, and Norway), collaborative relations between residents
and staff helped in particular to manage the situation as a whole. Here, solidarity
between clients and staff even increased.
As for external relations, the study demonstrates that the common objective to
assist vulnerable people facilitated collaboration between organisations and the devel-
opment of workable solutions among soup kitchens, day centres, and night shelters
(such as in Estonia, Finland, Hungary, and Norway). This confirms the understand-
ing that in a time of crisis, organisations (and individuals) benefit from the good
Kati Orru et al.
relations that have been fostered before the event. Crises, though, especially long-term
ones like the Covid-19 pandemic, also tend to introduce a new set of stakeholders
and forms of collaboration, which need to be created within a limited amount of
time (Alpaslan, Green, and Mitroff, 2009). Established collaborative projects indicate
the significance of social capital that emanates from external networks as a fundamen-
tal factor in improving the resilience of organisations.
The analysis highlights the role of social service centres as advocates for policies
more in tune with the needs of their clients. The pandemic revealed the structural
inequalities that exist within welfare systems towards certain population groups,
which aggravate the situation of those who are already vulnerable. For instance, the
migrants’ inhibited access to basic emergency services demonstrates the lack of con-
sideration of social vulnerabilities in crisis planning in many of the European coun-
tries reviewed in existing studies (see, for instance, Orru et al., 2021). Monitoring
governmental policies and flagging plans and recommendations that are harmful to
vulnerable groups are examples of the work done to enhance the external condi-
tions in which the organisations needed to operate during the Covid-19 pandemic.
This is vital in a time of crisis, as existing studies indicate that disasters can be used as
an excuse to marginalise and scapegoat further vulnerable groups, including immi-
grants, ethnic minorities, and those living in poverty (Devakumar et al., 2020;
Nisanci et al., 2020; Mukumbang, 2021). It is likely that without the intervention of
care services, governmental responses would have been much slower and less attuned
to the real needs of the homeless.
However, the studied country authorities demonstrated varied responsiveness to
the pleas of organisations. Advocacy work was more successful in countries where
stronger alliances between the state and non-governmental care services existed
before the crisis (such as in Estonia, Germany, and Hungary). By contrast, in some
countries (such as Italy and Lithuania), many closures of centres could have been
prevented if the government had been willing to work with social services to make
Figure 2. Changes introduced in organisations, protective factors and factors impeding
coping, and the size and types of effects on clients
Source: authors.
Resilience in care organisations
sure that they were able to administer their operations in a safe way instead of requir-
ing a halt to all face-to-face interactions, such as in day centres.
Figure 2 sums up the main factors facilitating and impeding resilience.
Outcomes for the different groups of clients
The third aim of the study was to assess the outcomes for the different groups of
clients. Figure 2 shows that the pandemic and the subsequent responses of the studied
care organisations entailed different types of outcomes for different types of clients
relying on different types of services. Overall, some of the greatest effects of the
pandemic were experienced by the individuals who had to turn to care services for
the first time. These people had been struggling to cope economically or due to
mental health prior to the pandemic, and given the overwhelming health, social,
and economic aspects of the crisis, they experienced a loss of hope in entering the
job market or finding other ways of improving their situation. This indicates the
very dynamic nature of social vulnerability in a crisis, as calamities may push people
who have coped sufficiently well before into a vulnerable situation.
The existing clients of residential rehabilitation facilities or night shelters that
reorganised to achieve full provision felt most safe and taken care of. In contrast,
frustration appeared among the homeless because, paradoxically, they were not
allowed to be on the street but had nowhere to stay—often they were fined and
removed by police in Czech Republic and Hungary. This was also the case in Italy
for migrant groups living on the street. In addition, despite efforts to communicate
with clients using the telephone and the internet, social isolation and loneliness were
described, impacting more severely on those with mental disorders. Furthermore,
the digitalised service formats did not permit all individuals who were in need of
support to be reached owing to poor access to the internet or digital skills. Lastly,
psychologically fragile clients struggled the most owing to increased fears and para-
noias. Thus, although the care organisations were able to maintain operations, they
were less successful in providing help to some groups.
Methodological limitations and issues for future research
This explorative study on care organisations’ responses to the Covid-19 pandemic of
2020–21 necessarily used a qualitative approach to map out the different responses
by different types of organisations and the variety of determinants of responses by
these organisations. The main analytical focus was not a comparison of countries,
nor of individual organisations within the 10 countries. The findings of this study
should be seen as a starting point for a more detailed investigation to define the
impacts of Covid-19 and safety measures among different types of care services and
different groups of service users. Future studies could also conduct in-depth compari-
sons of national contexts, using more data from each country. For a more detailed
understanding of the relevance of these factors, a more structured survey engaging
more organisations would be a welcome development. Current research centred on
Kati Orru et al.
the experiences of the homeless and individuals in precarious situations that have
reached out to care organisations reveals that they are ‘saved’, as one of the inter-
viewees put it, at least to some extent. However, the resilience of those individuals
in vulnerable situations that do not receive the support of any governmental or non-
governmental agencies needs further investigation. Future research should take a
more in-depth look at the perspectives of clients of care organisations.
Conclusion
Instead of closing down as a response to the Covid-19 threat and associated restric-
tions, the care organisations employed their long-term experiences and trust net-
works in dealing with clients, and shifted their structure and mode of operations
to pursue the mission. Across countries, relatively similar changes occurred in the four
key types of care organisations: while day centres needed to suspend their support
or digitalise fundamental counselling activities, night shelters and soup kitchens
broadly reorganised their work to minimise contacts; residential facilities were min-
imally affected. However, the increasing demand for services, the overburdening
of staff with new tasks (such as digitalisation), and the mounting infection threat
rarely met with appropriate support from health and care authorities. Therefore,
the vulnerability of the limited (volunteer) workforce and organisational coping
became evident. Those with a closer working relationship with other care organi-
sations and governmental institutions fared better in mobilising support to meet
the surge in need for food and accommodation assistance, reworking their services,
and disseminating accurate information. The infrastructure, including inappropri-
ate physical facilities, and a lack of PPE for infection control were the main factors
impeding resilience.
This study demonstrates that existing structural inequalities, including limited
access to official (health) emergency services, aggravate the situation of those who
are already vulnerable (such as migrants owing to poor communication skills)
during the crisis unless they find support networks within care organisations, among
others. In spite of the relatively resilient response of the care organisations, out-
comes were worse among some types of vulnerable groups than others. Next to
psychologically fragile clients and migrants, new clients—individuals who found
themselves in a vulnerable situation for the first time—were critically challenged.
Future research should take an in-depth look at these sources and mechanisms of
vulnerability during crises. National and municipal risk analyses and contingency
planning should incorporate the views and experiences of care organisations to
ensure fair representation of these actors and their clients’ needs. Crisis support funds
and stronger institutional alliances with care organisations are needed to maintain
access to safe services and trusted (information) networks among those who have
fallen into a vulnerable situation. Both anti-discrimination measures and proactive
awareness-raising are crucial to prevent the discrimination of disadvantaged groups
in future crises.
Resilience in care organisations
Appendix
Table A1. List of interviews
Number Place Date Institution/organisation
1Prague, Czech Republic 29 May 2020 TSA, national coordinator for social services
2Prague, Czech Republic 24 June 2020 TSA social services centre
3Tallinn, Estonia 29 May 2020 TSA alcohol rehabilitation centre
4Tallinn, Estonia 8 June 2020 TSA day centre for material and social support for homeless
and materially insecure individuals
5Tallinn, Estonia 16 June 2020 Department o f Social Welfare, one of Tallin n district govern ments
6Tallinn, Estonia 17 June 2020 Welfare Centre, night shelter and resocialisation unit
7Tallinn, Estonia 30 June 2020 Tallinn Social Work Centre, resocialisation accommodation
8 Helsinki, Finland 9 June 2020 TSA night shelter for homeless
9Helsinki, Finland 1 June 2020 TSA social service centre, social counselling
10 Tampere, Finland 28 May 2020 TSA day centre for material and social support
11 Cologne, Germany 8 June 2020 The Salvation Army ( TSA), Territorial Social Programmes
12 Hamburg, Germany 19 June 2020 TSA homeless shelter
13 Hamburg, Germany 26 June 2020 German Red Cross, day centre
14 Hamburg, Germany 3 July 2020 German Red Cross, strategy department.
15 Budapest, Hungary 24 June 2020 TSA, temporary shelter, rehabilitation hostel, day centre
16 Budapest, Hungary 25 June 2020 The Budapest Methodological Centre of Social Policy and its
Institutions, homeless services
17 Budapest, Hungary 19 June 2020 Hungarian Red Cross, Department of Disaster Management
18 Budapest, Hungary 1 July 2020 The Hungarian Charity Ser vice of the Order of Malta,
central Hungary
19 Rome, Italy 5 June 2020 TSA homeless shelter
20 Rome, Italy 16 July 2020 Day centre, reception attendance services
21 Bolzano, Italy 16 July 2020 Day care centre for material and social support
22 Rome, Italy 23 July 2020 24-hour reception and care centre
23 Klaipe˙da, Lithuania 28 May 2020 TSA day centre for material and social support of homeless
24 Klaipe˙da, Lithuania 30 June 2020 Association of Social Workers
25 Vilnius, Lithuania 8 July 2020 Food bank, collects and distributes food aid
26 Oslo, Norway 9 June 2020 TSA housing facility for homeless people with drug or
alcohol addiction
27 Oslo, Norway 11 June 2020 TSA day centre for active users of drugs or alcohol
28 Oslo, Norway 12 June 2020 Substance abuse care provision
29 Colares, Portugal 31 March 2021 TSA, residential centre for materially disadvantaged
30 Lisbon, Portugal 14 April 2021 TSA, Centre for Homeless People
31 Lisbon, Portugal 14 April 2021 TSA, Centre for Families and Needy People
32 Groningen,
The Netherlands
13 July 2020 TSA day centre for material and social support of homeless
Kati Orru et al.
Table A2. List of workshops
Place Date Facilities
Tallinn, Estonia 15 June 2021 Social welfare centre ( homeless night shelter, day centre, long-term rehabilita-
tion shelter); re-socialisation centre with 10 establishments (long-term shelters,
women’s and family refuge, homeless night shelter, long-term rehabilitation shel-
ter for people with mental health challenges and alcohol abusers) (12 participants)
Oslo, Norway 29 June 2021 TSA (The Salvation Army) migration centre, TSA food distribution centre, TSA drug
and alcohol rehabilitation centre (7 participants)
Tar tu , E st on ia 25 August 2021 Soup kitchen, homeless soup kitchen, rehabilitation centre (homeless night shelter,
day centre, long-term shelter), church charity (food and clothing) (5 participants)
Table A3. Challenges posed by the pandemic, institutional responses, influencing factors
and impacts on clients in studied countries
Country Challenges
introduced by
the pandemic
Institutional
response
Influencing factors:
theoretical
categories
Outcomes for users
in the first wave.
Did they receive
help, in lower
numbers, reduced
form?
Czech Republic • Day centres closed
• Common rooms of
residential centres
closed
• Difficulties with
implementing
distancing
regulations
• Lack of PPE in
the beginning
• Day centres transi-
tioned to outreach
work (such as giving
out food and masks)
• Night shelters
established 24/ 7
provision
• New programmes
developed for resi-
dents to keep them
occupied
• Hotels transitioned
to emergency
accommodation
• Short ages of staff,
committed staff
• Some organisations
established crisis
team that responded
to changing
regulations
• Donations from
public and
companies
• Changing regula-
tions/unclear or
harmful rules
• Growing resentment
and criminalisation
of homeless
• Less access to
social ser vices due
to closure of day
centres
• Residents struggled
with restricted
movement
Estonia • Day centres closed,
lost access to psy-
chosocial support
• Increased workload
and operating costs
• Difficulties with
implementing dis-
tancing regulations
• Client s with psycho-
logical disorders
needed additional
support
• Soup kitchen reor-
ganised to provide
food parcels
• Psychosocial support
and counselling via
telephone and
internet
• Dissemination of
information on regu-
lations and pandemic
• Reorganisation to
meet hygiene and
distancing
requirements
• Short age of staff,
committed and
experienced staff
• Lack of support for
and super vision of
staff
• Increased donations
• Help from official
institutions
• L ack of official gui de-
lines, inconsistency
of instruc tions from
city government
• Lack of recognition
of the contribution
of social workers
• Lack of social
support
• First resentment and
then habituation
among clients with
regard to new rules
• Residential care
clients were most
protected, ser vices
were adapted to
their needs
• Homeless night
shelter’s clients
were well taken
care of
Resilience in care organisations
Country Challenges
introduced by
the pandemic
Institutional
response
Influencing factors:
theoretical
categories
Outcomes for users
in the first wave.
Did they receive
help, in lower
numbers, reduced
form?
Finland • Day centres closed
• Social service activi-
ties suspended
• Difficulties with
implementing dis-
tancing regulations
• Teleworking was not
possible, despite
the instruction,
because the man-
aging operation
was working better
on site
• Lack of PPE in the
beginning
• Day centre was
focused solely on
food distribution
• Psychosocial support
and counselling via
telephone and
internet
• Group sessions
replaced by one-
on-one discussions
• Quick return to
everyday life with
guidelines and PPE
• Short ages of staff
and volunteers,
commitment of staff
• Established commu-
nal ways of working
• Collaborative
residents
• Collaboration
between NGOs
• Slow response and
no specific guidelines
from city authorities
• Lack of a social circle
and normal routine
• Good collaboration
between personnel
and clients
• Feeling of solidarity
among clients
• Misinformation on
available services
• Old clients were
missing and the
number of new
clients doubled,
presumably due to
layoffs
Germany • Many food banks
closed
• Number of clients
increased
• Emergency housing
opened
• Difficulties in imple-
menting hygiene
and distancing
regulations
• Lack of PPE
• Food banks
changed to handing
out packages
• Psychosocial support
and counselling via
telephone and
internet
• No recreational
activities
• Social media intro-
duced to interact
with potential donors
• Staff shortages
• Donations from citi-
zens and companies
• Assist ance from
authorities
• Volunteers
• Less contact with
(financial) donors
led to a decrease in
donations
• More clients accom-
modated with the
help of emergency
residential housing
• Homeless remain-
ing on streets, not
receiving sufficient
psychosocial, food,
or hygiene support
• Homeless with
mental illness had
difficulties accessing
shelters and articu-
lating their needs
• Feeling of solidarity
among clients
• Lack of a social circle
Hungary • Day centres closed,
lost access to psy-
chosocial support
and hygiene facilities
• Number of clients
increased
• Lack of PPE
• Challenge to provide
assistance remotely
• Difficulties in imple-
menting hygiene
and distancing
regulations
• Not enough accom-
modation for new
clients
• Food parcels instead
of hot meals in day
centres
• Night hostels shifted
to full provision,
leading to chal-
lenges providing
catering
• Change to digital
counselling
• Staff shortages,
new volunteers
• Old infrastructure of
buildings not suitable
for high capacity and
social distancing
• Establishment of
National Humani-
tarian Coordination
Council
• Donations from pub-
lic and companies
• Lack of information
from the government
• Social exclusion of
homeless increased
• Some homeless had
to stay on the street s
due to overcrowding
of shelters
• Psychologically frag-
ile clients struggled
to go without help
• Lack of a social circle
Kati Orru et al.
Country Challenges
introduced by
the pandemic
Institutional
response
Influencing factors:
theoretical
categories
Outcomes for users
in the first wave.
Did they receive
help, in lower
numbers, reduced
form?
Italy • Day centres closed,
lost access to psy-
chosocial support
and hygiene facilities
• Number of clients
increased
• Challenge keeping in
contact with usual
clients remotely
• Many residential
facilities unable to
accept new clients
• Difficulties in imple-
menting hygiene and
distancing regula-
tions, especially
among users with
drug addiction
and psychological
problems
• Additional support
(extended Wi-Fi
network and elec-
tronic recharging,
delivery of laundr y
to outside the centre)
• Day centres reorgan-
ised into a dormitor y
• Psychosocial support
and counselling via
telephone and
internet
• Extending opening
hours to plan access
to showers and
washing machines,
sanitisation etc.
• Dissemination of
information on
regulations and
pandemic situation
• Flexible and com-
mitted staff
• Continuous training
• Social campaign to
raise awareness
of homelessness
increased support
• Net working between
care organisations
• Slow response and
no specific guidelines
from city authorities
• Clients in residen-
tial centres and
remotely received
continuous support
• Improved health
habits thanks to
training by NGOs
• Most fragile people
were less able to
reach the centres
• Psychologically frag-
ile clients struggled
to go without help
• Migrant s were frus-
trated, being banned
from the streets and
having nowhere
to stay
Lithuania • Day centres closed,
lost access to psy-
chosocial support
• Need for food
support increased
significantly
• Higher operating
costs due to
increased need for
food support and
rearrangements
• Limited resources,
lack of PPE
• Psychosocial sup -
port and counselling
via telephone and
internet
• Day centres started
to provide food
parcels
• Rearrangements to
meet regulations of
social distancing and
hygiene (working
in shifts, social
distancing)
• Recruiting volunteers
via media campaign
• A significant number
of new volunteers
• Donations from pub-
lic and companies
• Cooperation
between govern-
ment institutions
and social support
organisations,
between care
organisations
• Lack of guidelines
and municipality
support (except
medical supplies)
• Homeless received
shelter service
• Digital counselling
was not available or
suitable to everyone
• New clients experi-
encing psychological
strain struggled
without help
Norway • Day centres closed,
clients lost access
to psychosocial
assistance and
hygiene facilities
• In residential set-
tings, social activities
stopped, common
rooms closed, per-
sonal contact with
clients suspended
• Difficulties with
implementing dis-
tancing regulations
• Day centres transi-
tioned to outreach
to follow up with
clients
• Psychosocial support
and counselling via
telephone and
internet
• Extended opening
hours
• Ser ving food through
windows/food truck
• Short ages of staff,
new volunteers
• Management
responded to
crisis quickly and
inventively
• Cooperation with
municipality to
obtain PPE
• Donations from
government, public
and companies
• Difficulty following
up with clients
• Misinformation was
a big problem in
day centres, but not
in residential centres
• Lack of social
support
• Psychologically frag-
ile clients struggled
to go without help
Resilience in care organisations
Country Challenges
introduced by
the pandemic
Institutional
response
Influencing factors:
theoretical
categories
Outcomes for users
in the first wave.
Did they receive
help, in lower
numbers, reduced
form?
Portugal • Difficulties in main-
taining social
distancing among
service users and
staff
• Meetings with
elderly cancelled
and contact had
to be made by
telephone
• Need for food
support increased
• Several retirement
homes closed
• Food provision
programme transi-
tioned to serving
food ‘at home’
• ‘Meals on Wheels’
programme
expanded to meet
increased demand
• Addition of new
facilities to accom-
modate more
individuals
• Night shelters con-
verted to 24-hour
day centres to
reduce unnecessary
movement and pro-
tect homeless
• Staff shortages
• Increased donations
• Good relations
between the local
government and
care organisations
• Recognition of the
level of care provided
by organisations
• Mental strain on
staff to comply with
regulations and
maintain high level
of protection
• Increase in staff
numbers due to
government-funded
programme
• Insufficient help
from local health
authorities
• Increase in volun-
teer numbers for
certain services
• Non-Portuguese
nationals (that is,
from Brazil) experi-
enced helplessness
due to being a for-
eigner and shame in
asking for assistance
• Families were left
without income and
had difficulties
accessing state
support
• Staff developed
new programmes to
combat boredom,
installed televisions
in bedrooms, and
even bought a new
pet for the home
The Netherlands • Day centres closed,
lost access to psy-
chosocial support
and hygiene facilities
• Number of clients
increased
• Lack of housing for
homeless
• Day centres halted
usual activities,
transitioned to food
distribution
• Increase in food
distributed
• Hotels transitioned
to emergency
accommodation
• Staff shortages,
new volunteers
• Increase in food
donations
• More homeless were
able to be housed
in emergency
accommodation
• Psychologically frag-
ile clients struggled
to go without help
• Clients were grateful
to staff, not aggres-
sive or stressed
Source: authors.
Data availability statement
The data that support the findings of this study are available on request from the corre -
sponding author. The data are not publicly available due to privacy or ethical restrictions.
Correspondence
Kati Orru, Institute of Social Studies, University of Tartu, Lossi 36, 510 03 Ta r tu,
Estonia. Email: kati.orru @ut.ee
Kati Orru et al.
Endnotes
1 Kati Or ru is an Associate Professor in Sociology of Sustainability at the Institute of Socia l Sciences,
University of Tartu, Estonia; Kristi Nero is a PhD candid ate at the Inst itute of Social Sciences,
University of Tartu, Estonia; Tor-Olav Nævestad is a Chief Research Sociologist at the Transport
Economics Institute, Norway; Abriel Schieffelers is a Project Coordinator at the European Affairs
Office, Salvation Army, Belg ium; Alexandra Olson is a Project Coordinator at the Europea n Af fairs
Office, Salvation Army, Belg ium; Merja Airola is a Senior Scientist at the VTT Technical Research
Centre of Finland, Fin land; Austeja Kazemekait yte is a PhD candid ate at the University of Trento,
Italy; Gabr iella Lovasz is a Sen ior Project Officer at Geonardo Ltd, Hungary; Giuseppe Scurci is
a Researcher at the University of Trento, Italy; Johanna Ludvig sen is a Chief Research Economist
at the Transport Economics Institute, Norway; and Daniel A. de los Rios Pérez is a Lecturer at the
Jönköping Inter national Business School, Jönköping Universit y, Sweden.
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