PORTLAND, Ore. – Health care doesn't stop after a person leaves the doctor's office. Factors outside of the traditional care setting such as housing play a pivotal role in a person's overall health.

Michael Mellick, a housing case manager with CareOregon, says anybody who has experienced chronic homelessness most likely experiences other issues as well.

"It's safe to assume they're going to have substance-use dependence issues, which we try to help them with,” says Mellick. “There's mental-health issues that often come into play. There are criminal background involvement issues that have to be remedied."

Addressing social determinants such as adequate housing are mandates for coordinated care organizations, which manage the Oregon Health Plan in local communities.

In Portland, six health organizations, including CareOregon and Kaiser Permanente, launched the "Housing is Health" initiative in 2016. Funding from it has supported two developments for low-income tenants, and another project is scheduled to open this summer.

Housing is Health is one part of CareOregon's response to housing issues. Case managers such as Mellick help non-residential clients look for solutions to their unique needs.

He describes a client who had lived on the streets for two years with a chronic lung disease. After helping to clear up his legal issues, Mellick found housing for the client.

He says the man is older and in a vulnerable position, and housing is helping to extend his life.

"He continues to engage in behaviors that aren't necessarily the healthiest for him but his utilization and the cost of his care drastically decreased for the simple fact that he was now sleeping inside in a warm, safe place,” says Mellick.

Mellick says one common thread among clients is a feeling of isolation. It can come from a variety of sources, such as trauma at an early age or the effects of racism or poverty.

He says addressing this could make for a better society.

"You're not just ending with the individual,” says Mellick. “You're looking at the individual's relationship with community. Healing, recovery, renewal. It goes back to the notion of relationships and the person's place in the community."

The North Dakota Legislature is considering bolstering funding to help military veterans facing homelessness. Key voices say more details need to be sorted out. The state Senate this week unanimously approved a bill that, under its original intent, directed gaming tax proceeds from support organizations, such as pull tabs at an American Legion, to programs and funds for veterans with specific needs. Stable housing is among them.

Christopher Deery, veterans service director leads veterans services for Cass County, said during recent testimony that offices like his want to get a roof over the head of all past servicemembers. But challenges still get in the way, such as pandemic relief drying up.

"We have a lot of veterans with a lot of needs. We're slowly running out of options here, and we just need a little bit of help so we can get that number to zero," he explained.

The bill has cleared both legislative chambers without opposition. But a primary sponsor says because of changes during the voting process, there's still discussion about final language - namely what the funding levels should look like. That suggests additional votes this session. There was chatter during debate about opening the floodgates for support groups for other causes.

Through its Supportive Services for Veteran Families program, Community Action Partnership of North Dakota says it handled an additional 70 cases last year. Of those seeking help, all were either on the brink of homelessness, or already without a home.

Max Pontenila, program specialist veteran and program specialist for the group's Minot office, said as they cobble together resources, they're balancing the need of building trust with clients.

"As veterans, and this is true even on a personal level, raising your hand saying, 'Hey, I need help,' that is a hard experience," he said.

Advocates suggest that hard experience could become more common if the resources aren't there. Nationally, the number of veterans experiencing homelessness declined last year. But there was a 7% increase the previous year, marking the first such spike in a while.

By Angela Hart for KFF Health News.
Broadcast version by Suzanne Potter for California News Service reporting for the KFF Health News-Public News Service Collaboration

As flames engulfed a nearby canyon, dozens of residents in a sober-living home fled to an unoccupied building about 30 miles south. The evacuees, many of whom were previously homeless, watched helplessly as their home burned on live TV.

When they awoke on air mattresses the next morning, loss set in. Some feared uncertainty. Others were jolted back to lives they thought they’d left behind.

“I had nothing but the clothes on my back. It just brought back all of those feelings of being homeless and a drug addict,” said one resident, Sean Brown. “Kind of like I was back at square one.”

The large two-story Altadena house, known to staff and residents as Art House, was surrounded by fruit trees and rugged mountains. For many, it was a safe space that enabled them to achieve and maintain sobriety, rebuild relationships, and hold down jobs.

Brown, 35, was among nearly 50 people displaced in January after the massive Eaton Fire destroyed one property and damaged another operated by the nonprofit Los Angeles Centers for Alcohol and Drug Abuse. Supported by public dollars, the organization provides housing and behavioral health treatment to people struggling with addiction, many who had been living on the streets. Operators say both properties are uninhabitable and that they are searching for permanent housing for those displaced.

“Our residents are still in temporary lodging. Right now we’re looking for something on an interim basis, but we still need to identify long-term housing for them,” said Juan Navarro, CEO of the nonprofit. “And we need even more beds. We’re seeing even bigger demand for treatment and services after the fires.”

In the weeks since one of the nation’s costliest natural disasters, it’s become evident that the Los Angeles wildfires have not only displaced people who had dug themselves out of homelessness and gotten into housing, but also dealt a blow to the region’s homelessness response. That far-reaching system of care formed by government agencies and local nonprofits has been buoyed by billions of dollars from the city, county, and state in recent years to combat California’s homelessness epidemic.

Now, wildfires are adding pressure to a system already under tremendous strain in getting chronically homeless people indoors. Homeless service operators and street medicine providers have been putting pressure on state and local leaders to allocate more funding to house people on the streets, but they are running up against competing demands for wildfire recovery — and tighter budgets.

“Many of the people we work with have already lost everything and they’re trying to rebuild their lives, and now there’s a whole other group of people doing the same thing and competing for the same resources,” said Jennifer Hark Dietz a licensed clinical social worker and the CEO of PATH, which provides services and housing for homeless people.

In recent years, state and local leaders have leveraged unprecedented investments to open thousands of shelters and temporary and permanent units. That’s helped Los Angeles County and the state notch meaningful gains, even as more than 187,000 people remain homeless in California, including 75,000 people across Los Angeles County.

The 2024 homelessness tally showed a 45% increase in the number of people who in the past year moved off the streets into permanent housing, and the number who moved from tents into temporary housing rose 32%, according to Va Lecia Adams Kellum, CEO of the Los Angeles Homeless Services Authority, which leads the countywide homelessness response system. That’s nearly 30,000 permanent housing placements across Los Angeles County.

And while homelessness rose 18% nationwide from 2023 to 2024, according to the most recent federal estimate, it increased only 3% in California. More strikingly, Los Angeles County reduced overall homelessness, albeit slightly.

The number of people living outside fell 5.1% in Los Angeles County, and in the city of Los Angeles, the number of unsheltered people dropped 10.4%.

That hard-fought progress is now in peril as the wildfires displaced tens of thousands of Los Angeles residents and destroyed more than 16,000 structures. Affordable housing, already in short supply, is being further strained.

Formerly homeless people who have experienced addiction, domestic violence, or mental illness now worry they won’t be prioritized for placements, despite losing their homes and qualifying for state and local homelessness initiatives to get people indoors. Many homeless people who have long waited for housing will be forced to wait even longer, as more displaced people face homelessness and compete for costly housing.

Homeless Again

It’s unclear how many formerly homeless people are homeless again. Street medicine providers and other front-line workers say some are temporarily living in hotels, while others moved in with friends or family members.

There’s evidence that some have fallen back into homelessness.

“We’re already seeing some people have moved into their vehicles because they don’t have the money to pay for even temporary housing,” Adams Kellum said. “Before the fires, we were already seeing very vulnerable people unable to manage their rents, so this competition for housing puts people at even greater risk for homelessness.”

Adams Kellum said coordinating resources and services across a vast region has led to major progress but that more money is needed to help move people from short-term to permanent housing.

For now, residents of the burned-down Art House will be allowed to reside in an empty building in Santa Fe Springs that the nonprofit had planned to redevelop for residential treatment, Navarro said. He said the nonprofit is looking for more stable housing for those displaced but that rehousing them at Art House remains out of reach for now.

Residents grieve the loss of the Art House’s transformative setting, which they call an “empowerment campus.” Brown said that he has embraced that ethos, even as he has been displaced and remains traumatized by the wildfires. He is currently working two jobs and taking classes toward a bachelor’s degree.

Paul Rosales, a 24-year-old in recovery from meth, said Art House was a place of healing. “That’s where I found myself; it’s where I built my recovery. There was a beautiful orange tree, and the mountains were just a short walk away where you could meditate and watch the sunset.

“It was away from Skid Row. I knew I was safe,” Rosales said. “That’s all gone now.”

Residents say they’re grateful they aren’t on the streets, but anxiety grows by the day, especially for queer and transgender people who had formed a community there.

“It’s constant stress of not knowing if I’m going to be in a stable housing situation,” said Alexandria Castaneda, 29, who was addicted to meth but got sober after getting indoors.

Battle for Resources

Sarah Hoppmeyer, chief program officer for Union Station Homeless Services, which provides housing for people on the streets, said she worries about dwindling resources. She and other providers stressed the importance of not overlooking people currently stuck in homelessness, many of whom have been waiting years for housing.

“We don’t want the wildfires to de-prioritize people who were already experiencing homelessness,” she said.

Elected leaders have pledged to preserve the gains Los Angeles County has made in reducing homelessness by allocating existing resources and demanding more. Several voter-approved initiatives in Los Angeles are critical, they say, but so too is lobbying for state support.

“Without continued and expanded support and resources, we risk losing ground” in reducing the number of people living on the streets, said Los Angeles County Supervisor Kathryn Barger, chair of the county board.

Previous massive fires have led to increases in homelessness, including in 2018 in Sonoma County and in 2024 on Maui, whose homelessness rate soared the year after fires.

State Sen. Sasha Renée Pérez, a Democrat whose district includes parts of Los Angeles County that burned in the wildfires, said she will continue pressing for additional homelessness funding as a member of the Senate budget committee. While Gov. Gavin Newsom’s administration says the state has plowed an unprecedented $27 billion into local homelessness response and prevention initiatives, he didn’t include any new money for battling the homelessness crisis in his proposal this year.

“Unfortunately, this year we didn’t see additional money being placed into that fund,” Pérez said. “But we have to keep making these investments.”

Newsom said Monday the state should not continue to “fund failure.” He said he is open to negotiations with cities, counties, and state lawmakers so long as any new homelessness funding comes with greater accountability, meaning that local governments use the money to clear encampments, dismantle tents, and reduce unsheltered homelessness.

Newsom officials stressed that the state budget is tight — it’s narrowly balanced and under greater strain than in previous years, with threats from the Trump administration and the potential loss of critical federal funding for programs such as Medicaid. The governor said he is “hopeful that we can land on an agreement,” but he warned the state could claw back funding if local governments aren’t adequately addressing street homelessness.

“We have been too permissive as it relates to encampments and tents. We need them cleaned up,” Newsom said. “We’re providing unprecedented support. Now we need to see unprecedented results.”

Assembly member John Harabedian, another Los Angeles-area Democrat, said additional homelessness spending is critical for wildfire victims and to continue combating the crisis statewide.

“Those folks who were already homeless, who just got into some sort of housing stability but then lost it again — they’re going to need immediate attention,” he said. “Our system is failing people.”


Angela Hart wrote this story for KFF Health News.


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There are only 26 affordable housing units in Colorado for every 100 low-income households, according to a new report listing Colorado as the sixth least-affordable state in the nation.

The report links the lack of affordable housing to decades of underinvestment at both the federal and state level.

Kinsey Hasstedt, state and local policy director for Enterprise Community Partners in Colorado, said rents and mortgages have become too high for many essential workers.

"We've seen for a long time wages not keep up with the cost of living here," Hasstedt pointed out. "I think this is particularly true for folks who are working in lower-wage jobs, often having to work multiple jobs."

Eight in 10 Coloradans who work in low-paying jobs -- in education, health care and the service industry -- spend more than half their income just to stay housed. Private developers have constructed plenty of homes for top earners and investors. There are currently 22,000 vacant housing units in metro Denver alone, more than five empty homes for every Coloradan experiencing homelessness.

The Trump administration has fired federal workers and frozen housing assistance funds as it works to remake government and reduce waste. Hasstedt noted ending HUD's Green and Resilient Retrofit Program would put existing affordable housing stock at risk of being turned into market-rate homes.

"If we lose funds like that federal program, that are able to help preserve buildings and their affordability, then the addition of any new affordable development is really just going to be kind of adding to a bucket that's leaking out of the bottom," Hasstedt argued.

Colorado lawmakers are considering measures aiming to streamline homeless support infrastructure and keep people from losing their housing, including domestic violence survivors.

Hasstedt emphasized it is important to be strategic when investing limited public resources.

"We really need to be targeting and prioritizing those funds to the households and the people of Colorado who need them most," Hasstedt contended. "What we have seen in recent years is an interest from lawmakers in directing those funds into serving higher-income households."


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