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."

Recent surveys show a majority of North Dakotans want housing that allows them to live independently as they age. But there aren't a lot of suitable options.

Two architectural design winners hope to address that problem. This week, AARP North Dakota announced the winners of the state's first Missing Middle Housing design competition. The organization worked with several partners on this initiative, noting that older adults considering downsizing are often limited to staying in their costly single-family home, or moving into an apartment-like setting for seniors.

Agatha Frisby, owner of Prairie Centre Architecture, said her winning concept tried to showcase something in between.

"It still gave people that are potentially moving into these homes some individuality and some personal space," she explained.

Frisby's design emphasizes low-maintenance needs and efficient use of daily-living space, such as doing away with hallways and corridors. Affordability was another goal for participants. Project officials say these blueprints were drawn up with Fargo in mind, but could easily be pursued by housing developers and local governments elsewhere.

There was also a category for architectural students.

Noah Boen, a fourth-year architecture student North Dakota State University, saw his design finish in first place. He said some of the smaller details, such as having a front entryway that's functional for this population, could make a big difference.

"When they're getting ready to go out the door, not many older folks have a place where they can sit down, tie their shoes, and have a bunch of storage right next to the door," he explained.

Boen added that all the ground-floor windows are the same dimensions, hopefully making the construction process easier and not too costly for developers. A $5,000 cash prize was awarded to the winning professional design entry, and the student winner received a scholarship.

With housing prices nearly doubling in the last 10 years, the number of Oregonians who can afford to buy a home without assistance has dwindled and a new coalition has formed to change it.

The Unlocking Home Ownership Coalition is made up of more than 20 Oregon organizations, and is submitting plans to the Legislature to help address the problem. The plans include investing in affordable housing, assistance for first-time homebuyers, and closing the 15% homeownership gap for communities of color.

Shannon Vilhauer, executive director of Habitat for Humanity of Oregon, which is leading the coalition, said helping people get a home is the right thing to do.

"Some Oregonians have just done all the right things, right? Worked on credit repair, saving for a down payment," Vilhauer outlined. "And yet interest rates are high, wages have not kept pace with home prices, and sometimes we all need a hand up to enter this first-time homeownership market."

She noted people of color, especially African Americans, have a long history of being excluded from homeownership in Oregon. The state constitution originally banned Black people from owning land. Some were also denied benefits through the GI Bill, or were subject to redlining into the 1990s.

Vilhauer pointed out Portland is an obvious example of systemic racism around housing.

"That's a city where we did have redlining; where a highway was built through generational, African American foundational wealth, and that wealth was actively stripped from communities," Vilhauer explained.

Owning a home means having long-term, stable housing costs and is often more affordable over time than renting. Along with the financial benefits, Vilhauer added studies show kids who grow up in homes their parents own are more likely to graduate from high school and go to college and are more likely to own their own homes.

"When we talk about really generational opportunity and the springboard to being a fully contributing and supported member of the community, we really think that homeownership is a critical piece of that puzzle," Villehauer emphasized.

Heading into the 2025 session, Villehauer is optimistic with the number of state legislators making affordable housing a top priority, the coalition's proposals will move forward.

The faith-based nonprofit Our Calling is working with unsheltered clients in north Texas to create a long-term exit plan to help them rebuild their lives.

More than 4,400 unhoused people live in Dallas and Collin counties. A recent study by the Dallas County Health Department shows it costs more than $193 million annually to care for people experiencing homelessness.

Wayne Walker, founder and pastor of the nonprofit Our Calling, said in its 15 years of operation, it has found a lack of community sends people into homelessness.

"All of us have financial problems, and every single person has crisis in their life," Walker pointed out. "The difference between someone who's experiencing homelessness and one who's not is one of those people had a team of friends that they could call, family in their life, coworkers, and the other one doesn't."

He noted before COVID, they assisted about 15 people per week. The number has now increased to 75 people a week.

Walker explained data collected during the intake process helps them decide the best way to help the unsheltered person.

"We've built a technology platform that allows us to use artificial intelligence as we're looking at the best exit plan for this person," Walker stressed. "Traditionally, years ago, you'd send someone to a shelter or try to get them into some kind of government housing. Well, we would consider that two different exit plans, and in our system we have over 800 different exit plans."

Once a plan is designed and implemented, Our Calling stays in contact with the individual for a year to ensure they are in a healthy community with all the services and support they need to thrive.

They have also created the Neighbor Solutions app to help individuals assist anyone experiencing homelessness. Walker added it can be used by police officers, first responders and everyday citizens.

"Individuals across the U.S. will pull out their phones and open this app to figure out, 'Where is the closest shelter? Where is the closest domestic-violence center? Where can I feed my family?'" Walker outlined. "And that app is the beginning of a platform of apps we've put together to help not only the person experiencing homelessness, but the people that want to help those people experiencing homelessness."


get more stories like this via email