PORTLAND, Ore. – La atención de la salud no termina cuando una persona sale del consultorio médico. Varios factores externos del esquema tradicional de atención, como la vivienda, juegan un papel primordial en la salud general de una persona. Michael Mellick, administrador de casos de vivienda en CareOregon, dice que cualquier persona que experimente una falta crónica de vivienda, seguramente experimenta también otros problemas.

“Puede asumirse que caerán en problemas de dependencia de substancias, y tratamos de ayudarles con eso. Y seguido aparecen problemas de salud mental. Hay problemas de antecedentes criminales que deben ser resueltos.”

Enfrentar las determinantes sociales como una vivienda adecuada es obligatorio para las Organizaciones Coordinadas de Atención (“Coordinated Care Organizations”), que manejan el Plan de Salud de Oregon (“Oregon Health Plan”) en las comunidades locales. En Portland, seis organizaciones de salud –incluyendo “CareOregon" y “Kaiser Permanente”, lanzaron en 2016 la iniciativa La Vivienda es Salud (“Housing is Health”). Los fondos de ésta han sostenido dos desarrollos para propietarios de bajos ingresos, y otro proyecto está programado para abrir sus puertas este verano.

“Housing is Health” es parte de la respuesta de CareOregon a los problemas de vivienda. Los administradores del caso como Mellick ayudan a los clientes no residenciales a buscar soluciones para sus necesidades específicas. Describe a un cliente que había vivido en las calles durante dos años con una enfermedad pulmonar crónica. Dice que el hombre es viejo y está en una posición vulnerable, y que la vivienda le está ayudando a extender su vida.

“Sigue involucrándose en conductas que no necesariamente son las más saludables para él, pero su utilización y el costo de su atención decrecieron drásticamente por el simple hecho de que ahora duerme en un lugar cálido y seguro.”

Mellick dice que una amenaza frecuente para los clientes es el sentimiento de aislamiento. Puede venir de una variedad de fuentes, como un trauma en una edad temprana, o los efectos del racismo o la pobreza. Agrega que tratar esto podría contribuir a una sociedad mejor.

“No estás nada más acabando en el individuo – estás viendo su relación individual con la comunidad. Alivio, recuperación, renovación. Esto va hasta el concepto de las relaciones y el lugar de una persona en la comunidad.”

Construction will begin early next year on new affordable housing dedicated to low-income Oregon farmworkers. This project is the latest by the Farmworker Housing Development Corporation, a nonprofit that is partnering with Energy Trust of Oregon to make their housing more energy efficient. This year, the FHDC hosted workshops teaching more than 200 families how to save energy at home.

Ramon Martinez, communications and advocacy coordinator with the FHDC, said the payoffs are significant. Along with receiving more than $20,000 in incentives to help reduce energy use across their properties, residents' bills are down.

"During the cold months, some people are afraid to turn on the heater, right? But its been great because I've heard successful stories about residents seeing $200, $300 bills, lowering it down to the $100 range," he explained.

Research shows that most farmworkers in Oregon do not have access to affordable housing and often live in over-crowded conditions.

In Oregon and Washington, 32% of farmworker households live in poverty, which is more than twice as much as the general U.S. population. The Farmworker Housing Development Corporation manages 460 units across the central Willamette Valley, providing affordable housing to more than 2,000 people. Along with rental housing, it also helps farmworkers who are interested in becoming homeowners.

Christian Meneses-Zurita, senior asset manager with the FHDC, said it has hosted homebuyer resource fairs and recently started a fund to help farmworkers find housing and pay for education.

"Our affordable housing options can be a stepping stone," Meneses-Zurita said.

More information about the Ramon Ramirez Fund is at www.FHDC.org.

In early 2025, construction will begin on new affordable housing dedicated to low-income Oregon farmworkers.


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One life-altering situation turned a North Carolina woman's stability into homelessness and now, she is sharing her journey to humanize homelessness and advocate for solutions to affordable housing.

Tonya Adams-Ruffin, 54, never imagined she would end up on the streets. A combination of domestic violence and a work accident left her without a home, a situation from which she is still recovering as she transitions into new housing.

"That was one of the hardest things that I had to do," Adams-Ruffin explained. "Not knowing if someone is going to try and hurt you, not feeling safe."

With support from the Interfaith Council for Social Services, Adams-Ruffin is using her experience to lead and advocate for change. After receiving leadership training from the council, she has taken on roles such as working the polls in her community and raising awareness about the realities of being unhoused.

Another way Adams-Ruffin is raising her voice to dispel myths about homelessness involves creating signs to raise awareness, with messages like "We may be homeless, but we're not helpless." The signs are part of her larger effort to spotlight the struggles faced by homeless individuals, challenges extending beyond appearances to include barriers in accessing essential resources such as safety, food and shelter, even from organizations designed to provide them.

"Just because you're homeless, you don't want to have to be in a situation where you can't bathe, eat, lie down when you need to and feel safe," Adams-Ruffin pointed out. "What I would do is say, 'Look, we need to do more with affordable housing.'"

Adams-Ruffin stressed her advocacy thrives through partnership with the council, which helps her amplify her vision for community impact. She is also raising awareness about a national grant to support those facing homelessness.

Alyssa Hinton, voter engagement project lead for the council, said the organization is providing the resources and support Adams-Ruffin needs to make a difference.

"There is a national grant that is up for $25,000 for anyone who has faced or is facing homelessness right now," Hinton noted. "We are priming and prepping our members to be able to apply for that grant. We have ideas. We can get this money. We have a place to do this. Let's do it together."

In 2023, nearly 10,000 people in North Carolina were homeless on any given night.


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Low-income Montana residents are getting help accessing legal aid online.

In some cases, updates to automated legal forms could help residents facing eviction stay in their homes, and also assist people who need help with family law issues.

Montana Legal Services Association will use the $275,000 technology assistance grant to overhaul and redesign its most-used automated, online legal forms.

MLSA's Community Legal Education Coordinator Linden Howard-Murphy said the information from those forms will be integrated into the state's court systems.

"We know that not everyone can afford a lawyer, and we also know that navigating the court system on your own can be extremely overwhelming," said Howard-Murphy. "One of the cornerstones of our work here at MLSA is empowering Montanans with the tools they need to handle their civil legal problems pro se. Pro se means without a lawyer."

MLSA data show there is only one legal aid attorney for every 8,900 Montanans who need civil legal help. Howard-Murphy said upgrading the online forms will help improve those numbers.

Ron Flagg - president of the Washington, D.C.-based Legal Services Corporation, which awarded the grant - said streamlining the online help low-income Montanans can access could be the difference between staying in their home and being evicted.

"And if you're living on the edge, that means you're one medical expense, one fender-bender from not being able to pay your rent," said Flagg. "And having legal assistance available in those cases is a game changer."

The Legal Services Corporation funds 130 nonprofit legal aid programs nationwide.