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.”

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."


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