‘We have to just do it’: Providers, political leaders preparing push to house thousands more chronically homeless neighbors

September 25, 2017

Chair Deborah Kafoury, right, with Portland Commissioner Nick Fish, left, at a summit Sept. 14, 2017, on supportive housing.
Multnomah County and Portland leaders are working on a plan to dramatically expand “supportive housing” for thousands of the most vulnerable neighbors on our streets.

The Board of Commissioners and Portland City Council are both set to vote on the vision next month, officials said at a summit on supportive housing Thursday, Sept. 14. The multimillion-dollar plan would call upon a wide range of community partners to help produce at least 2,000 more apartments or vouchers by 2028.

Partners include Home Forward, state and regional agencies, housing developers, and health care, criminal justice and social service providers. The work builds on a recommendation to set aside 300 units from the 1,300 expected from Portland’s recently approved housing bond.

Supportive housing is sometimes the only effective strategy for people struggling with significant disabilities and long-term homelessness. Without it, many of them cycle through hospital beds, jail cells, shelter mats and sidewalks.

Units of supportive housing are deeply affordable and come with services attached. That helps ensure that people experiencing homelessness who also have a physical disability, mental illness or an addiction can rebuild skills and live independently. This fosters success for people who wouldn’t stay housed without services, or who wouldn’t stay connected to services without housing.

“We’ll never get there if we’re having conversations about which comes first, the chicken or the egg. Is it the housing or the health care? We have to just do it,” Chair Deborah Kafoury said at the summit, held at Central City Concern’s Old Town Recovery Center.

“We can build a Sellwood Bridge. We can build a new downtown courthouse. We can build the Orange Line,” she continued. “But we can’t house our most vulnerable citizens? That’s not the community I want to live in.”

“Unless you set a goal, you won’t get there,” Portland Commissioner Nick Fish said. “It’s time for us to set a bold vision.”

Supportive housing can save money

A recent study of the region’s homeless services data by the Corporation for Supportive Housing (CSH) found that Multnomah County is short roughly 2,800 units. That estimate is based on the number of chronically homeless neighbors reported in this year’s Point in Time Count.

Rebecca Ramsay of CareOregon speaks during a summit Sept. 14, 2017, on supportive housing.
Filling that need would all but double the nearly 2,900 units and vouchers available currently. The combined cost of building and sustaining that many units and vouchers would be about $413 million, the study found.

But regional and national studies have found supportive housing creates savings in health care, criminal justice and other services.

At an estimated cost of $24 to $54 per night, the cost of a supportive unit is a fraction of the nightly cost of an inpatient stay at Oregon State Hospital ($2,700), a trip to the emergency room ($2,000) or a Multnomah County jail bed ($200).

Moreover, Medicaid recipients who moved into supportive housing at Bud Clark Commons cost the Oregon Health Plan roughly $1,100 less a month than when they still lived on the streets.

“We think [2,000 units is] doable,” said Heather Lyons, an associate director at CSH and a former City of Portland homelessness programs manager. “It’s hard, but it’s not impossible.”

‘Working across sectors’

Home Forward, the Portland Housing Bureau, Oregon Housing and Community Services, El Programa Hispano Católico, the Oregon Health Authority and CareOregon were among the agencies participating in the summit.

Margaret Salazar, director of Oregon Housing and Community Services, speaks during a summit Sept. 14, 2017, on supportive housing.
They took part in a “fishbowl” discussion that gave providers and elected officials a chance to frankly talk through the upsides of supportive housing -- along with some of the barriers still in the way.

Cost is one of those barriers. Experts from Los Angeles County and the Seattle-area told of persuading voters to approve hundreds of millions of dollars for supportive housing, mental health treatment and homelessness services.

But many of those successful ballot measures involved increasing sales taxes. Oregon doesn’t allow sales taxes, and voters have repeatedly voted against adding them.

“You write that down,” Margaret Salazar, director of Oregon Housing and Community Services, said of sales taxes as a remedy, “and then you cross it off.”

As they work to raise new long-term revenue, or lobby for an infusion of federal aid, participants said they would also have to work harder to align the money they’re already spending individually on housing, health care, addiction treatment and employment services.

The units proposed in Portland’s affordable housing bond were held up as an example. The Oregon Health Authority and Oregon Housing and Community Services spoke about their work to produce housing connected with mental health treatment. And Central City Concern in August broke ground on a 51-supportive-unit project built in partnership with local hospitals.

Experts also said the medical and social services systems must do more to share data about patients. Providers need more flexibility to spend Medicaid funding on housing and housing assistance -- recognizing that some patients struggling with addiction or mental illness need stability just as much as treatment.

“To expect them to be able to manage their chronic medical condition, to get to their appointments and then get the medication they need to remain stable, while living on the streets, it’s just impossible,” said Rebecca Ramsay, executive director of CareOregon. “I don’t think any of us are going to solve this without working across sectors.”

‘It’s the most humane approach’

Supportive housing is often seen as a way to save money spent on so-called “high utilizers” of the medical, social services and criminal justice systems.

Patricia Rojas, director of El Programa Hispano Católico, speaks during a summit on supportive housing Sept. 14, 2017.
Ramsay said conversations often center around those clients because it’s one way to show results. But she and others said solving chronic homelessness and addressing instability means taking a wider look at the community.

Kari Lyons, director of the Welcome Home Coalition, said supportive housing could also be pitched as a cost-effective strategy for addressing racial disparities among people experiencing poverty and homelessness.

If more black moms are experiencing homelessness, she said, shouldn’t healthcare organizations and social services agencies also study how supportive housing can help cut costs associated with early-term pregnancies and improve early learning outcomes?

“Some folks cost just as much,” Lyons said, “but we don’t have the data.”

Patricia Rojas, director of El Programa Hispano Católico, said providers should remember that supportive housing isn’t just cost-effective.

“It’s the most humane approach to creating stability for individuals and families,” she said. “We have to make sure that, whatever we do, the voice of the community is at the center of it. Having a process that’s inclusive of those who are the most impacted will be one of our biggest challenges.”

Chair Kafoury said a vision for supportive housing will be tough -- but achievable.

She mentioned the initial trepidation around partnering with the City of Portland in the Joint Office of Homeless Services, empowering the community as part of the A Home for Everyone initiative, and committing to spend millions of dollars more on the work.

“We found the money. We found it by prioritizing. We have as much money as we need for everything else, it seems,” she said. “It’s hard choices. It’s not easy. Nobody wants to talk about making hard choices.”