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."

In the past two years, homelessness in America has risen only 1%, according to the U.S. Department of Housing and Urban Development - which nonetheless reports a divide between urban and rural areas. In New Mexico, homelessness declined by one-third in the past decade, according to a summary delivered to state lawmakers by the Legislative Finance Committee.

Jeff Olivet, executive director of the U.S. Interagency Council on Homelessness, said having enough rent to stay housed requires finding a job that pays a decent wage - often harder in rural areas - where even a 10-mile distance can be a huge barrier.

"To get from a place that's affordable to live to a job that pays a living wage - if you don't have a vehicle - there's just not the public transportation infrastructure or any way to get there," he said.

New Mexico's emergency homeless shelter capacity has more than doubled since 2016, with progress especially noted in Albuquerque. The report to the Legislature showed that on any given night, New Mexico has about 2,600 people who are homeless.

Like many other states, the supply of affordable housing in New Mexico has declined - by 50% over a recent 20 year period, according to the recent report. That makes finding housing especially tough for individuals struggling with mental health and substance-abuse issues, and in those cases treatment is often only available in larger cities such as like Albuquerque or Santa Fe, according to Olivet.

"In many rural parts of the country, rural New Mexico for example - where's there's just massive distance, even if they're wanting to get treatment, ready to go into treatment - there's no place available within 100-miles, 200 miles," he said.

The HUD report showed during the pandemic, economic stressors and the dramatic increase in rental costs drove homelessness upward, but large investments by states and the federal government through the American Rescue Plan reduced the overall numbers nationwide.

The Nevada Housing Justice Alliance, tenants, lawmakers and community leaders gathered at a news conference outside the Capitol in Carson City this week to rally for legislation to expand legal protections for renters and increase rent control.

According to lawmakers, Nevada rent prices soared above the rest of the country last year. They said access to affordable housing is a top issue facing families.

Assmeblywoman Shondra Summers-Armstrong, D-Las Vegas, said her bill, Assembly Bill 340, intends to change the summary eviction process. Currently in order to challenge an eviction in Nevada, tenants must make the first court filing. She said changing this would allow renters a chance to defend themselves.

"Something must be done," she said. "We cannot move forward another legislative session pretending like we don't have a crisis. We have a crisis."

Summers-Armstrong said her bill aims to change the procedure so that landlords would first have to go to court to have a tenant evicted, and provide them with plenty of notice to answer the complaint. She said it creates a more "fair legal process."

There are a number of bills that aim to provide solutions to what some see as an afforable housing crisis. Sen. Pat Spearman, D-North Las Vegas, said her bill, Senate Bill 363, prioritizes housing for women veterans, women who were formerly incarcerated, those recovering from domestic violence - and senior women who are housing insecure.

"They are four times more likely to not have a place to stay than their peers," she said. "As a matter of fact, those four groups are the highest, the fastest-growing, homeless groups in the United States."

Spearman and other lawmakers are pushing for legislation to keep some of the state's lowest-income residents housed, while also aiming to prevent an eviction crisis as federal dollars distributed for rental assistance during the pandemic are set to expire.

A recent report examines Connecticut's eviction crisis and addresses some solutions to it. The report from Connecticut Voices for Children finds 39% of renters in the state who were not current on rent payments felt they would be evicted in the next two months. That rate was higher for Black and Latino renters, reaching 54% and 56% respectively. The report also finds high absenteeism rates correlate to some kids facing housing insecurity. But, the report takes a look at some short-term policy recommendations to help renters in the state.

Samaila Adelaiye, research and policy fellow with Connecticut Voices for Children, said one of the primary areas of focus was income support.

"When it comes to income and income equivalent supports, we make recommendations for making the Connecticut property tax credit fully refundable and available to renters. Because while renters indirectly pay property taxes, they do not have access to relief through Connecticut's property tax credit," Adelaiye said.

He added they support different pieces of legislation addressing tenant protections. Other recommendations in the report include increasing funding for rental assistance, making a state child tax credit permanent, and sustaining funding for the state's Right to Counsel program. This report is one of a two-part series; the second report will address more long-term solutions.

Although the report provides avenues for alleviating Connecticut's eviction crisis, there are additional questions it raises. Adelaiye noted most of these revolve around renters in the state having enough money for other necessities outside of rent. He said there are numerous issues coming out of the state's housing crisis.

"We know that evictions particularly are the product of the housing affordability crisis is causing more socio-economic harm, increasing financial strain leading in some cases to homelessness."

From here, Adelaiye said the high cost of housing must be addressed, with rent caps being one way to do that. Currently, Connecticut Senate Bill 4 would have included a rent cap, but that was eliminated while the bill was in committee. However, should the bill pass, it will allow for a series of tenant protections including a winter eviction moratorium, making it illegal to evict anyone from December through March.