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."

A new design competition is looking to find better housing for Fargo's aging population.

Like many other states, North Dakota has a growing number of people increasingly burdened by their own homes. Oftentimes, they want to stay in their communities but their properties might be too large, too expensive to maintain or too unsafe to occupy.

Janelle Moos, associate state director of advocacy for AARP North Dakota, said there are not enough options for people looking to downsize.

"A lot of housing and zoning has really promoted single family homes or very large scale apartments," Moos explained. "We've kind of lost that middle ground to say, 'There are other types of housing that exist and can coexist and what people want, right?'"

AARP is asking interested architects, designers, builders and students to submit designs for those midlevel units, including a duplex, triplex or cluster subdivision. Moos pointed out the goal is to show off the viability of age-friendly homes and hopefully come away with some plans for future development.

More than 65% of North Dakota residents named housing as the state's biggest overall need in a survey last year.

The competition closes in early October and the winner is eligible for a cash prize. Moos noted people can then hire the designer, obtain a building permit and begin construction.

"The hope is that it's not just a conversation and it's not just a hypothetical," Moos emphasized. "We want to come away with several really viable, buildable, missing middle housing plans with universal divine design elements. So, by that I mean truly age-friendly."

Judges and advisers include government officials, design experts and architects from across the state. Nationwide, one group estimates a need for more than 800,000 senior housing units by 2030.

With rising housing costs an ongoing issue, a new report shows how fast rents have increased in Maryland and nationwide.

The National Low Income Housing Coalition's "Out of Reach" report shows that, even when accounting for higher state- and county-level minimum wages, the average minimum-wage worker in the United States would have to work 95 hours a week to afford a one-bedroom rental home.

Diane Yentel, coalition president and CEO, noted renters with the lowest incomes have faced a long-standing trend of rents rising faster than wages.

"Between 2001 and 2021, rents increased about 18%," she explained, "while household income only increased by about 3%."

In Maryland, the report found the fair market rent for a two-bedroom apartment is more than $1,900 a month, which translates to a Housing Wage of nearly $37 an hour, the ninth-highest in the nation.

The coalition said affordable rental housing isn't likely to be built without public subsidies. The availability of affordable housing is constrained in part by the high development and operating cost of new rental housing, resulting in market forces that drive developers to target higher-end customers.

The report shows the median monthly rent for new multifamily units in the third quarter of last year was more than $1,800 a month, while just 2% of new units had rents less than $850 per month.

As supply constraints drive costs higher, Yentel predicted the nation's housing crisis will worsen.

"Increased rents are resulting in increased homelessness," she insisted. "The U.S. Government Accountability Office has found that a $100 increase in median monthly rent is associated with a 9% increase in homelessness in that community."

For its part, the federal government's ability to build new housing has been limited since 1999, when the Faircloth Amendment capped the number of public housing units that can be legally owned by the U.S. Department of Housing and Urban Development (HUD).




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Backers of President Joe Biden's rent cap proposal said it could benefit many New Yorkers.

The plan calls for capping rent increases at 5% in apartments owned by corporate landlords, or those landlords risk losing federal tax breaks. It comes as statewide rents are rapidly increasing. As of this month, New York City rents are 147% higher than the national average.

Cea Weaver, campaign coordinator for the group Housing Justice For All, said capping rents could greatly benefit New Yorkers struggling with housing costs.

"Many New Yorkers are already benefiting from stronger protections than what Biden has called for," Weaver acknowledged. "But for places that haven't opted into rent stabilization, which is many, in upstate New York especially, this would be hugely important, since half the state rents an unregulated apartment and this is potentially a lifeline."

The rent cap plan will require approval from Congress. It includes the Department of Housing and Urban Development investing $325 million nationwide in "Choice Neighborhood" grants, to support building affordable homes across the country.

Syracuse received $50 million from the program to build 1,400 affordable units. It comes as 31,000 households in Onondaga County spend more than one-third of their income on housing.

Beyond Biden's plan, New York's own good cause eviction protections passed earlier this year can help tenants. Since becoming law in May, four cities have opted in to the program. Though some housing advocates were against making it optional, Weaver noted the protections it offers reverberate in cities taking advantage of it.

"Right now, tenants in New York State have the right to renew their lease unless their landlord has a good reason to deny a lease renewal," Weaver explained. "The statutory protection is to remain in their home. And there's a nix on rent increases if you're rent-stabilized; it depends on what your local rent board voted for."

She notes cities adopting good cause eviction protections are also protecting tenants from almost 9% rent increases. Rochester and some Hudson Valley cities are considering opting in to these protections.


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