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.”

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.