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."

The Supreme Court case Grants Pass v. Gloria Johnson could upend homeless populations in Connecticut and nationwide.

The case centers around whether municipalities can fine or ticket people for sleeping outside when there is no shelter available. Connecticut had an eight-year decline in homelessness, but the last two Point-in-Time snapshots indicated it is rising again.

Sarah Fox, CEO of the Connecticut Coalition to End Homelessness, said ticketing and fining homeless people only harms them.

"It in fact prolongs their experience of homelessness," Fox asserted. "Once someone is engaged with the criminal legal system, it impacts and affects every other part of their life and their world."

She argued the state needs to work proactively to reduce homelessness, such as tackling the affordable-housing crisis. Connecticut has a shortage of more than 98,000 affordable rental homes. Fox suggested an interagency council on homelessness can ensure homeless people have better access to services and emphasized more funding will create a more effective system for sheltering homeless people. Homelessness has risen 6% nationally since 2017.

Ann Oliva, CEO of the National Alliance to End Homelessness, said affordable housing and services are key to ending homelessness. She stressed along with state- and local-level work, federal investments can help squelch rising homelessness.

"Investments by Congress in housing affordability, that means rental assistance for everybody who is eligible for rental assistance," Oliva stressed. "Right now, only one out of every four households that's eligible for federal rental assistance can get it because of funding challenges."

Based on the Supreme Court's ruling, she feels ordinances criminalizing homelessness could increase. Even so, Oliva added all three levels of government should be aware of actual solutions to curb homelessness.


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Residents in a rural North Carolina town grappling with economic challenges are getting a pathway to homeownership.

In Enfield, the average annual income is about $25,000, while the average home price in the state exceeds $300,000. The significant gap between income and housing costs makes homeownership unattainable for many residents.

Mondale Robinson, mayor of Enfield, said it is an issue with which he is all too familiar, having grown up in the town. He acknowledged the dire housing conditions faced by many residents.

"Housing there is third-world," Robinson asserted. "And I know that term is not politically correct, but I use it intentionally to remind people that while we may be in the so-called richest country in the world, my people are suffering from houses that are killing them."

He pointed out many people in the town are living things like severe mold or failing foundations. Recognizing the challenges posed by limited resources both on a town and federal level, Robinson explained he is tackling the issue by forming partnerships with construction firms and lending institutions. He noted through the Horizon Project, they aim to build energy-efficient homes priced affordably at about $105,000.

Robinson highlighted historically, the majority of Black residents there have been marginalized from experiencing positive changes in their neighborhoods. He explained previous investments focused on constructing homes that were unaffordable for the community. Robinson expressed optimism the initiative will serve as a foundation for achieving long-term equality and stability.

"We had a qualification seminar where we brought people in to see if they qualify for homes," Robinson recounted. "Of those 400 people that showed up, 174 already prequalified and have already started ordering their model homes and on the process to become homeowners."

He added families who qualify will receive smart homes with two to four bedrooms, an opportunity most people living on an hourly wage in the town would not have had access to.

In addition to the housing aspect of the project, Robinson emphasized the importance of economic development and sustainability. He said they will offer training to help new homeowners maintain their property.

He stressed another major part of the Horizon project is meant to help promote growth in the town and return ownership to the people who live there.

"When all of these new houses pop up in this rural space, we know what's to follow, businesses to follow," Robinson projected. "Also, we're looking for the mental victory that folk feel when they've purchased a home, alleviating the fact that you have a landlord that is not concerned with how your health is affected by the house you're living in."

By addressing housing affordability and promoting economic empowerment, Robinson hopes the Horizon Project will serve as a blueprint for similar initiatives across North Carolina and beyond. Qualified families will move into new homes by June, while ongoing support aims to assist others in future qualification.


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New York State housing advocates say they are furious about the so-called "good cause eviction bill" in the new state budget.

It grants tenant protections to people in New York City but all other municipalities will need to opt in. It also requires renters to know their landlord's portfolio to determine eligibility for "good cause" eviction protections and the information can be hard to find.

Ritti Singh, communications organizer for the group Housing Justice for All, said previous iterations would have balanced tenant and landlord interests.

"What it required landlords to do was to show they had a valid cause of eviction, which would include nonpayment, violating the lease, causing trouble, if the landlord wanted to move into the unit," Singh outlined. "It also allowed tenants to contest rent increases over 3%, or 1.5 times the rate of inflation."

For all its potential benefits, a New York University study noted "good cause" eviction comes with just as many drawbacks. It can discourage maintenance investments in buildings, and increase the cost of resolving landlord-tenant disputes. Singh noted the bill was not designed to crimp a landlord's ability to do business but to make the housing system fairer.

Cities like Rochester and Ithaca are close to declaring housing emergencies due to rising rents. Municipalities must have a vacancy study rate below 5% to declare a housing emergency. Singh pointed out the housing crisis affects renters statewide.

"Rents are rising faster in Syracuse than they are in New York City," Singh emphasized. "In March, rents hit record highs in New York City. Rural New York is expected to see a surge of evictions over the next decade, and Long Island renters face the highest cost burdens in all of New York State."

Newburgh declared a housing emergency last year but the Orange County Supreme Court recently overturned the decision. The petitioners' attorney argued Newburgh's vacancy study was inaccurate. The Emergency Tenant Protection Act does not cover the city's renters now and jeopardizes other tenant protections the city has proposed.


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