Michelle Hudnall is back indoors after living in a tent for five years.
In 2011, she became one of the original residents of Bud Clark Commons (BCC), an innovative Housing First development in Portland, Ore. She was No. 14 at the 130-unit property, a number she still remembers three years later.
Accepting the keys to a new apartment may seem like an easy choice to make, but it’s a hard adjustment after so many years outside, Hudnall says.
Strangers were offering her a place to live, social services, and connections she hadn’t had in years. While wary about the opportunity, the former school custodian moved into an apartment, bringing with her a couple of backpacks of clothes and her trusty black Labrador, Kyrra.
Hudnall, who, at 46, has survived everything from drug use to a nasty assault while homeless, has slowly come around and continues to call BCC home.
“They brought me back to life,” she says.
A reduction in Medicaid costs
Developed by Home Forward, the region’s public housing authority and the largest provider of affordable housing in the state, the eight-story development has meant stability for the people who inhabit it.
In addition to Hudnall, there’s Jeff Beaudry, who used to live in a storage unit. He’s on methadone and working with counselors. There’s also Mary Jess Darby, who was able to move out of a chaotic apartment she shared with 10 people.
On the surface, BCC gets Portland’s most vulnerable men and woman off the streets and into their own homes.
A deeper look shows that the development is doing even more, including significantly slashing health-care costs incurred by its residents, a benefit that extends far beyond the building’s property lines.
“It speaks to housing being a health-care intervention,” says Rachael Duke, supportive housing program director at Home Forward. A 15-year veteran of the agency, she’s been with the Bud Clark project from the start.
Researchers recently studied 99 of the development’s residents, examining both self-reported and Medicaid claims data.
They found that in the year after residents moved into BCC, the residents’ average Medicaid costs declined by a whopping 45 percent. In the year before moving in, Medicaid residents averaged spending $1,626 per month on health-care costs. In the year after moving in, those costs fell to $899 per month and continued into the second year.
In just the first year, total Medicaid cost savings exceeded $500,000, according to the study, by The Center for Outcomes Research and Education at Providence Health & Services.
While residents like Hudnall can attest to feeling better than when they were homeless, the study puts their improving health into hard numbers. It shows cost savings from residents avoiding acute health crises and reducing the number of inpatient and emergency-department visits while increasing their connection to outpatient behavioral-health, primary-care, and pharmacy services.
“People are accessing less-expensive, earlier, and more appropriate health care,” Duke explains.
The findings are important because they make a dollar-and-cents case for supportive housing, particularly when advocating for flexible programs for the homeless. Other studies of Housing First developments have found similar results.
The findings also make a link between housing and health, an important connection that raises the potential for new housing models and funding opportunities.
The BCC study focused on health-care costs, but there may be additional savings achieved in other areas, as well, such as the criminal justice system.
Housing at work
Designed by Holst Architecture of Portland, BCC is a sharp-looking building at the foot of the Broadway Bridge. Bright green accents provide splashes of color inside and out, and large windows let natural light shine throughout the building.
It’s earned multiple honors, including the American Institute of Architects and the Department of Housing and Urban Development’s Creating Community Award.
The building has three distinct uses: In addition to the permanent apartments, there is a day center for the homeless and a 90-bed men’s shelter operated by Transition Projects. Each use has its own separate entrance. There are also plans to build a new headquarters for the Multnomah County Health Department next door.
BCC didn’t come cheap. The cost was about $46.9 million for the entire development. The city contributed $29.5 million in tax-increment financing, while low-income housing tax credits allocated by Oregon Housing and Community Services generated $11.7 million from Wells Fargo. The project also received $3.3 million in gap financing made available through the American Recovery and Reinvestment Act of 2009.
Named after a former Portland mayor, BCC is the cornerstone of the region’s 10-year plan to end homelessness.
The apartments follow the Harm Reduction and Housing First approach, moving people off the streets or shelters into housing as quickly as possible without preconditions of treatment acceptance or compliance. In a change from traditional housing models, residents are not required to be clean and sober, but they are expected to adhere to general lease and community rules. The idea behind Housing First is to stabilize people’s housing immediately and then offer services, which can be more effective once recipients have a home.
BCC residents are selected based on their vulnerability, including health issues, rather than their place on a waiting list.
Because the development serves a difficult population, not all the stories come with happy endings. BCC loses about two people a month, including some to lease enforcement and some to death.
Residents pay 30 percent of any income they have for rent for their studio apartments.
The building has both practical and sustainable touches. On the gritty, pragmatic side, there is a “hot room” where residents’ belongings can be heated to kill bedbugs. Green features at the LEED Platinum building include a graywater-harvesting system and solar panels on the roof to heat water.
What’s most important, though, is what goes on inside. Home Forward staff and partner organizations provide a wide range of services that are likely contributing to the Medicaid cost savings.
Last year, more than 70 percent of residents participated in case-management services, 84 residents were enrolled in mental health services on site, and 41 participated in treatment services.
It starts with housing, says Duke, but the mental health services rank among the most important.
The city, a key partner in the development, provides approximately $240,000 a year to fund supportive services.
The BCC team recently introduced a wound-care clinic that’s offered twice weekly to help residents address skin issues. It’s funded through a Health Commons Grant from the Center for Medicare and Medicaid Innovation and administered by CareOregon Advantage.
It’s a move that deepens the services at BCC, one more link between housing and health care.
“What’s best about the changes in Medicaid costs is that they equate not to less care but to more appropriate and timely health care,” Duke says. “That means we can invest more in housing and less in emergency medical care. It’s also led to residents reporting they are healthier and happier.”
To read Integrating Housing & Health: A Health-Focused Evaluation of the Apartments at Bud Clark Commons, visit http://go.hw.net/AHF1114Bud.