Oregon health centers face funding, staffing challenges as they work to address homelessness


Shane Ersland


While Oregon lawmakers have invested hundreds of millions of dollars to address the issue, homelessness continues to present complex challenges for the state that are not easily solved. Stakeholders discussed additional efforts intended to help those in need at the 2023 Oregon State of Reform Health Policy Conference. 

Julie Akins, senior director of housing and community liaison at AllCare Health, said it’s vital to look at the economic reasons that lead to people becoming unhoused. 

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“If you’re making $15 an hour—that’s what people are making working in retail (and) fast food restaurants—if you’re fortunate to work full-time, which most people aren’t, you’re bringing home $2,000 a month after taxes, when the rent is $1,700 a month,” Akins said. “It’s math, and it’s how people wind up on the street.”

Sarah Holland is the senior director of supportive housing and employment services at Central City Concern, a federally-qualified health center (FQHC) that serves about 13,000 Oregonians. It operates about 2,800 housing units for those in need.

“We have everything from dorm-based stabilization shelters to permanent supportive housing, and transitional programs in between,” Holland said. “We have programs specifically designed for veterans and those leaving incarceration. We also work extensively in the recovery community. And we offer employment services. We have programs such as Clean Start.”

Central City Concern, like most healthcare operations, faces workforce challenges, however. The FQHC opened six new buildings—mostly consisting of Housing First models—in the last 18 months.

“I’ve had almost complete turnover in the workforce in those buildings. It is more expensive to do this work than it has ever been before. We’re taking losses in these programs because it’s the right thing to do. And we’re accepting the reality that I’m hiring completely inexperienced, well-intentioned people, and I have to train them from scratch. That’s the reality of CBO (community-based organization) capacity.”

— Holland

Akins said the allotment of GHAP Capacity Building Program grants could help CBOs address their staffing challenges.

“That’s money for staffing and office infrastructure that I’m hoping will be helpful for CBO staffing,” Akins said. “One of the things we’re finding as a CCO (coordinated care organization) is it’s hard for us to find providers, doctors, nurses, phlebotomists, (and) administrative staff. It’s hard to attract them because they can’t find a house. So we’re even talking about building our own housing for these folks so we can have more workforce housing. And other businesses are doing the same.”

Holland said Central City Concern recently started offering paid internships for peers. 

“They get their certification hours, then go and spend three months in our programs working with our peer staff and getting experience,” Holland said. “And then we help them find jobs, sometimes with us, and sometimes someplace else. That’s a small step we’ve taken in helping with workforce development.”

Central City Concern is also launching an initiative in which it employs Oregonians working to get their certified alcohol drug counselor (CADC) license. 

“We are helping individuals who are exiting houselessness, who have lived experience, get their CADC paid for, and be able to get a living wage while they are getting their certification. There’s a lot of opportunity for innovations like that. It’s a huge investment and we take on a lot of responsibility to get those certifications. So as much as we can make those pathways easier, and take away that financial investment on the front end, is going to help with shifting that vast need of people with training.”

— Holland

Multnomah County Joint Office of Homeless Services Director Daniel Field said Gov. Tina Kotek’s multi-agency housing collaborative will help address homelessness in Portland. 

“The one in the Portland area includes stakeholders who haven’t been at the table before around health and housing issues: the city of Portland, the county, the city of Gresham, nonprofits, (and) CareOregon,” Field said. “And the idea is to look at specific sites. We looked at a site under the Steel Bridge, and we’ll look at a site in Gresham [along the Columbia River where homeless people camp]. And we’ll think about what it takes to move people into housing.”

Field would like to see more funding become available for mobile medical care as well.

“Mobile health has happened way slower than it should have,” he said. “Why every CCO in the state doesn’t have a highly active mobile or remote health program is beyond me. They should, regardless of size, whether it’s one caregiver one day a week or a fully-staffed van. I’m hoping that’s one area of collaboration in the coming years we can leverage in Portland. That seems very fundamental to me.”

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