Where you live is directly connected to how long you live and how healthy you are along the way.

Tonight on Health Matters, a report from the Spokane Regional Health District identifies housing as one of the county's top health concerns, and our region is feeling the weight of it.

What does that mean for the health of our entire community and what's being done about it?

Good evening, I'm Aaron Luna.

Most of us think of health as something that happens in a doctor's office or an emergency room.

We also know where a person sleeps at night, whether their home is safe and stable, and health care accessibility.

Those things greatly shape health outcomes.

A recently released report by the Spokane Regional Health District, in partnership with Providence and Multi Care, identified housing cost burden as one of the top three health priorities for Spokane County.

Joining us tonight to help us better understand what this means for our community.

Jazzy Landes is research scientist at the Spokane Regional Health District.

Dawn Kinder director of neighborhood housing and Human services for the City of Spokane.

And Doctor Robert Lippman, Providence Community clinic manager.

Thank you all for being here.

And, Jazzy, let's start with the report itself, the 20 24-25 Community Health Needs Assessment from Spokane Regional Health District.

Who puts it together and tell us why it matters?

Yeah, so the community health needs assessment or the C H A is a giant study of our county's health and well-being.

And it doesn't look at just people who live here.

But it's people who live, work, learn and play here, people who come here to receive health care.

So it includes anyone who has a stake in the health and well-being of of folks in the care system in Spokane County.

So we work with Multi Care, Inland Northwest and Providence, Inland Northwest.

And our partnership is meant to really help surface what are our health needs in our county and what are the assets that we have.

And the reason why we look at both of those things is because it helps us to understand how can we leverage those local resources to solve our local problems.

And what does the report specifically say about housing in Spokane County?

We know that housing is a big issue for a lot of people.

When we look at housing by housing type, we have people who are homeowners, and those homeowners either have a mortgage or they don't.

And then we also have renters.

We know that about half of renters in Spokane County are considered housing cost burdened.

And this is when people spend 30% or more of their monthly income on housing costs.

And we understand that that's a challenge for people, because the more money they spend on housing, the less money they have for other necessities.

And so renters have a 50%.

50% of renters have, cost burden.

But we also know that only a quarter of homeowners with, mortgages have cost burden.

And it's even less than that.

Roughly 15% of homeowners with, no mortgage have cost burden.

So we know that there is inequity by the type of housing that you have.

And Dawn from the city's perspective, what's a health income to rent ratio.

And as a city have we ever been at that point with a healthy income to rent ratio.

Yeah.

So as Jose mentioned we typically consider less than 30% of your monthly income should be able to cover your housing costs.

Spokane was on, a fairly, you know, accurate trajectory with that pre 2015.

From 2008 to 2012, we had low vacancy rates, which helps control the cost.

From 2015 to 2020, we saw that really shift.

And Spokane matched national trends.

Right.

By 2021, about 50% of individuals were cost burdened with housing in Spokane.

Follow that arc.

So we certainly there was a point where Spokane was able to kind of say they were relatively affordable.

We've certainly left that behind.

And our vacancy rates now stay quite low.

We're still averaging 1.8 to 2.4% in vacancy, which is not conducive to affordable housing cost.

Yeah.

Ask anyone who's looking for a place to rent, and they'll tell you how difficult it is.

Absolutely.

And, Doctor Lippman, why is housing considered a health issue at all?

What is the connection between where someone lives and how healthy they are?

I mean, you know, I come from, the, the, the stance that housing is healthcare, right?

And so there are a lot of drivers, that determine someone's health outcomes as well as the, burden of treatment, that comes along side of, our expectations as, as clinical providers, that we place on a patient that's experiencing homelessness.

And so there are a lot of indicators that feed into, what the National Health Care homeless, council indicates is that there's a 20 year, life, you know, expectant rate that's dropped, basically, so you can subtract 20 years off of someone's life, from experiencing homelessness in itself.

So there are a lot of key drivers and environmental stability, kind of brings all of that opportunity, for someone to live a healthy lifestyle and manage that, in a stable environment.

And when we talk about housing cost burden, we're not just talking about people who are homeless.

We're also talking about people who are housed and barely holding on.

What health risks does that financial stress create?

I mean, there's a lot of, risk associated with length of stay, within the hospital system specifically.

You know, to give you an example with, you know, the partnership that we've created with the respite center.

I can give you an example of a patient, who has had a length of stay of 115 days.

We took that patient into the respite center.

Healing hearts.

And they had, another 145 days with us before that patient was successfully discharged into a higher level of care.

So we ultimately saved the hospital system 145 days of care, where they would otherwise have no other option.

Well, let's talk about the end of that spectrum.

Homelessness.

The 2025 point in time count found more than 1000 people in sheltered housing in Spokane County, meaning they're living in shelters or in transitional housing.

Now, that number is down by about 400 people since 2024.

And Dawn, what does that data tell us apart from just the basic numbers that we're seeing?

So we at the city, you know, really use the point in time count to look at trends, right?

This is a one night, or several night snapshot, depending on the shelter versus unsheltered count.

And it's looking at really our most crisis level intervention.

So we're talking literal homelessness, emergency shelters and transitional housing.

Spokane has very limited transitional housing, which we'll talk more about later, I'm sure.

But really what we want to see is those trends.

You know, we want to see fewer people experiencing literal homelessness, which is the unsheltered count.

But overall, it's not a reflective look at what the homeless system in whole is doing.

What do you think about projects like Robert just mentioned, the Healing Hearts Respite Center and the variety of other interventions on the street.

What we count in that point in time count is a fraction of the intervention serving the homeless population, and accounts for roughly a third of the people we actually serve on an annual basis.

So it is a snapshot of the most crisis level of care.

And we certainly use that data to inform decisions and investments.

But we lean more, intentionally on our regular annual data from project performance to really identify how are we doing as a community.

And what kinds of outcomes are we seeing with people as opposed to just counting them?

Right.

But those are some of the numbers that are the most public facing.

There are absolutely a very public facing tool, and there's a lot of interest in that on an annual basis, which we completely understand.

I think sometimes the the visual ness of homelessness is really that acute street population.

And the point in time counts certainly answer some questions specific to that group of people.

And what are the most common pathways that lead to homelessness.

Is it usually one big crisis.

Does it build over time.

What are you seeing out there.

You know I'm not sure if we asked that in the 2025 point in time count in the 2024 point in time count, we did ask specifically about people's, self-reported cause of homelessness, and it runs the gamut.

We certainly see things like compounding affordability, right?

Not just the affordability of housing, but you add health care costs, child care, lost wages.

The compounding effects around affordability, certainly things around individual tragedy and trauma, generational poverty.

And of course, you see mental health and behavioral health enter the scene as well.

But it's a wide variety of reasons that any individual family would find themselves homeless.

And there's a population that doesn't always come to mind when we picture homelessness and that seniors.

And what are you seeing with older adults in Spokane?

You know, we've gotten this question a lot lately.

And so we polled both the 2024 and 2025, both the longitudinal systems analysis data, as well as the point in time count data.

They reflect a similar number, but two different kind of groups of interventions.

We tend to see 19 to 22% of people being served over the age of 55.

Most of them are in that 55 to 65 range, but about 5% of them are in that 65 plus.

I know a lot of our scattered sites have seen an anecdotal increase in individuals over that 65 age.

And so we are seeing housing affordability, and the stagnated, you know, SSI type income streams kind of coming into conflict.

We certainly hear to from some of our senior serving agencies that even those who are not facing a mortgage payment are overburdened with property taxes they can no longer afford, which is forcing people into housing instability.

So we're seeing more seniors find themselves on that brink.

And then unfortunately, some of them are actually finding their way to an emergency shelter.

And Doctor Lippman, in your work at Providence Community Clinic, tell us about the people that you serve.

Yeah.

As, walk in, you know, we consider ourselves a walk in safety net and ultimately a legacy clinic.

You know, that primarily serves those experiencing chronic homelessness.

So single adults.

Right?

So when you know, you mentioned, you know, when we talk about homelessness, sometimes we have this misconception to generalize a bulk of information as a whole, population group when actually it's broken down into different, age categories, families, youth, veterans.

You know, these are all different subgroups of a population.

Our clinic specifically, we serve, single adults, as well as serving those in the community from an outreach perspective.

So bringing health care, to where the patient is with this partnership with, healing hearts respite.

And in your experience was when someone without stable housing gets sick, you are an option at the clinic.

Where else can they go?

There are not a lot of options.

I mean primarily referrals into respite either come from the Providence Hospital network system.

Comes from our clinic, Providence Community Clinic.

We've had, referrals come from Saint Luke's as well for patients being ready for discharge.

But ultimately, you know, we're utilizing respite as a tool, to capture patients being discharged from the hospital who may present to be stable upon discharge, right.

With Emergency Medical Treatment and Labor Act describes the transfer of care, ensuring that someone is stable.

Well, when they reach their destination, if that's in a shelter location or in a respite center, oftentimes they have a changing condition upon that transfer.

And so our support, our clinical support is really to continue that stabilized condition once they reach, an environment that's suitable, to provide them a more longitudinal support to recover from their health condition or manage their chronic health condition as well.

That's another aspect that is a lot of, homeless health care service delivery focuses on acute care needs, where these are, some individuals, you know, experiencing homelessness for a while, for years.

We have these built up chronic health conditions that haven't been managed.

Just from systematic barriers, and then other priorities from someone experiencing homelessness.

Right.

There are other priorities other than getting, you know, making a specific appointment, you know, a specific day, a specific time out of the week.

And you kind of gave an example earlier, just talked a little bit more about what the impact that that makes for our health system as a whole.

The I mean, the impact with the health system as a whole, I think it's, you know, better, or you see the effects of it more so on the population group itself, the health care system was designed for most likely someone who's housed someone, you know, who who, doesn't have to juggle all these physiological needs, like food insecurity, housing insecurity, clothing insecurity, all these different, types of barriers.

Someone experiencing, you know what?

We're what we're able to what we're able to see is that, The system itself is tailored for individuals who are housed, not necessarily someone experiencing homelessness.

So there are certain policies in place as well within the health care system, that prevents someone from accessing care.

That's a big priority within the health care system is access to care.

So how can we better create access, especially with a mission driven organization that I work for?

How can we create access for our most poor and vulnerable, on the streets, experiencing homelessness?

So that's what the legacy of our clinic was.

You know, how it was produced and how is incepted back in 76 by Sister Peter Claver.

Nice and jazzy, beyond the direct health care cost, how does homelessness and housing instability affect the health of the broader community?

When we think about homelessness, we often think about, we think about it at the individual level or the household level.

But the reality is that our community is made up of many households, and what we experience at the household level rolls up to the community level.

And so when we have things like, financial stress or chronic stress that feeds into our mental health and our physical health, it increases the demand on the health system.

We also see things like, even just with homelessness, we'll see higher utilization of emergency services or with emergency care and they're accessing the types of care that they can.

But the reality is that when these things happen, it affects everybody in our community.

And so, even if you're not affected by an issue, right, say you're not a renter.

And so the 50% of renters who are housing cost burdened, you may not be able to connect with that, but in reality, you are experiencing that because those conditions shape the conditions of our community.

So in every way, whether it's, another household's health or another population's health, we are part of the same economic system.

We are part of the same education system.

So all of the systems that we appreciate in our community that we utilize in our community, what one group feels, we also feel, even if that's invisible.

And what is the cost to the city in terms of services, emergency response, public resources when people don't have that stable housing component?

Yeah, I think the city certainly whether it's, you know, public safety, first responders, are certainly engaged in that system.

We partner very closely with law enforcement and fire, we've recently done a lot of investments to the opioid, settlement funds to try and get more care onto the street to identify folks, you know, in real time.

And there is a burden placed then on those responding agencies, because we do have folks in distress.

And I think to to Jazz's point and is a community response, I think part of why we've made some strategic pivots to try and decentralize services, where it makes sense is to try and make sure that the entirety of the community is participating in the solution.

But we absolutely have secondary impacts that the city experiences, whether it's financial or otherwise.

Based on individuals who are experiencing the trauma of homelessness.

We've been talking about the scope of this problem.

Now let's talk about solutions that are working right here in Spokane as part of Providence's Community Health Improvement Plan, which directly responds to the findings in the report.

They have partnered with a local organization to create a unique kind of care for people experiencing homelessness.

On a noisy street corner in downtown Spokane.

Providence Health Clinic is quietly celebrating its 50th anniversary.

It was the first free clinic in the state of Washington.

That's a big legacy that I think needs to be celebrated and and be shouted across the community.

The doctors and nurses inside, providing a service that often goes unnoticed by the general public.

We see a lot of frostbite.

Trench foot.

We see a lot of sun exposure in the summertime.

Heat stroke and things like that.

We see a lot of chronic disease.

We see a lot of folks who, because of their lack of, having a home to stay in, have very, great difficulty in managing chronic conditions.

Anyone can use the clinic.

Medical director, Doctor Sima Eisen has been practicing medicine for 40 years and has been with the clinic almost ten years.

I always say in internal medicine, you think you've seen everything until you see something new.

She says the vast majority of people being treated right now have vastly different issues than 10 to 20 years ago, and a lot of our patients have both drug issues and mental health issues, which become real challenge, especially if they come here and their schizophrenia is out of control.

So they may be thinking, someone I'm not, or hearing voices or that or the drug use, they come in here and they are intoxicated or high.

The health clinic strives to meet patients where they are addressing their unique health issues.

If we get sick, we get a cold.

What do we do?

We go to bed.

Let's say you live on the street and you get a just a mildest of illness.

You have no place to heal.

And to me, that was very profound.

There's also a large need for people experiencing homelessness, leaving the hospital to find a safe space to recover, because the folks coming out of the hospital cannot go directly from a hospital to the shelter system.

Julie Garcia is the executive director of Jewelz Helping Hands, which has been operating the Healing Hearts Respite Center at Westminster Church for a year now.

And then they come in, they see doctors, they see nurses, they get on a care plan and we, the doctor and Providence, decide how long somebody needs the space for.

And then we we work towards that goal.

The respite center is operated in partnership with Providence and works closely with the Community Health Clinic.

The hospital can no longer keep them there.

They just go out to the street.

And that is it's an inappropriate place for people in this condition to go to people who have just had legs amputated or have pneumonia.

People with dementia who don't know how to manage their care.

This is how we get people dying super easy on our streets.

Mental health and addiction are a common factor shared by the people experiencing homelessness that filter through the respite center.

Another growing population needing this type of care.

It's absolutely growing because the biggest population flowing into homelessness now is our elderly population.

The respite center is oftentimes the only option for patients leaving hospitals, because homeless shelters don't have the tools and services these patients need for a successful recovery.

There's no pathway from the hospital to a shelter that doesn't stop at a place like this.

The work is not easy, and the need changes with the community's health issues.

Along with the challenges come successes, sometimes the smallest ones making the largest impact.

And he came back probably 4 or 6 months later, and I just happened to be in the clinic, and he came and he hugged all of us because not only did his frostbite cure, but he stopped drinking and he got housing, and he apologized for how mean he was to all of us.

Like, he's like, I'm better now.

I'm housed because I was able to get my medical taken care of.

I never had to go to a shelter.

I was able to move from integrated medical respite into a nursing home, and I could finish my treatment there.

And he said, now I have my own apartment.

I love this population.

I really, They are.

When you are able to help somebody who is, has been so traumatized in the past from a number of different things, it's just so wonderful to hear from someone.

Thank you for treating me like a human being.

And Doctor Lipman, you're the clinic manager for the community clinic.

Walk us through.

Why that bridge between hospital and shelter is so critical.

It goes back to that burden of treatment, right?

What?

What is the expectation of this patient?

To follow up with their care plan post discharge from the hospital, right.

Is the expectation that they make that schedule appointment a month down, the month down.

The road at 3:00 in the afternoon?

That's a pretty high expectation with with someone, you know, experiencing homelessness, living on the street and knowing where you're going to get your next meal, where you're going to stay that night.

Especially with with the individuals that we're seeing within respite.

This is, you know, our average age.

Throughout 2025 was 57 years old.

And then there's another, age demographic as well within our clinic that we see that's younger.

And so we're seeing within, you know, that hospital discharge process.

An older population group.

And when you tie in that factor, I'd mentioned earlier of a 20 year, you know, decreased life expectancy.

You know, that's someone, who we need to keep on our radar as far as following up with their care.

And what's the reality of the situation where someone who leaves the hospital and doesn't have a place to go, like respite care?

I mean, it's it's a tough scenario.

There are not a lot of options.

I mean, we use the resources that we have in the community, like the navigation center, you know, working with the hospital, hospital discharge planners to see where might be the best fit for this patient after looking at their chart, where's the best fit for this individual?

Is it within respite?

Do they require that higher level of care?

Maybe not.

Is this something that they can manage within the normal shelter, general population setting?

Potentially.

Or is it, is it something, you know, unfortunately, that they'll have to manage on the, on the street?

You know, we kind of, assess that with each referral, that that comes from the hospital to make sure that, you know, someone who who needs that higher level of care, isn't ending up on the street with that change of condition.

And, Dawn the city of Spokane has also been working on several initiatives to move people into stable housing.

What strategies are showing promise and where do gaps still exist?

Yeah.

So I think we've been, you know, in the last two years, we've really kind of shifted some of the system focus, really using data to kind of inform those decisions and then listening really closely to partners on the ground.

I think a couple of things that we're seeing, you know, some good success with so far.

One is really this scattered site model, which includes the Healing Hearts project.

But we've seen an 85% increase in folks exiting shelter to permanent housing over the 2024 data.

Which we do believe is attributable to these smaller sites with more intensive services.

We also see that transitional housing and rapid rehousing are very successful models.

Those look very, very good in the, in the LSA data.

And those are really unique interventions.

You know, one is really underfunded transitional housing.

And rapid rehousing is facing a lot of potential cuts at the federal level.

So we're certainly tracking some of those things.

Another thing I would, would mention too, is that we do have this move on strategy, which is really about how do we take somebody who's been given a subsidized unit and help them exit into market housing so that we can keep that flow in the system?

Pre-COVID, the system had done a lot of work on that.

Covid kind of stalled that effort, and we brought that back pretty heavy when we came into office.

And we've seen a 54% increase in folks exiting subsidized housing to permanent housing for their own.

Which we know is also critical, and making space for an individual to move their way from shelter to independent housing.

And that system flow is really, really important.

We can add emergency shelter, our way out of homelessness.

There have to be housing options on the back end for folks.

So really leaning into that.

In terms of gaps are certainly funding concerns from the federal level that we are waiting to hear on.

We certainly would love to have more transitional housing in the region, which is really supportive, stabilizing 24 month, programing.

We also love to see additional assisted living facilities come online.

We've seen some expansion in the last year or so in Spokane.

But to Doctor Lippman's point, we have a lot of individuals exiting hospitals needing more full time care than a shelter or independent housing can provide.

So continued expansion in those areas, and then really staying on top of our data to make sure that our investments align with what's working.

And we painted a good picture of where we are as a community real quickly.

What would success look like if we were sitting here in 5 or 10 years, which we're running a little short on time.

So some quick answers.

Yeah.

I mean, you know, I mentioned this in our interview.

You know, I think our community is ready for an Edward Thomas house level of care.

You know, that's run by, U-dub and Harborview over on the other side of the mountains in to expand respite, you know, and and really to to work with our hospital systems to kind of, you know, take ownership of that initiative because there is a lot of, relation between what the hospital system is doing versus what the primary care, world is doing as well.

So really being able to, you know, the hospital and urgent care is looked at as like a safety net in itself, for, for patients.

So, you know, from my perspective on, you know, working with single adults and looking at this aging population and the success we've had with, getting individuals placed into adult family homes, I think, you know, prioritizing that age group and in the medically fragile, because we haven't even spoken.

We I've just mainly been speaking about physical health.

Right there.

Other components as far as someone's health goes, when it comes to, mental health stability.

You know, the whole bio psychosocial, spiritual, kind of, holistic care for someone.

So Edward Thomas house is my answer.

Well, thank you to Jazzy Landes, Dawn Kinder, and Doctor Lippman for being here tonight to help us understand this issue and what we can do about it.

If you or someone you know needs help with housing or accessing services, reach out to the Spokane Regional Health District at srhd.org or contact the City of Spokane's Neighborhood Housing and Human Services office.

You can share this episode with friends and family.

Just visit ksps.org.

Stay healthy.

Good night.